antenatal disorders Flashcards
two key causes of sepsis in pregnancy
chorioamnionitis
UTI
symptoms of chorioamnionitis
abdo pain
uterine tenderness
vaginal discharge
symptoms of UTI
- Dysuria
- Urinary frequency
- Suprapubic pain
- Renal angle pain (with pyelonephritis)
- Vomiting (with pyelonephritis)
investigations for chorioamnionitis
blood culture
blood gas
MEOWS
vaginal swab
U+Es and MSU for kidney function and UTIs
management of normal sepsis
within 1 hour of diagnosis
three tests-
blood lactate
blood cultures
urine output
three treatments-
oxygen (maintain 94-98%)
empirical broad spec IV antib
Iv fluids challenge
maternal sepsis management
IV antibiotic administration
full septic screen
antipyretic measures and Iv fluids
continuous foetal and maternal monitoring
causes of APH
placenta praevia
placental abruption
vasa praevia
uterine rupture
local lesions of genital tract (polyps, cancer)
APH of unknown origin
severity of APH based on RCOG guidelines
- Spotting: streaks of blood on underwear
- Minor haemorrhage: less than 50ml blood loss
- Major haemorrhage: 50 – 1000ml blood loss
- Massive haemorrhage: more than 1000 ml blood loss or signs of shock
placenta praevia
placenta is attached in lower portion of uterus lower than presenting part of foetus
Low-lying placentais used when the placenta is within 20mm of theinternal cervical os
Placenta praeviais used only when the placenta iscoveringtheinternal cervical os
found on anomaly transvaginal USS at 20 week to assess position of placenta
presentation of placenta praevia
- Asymptomatic
- Antepartum haemorrhage: painless vaginal bleeding
- Placental location close to or covering the cervical os at 20-week Anomaly scan
antepartum or postpartum haemorrhage
diagnosis of placenta praevia and management
Anomaly Transvaginal USS at 20-week to assess the position of the placenta
Repeat transvaginal USS at 32 weeks & 36 weeks to assess placental position
asymptomatic-
- Corticosteroids between 34-36 weeks
- Planned C-section between 36-37 weeks
if bleeding-
- Corticosteroids before 34 weeks if bleeding
- Planned C-section between 34-36 weeks if bleeding
Emergency C-section may be required withpremature labourorantenatal bleeding
vasa praevia
fetal vessels - two umbilical arteries and one umbilical vein- travel across the internal os
very rare condition
they are unprotected by placental tissue or the umbilical cord, pass near to the cervix. These exposed vessels are prone to bleeding, particularly when the membranes are ruptured during labour and at birth
can be multi-lobed (travelling between lobes)
or velamentous
management vasa praevia
if vessels found on vag exam or ultrasound then C section planned before natural labour
emergency C section and neonatal resus if following rupture of membranes
presentation vasa praevia and diagosis
painless vaginal bleeding
- Pulsating vessels seen during vaginal examination
- Foetal distress and dark-red bleeding following rupture of the membranes
Often diagnosed during labour when foetal distress and dark-red bleeding occurs following rupture of the membranes (High-Risk Mortality)
ultrasound
placental abruption what is and 2 types
when placenta seperates from wall of uterus during pregnancy causing extensive bleeding
revealed
concealed (bleeding remains in uterine cavity due to closed os)
mixed
