Counselling Flashcards
Indications for induction of labour
Prolonged gestation which increases risk of still birth, LSCS etc
Prelabour rupture of membranes (>24 hrs before labour) which increases risk of infection
Maternal health conditions e.g. diabetes, hypertension or heart disease which can increase the risk of stillbirth and large baby
Disadvantages of induction of labour
Labour ward vs midwifery-led unit, no birth pool
May be more painful
Longer stay in hospital
Talk through the process of induction of labour
Most will get membrane sweep first (adjunct) to stimulate release of prostaglandins- increases chance of natural labour, can cause discomfort
Then depending on bishops score management is different:
<6 (unfavourable cervix) then PV prostaglandins or mechanical method e.g. balloon catheter is offered to increase favourability of cervix
> 6 (favourable cervix) then amniotomy +/- oxytocin infusion is recommended
Pros and cons of prostaglandin use in IOL
Hormones that mimic the ones in ur body that make contractions happen
Usually done when bishops <6 alongside ?balloon catheter
Reduces likelihood of needing mechanical methods
But can cause hyperstimulation
Pros and cons of amniotomy
Amnihook to artificially break the membranes to release prostaglandins
Must be done before oxytocin drip
But can be uncomfortable- pain relief can be provided
Alternative to OGD
Barium swallow
Non-invasive and doesnt require sedation
Shows motility problems in the oesophagus but can’t examine the mucosa or get a biopsy
What do you have to do before an OGD
Stop PPIs 2 weeks before
Not eat for 6 hours, clear fluids for 2 hours (same as surgery)
?stop anticoagulants also
2 options for anaesthesia during OGD
Throat spray- numbing back of throat, no gag reflex
IV sedation- relaxes patient but they stay awake, must be taken home
Side effects and risks of OGD
SE:
- gagging
- sore throat
- nausea/ abdominal pain
- minor bleeding
Risks:
- damage to teeth- mouthguard
- aspiration pneumonia
- perforation
- infection
- over-sedation
Alternative to colonoscopy
CT colonography (virtual colonoscopy)
Imaging test- air enema and then CT from different angle creates 3D model
Less invasive but not as detailed and no biopsies
How to prepare for colonoscopy
Bowel prep- low fibre diet for 2-3 days and increase fluids
Then take very strong laxative the day before -> diarrhoea
Eating 6 hrs, clear fluids 2 hrs
Pros and cons of the 2 types of dialysis
Haemodialysis and peritoneal dialysis (catheter into peritoneum- fluid changed either overnight or 4x a day )
Haemodialysis has a social aspect, performed by HCP, has dialysis-free days and can be done at home.
BUT diet and fluid intake are restricted, requires vascular access and can cause SE including infection, muscle cramps, itchy feeling
Peritoneal dialysis is more flexible and freeing, but is done every day, you have as permanent catheter in, and has risks e.g. hernia, infection, scarring
5 transfusion side effects and management
Anaphylaxis -> stop and IM adrenaline etc ABCDE
TACO -> stop and Tx as acute HF
TRALI -> stop and supportive care e.g. O2
Haemolytic reaction (ABO incompatibility) -> stop and supportive Mx
Febrile non-haemolytic transfusion reaction -> slow and paracetamol
How to differentiate between TRALI and TACO
Both present with SOB, hypoxaemia
TRALI more severe
TACO more likely in HF patients
TACO more of an overload picture, TRALi has CXR white out
How does acute haemolytic transfusion reaction present
Fever, hypotension, agitation, flushing, chest/ abdominal pain, DIC/ bleeding, AKI
Occurs in minutes of BT
If rigors consider bacterial contamination instead
What is UKMEC4 for COCP
<3wks p.p if not breastfeeding
<6wks p.p if breastfeeding
Breast cancer
> 35 and smoke >15 a day
VTE history
Recent immobilisation
Thrombogenic mutations
Antiphospholipid
AF
Migraine with aura
What percentage of women using the COCP get pregnant after a year
9%
Actually effectiveness is 99% but people dont use it right so it is 91% effective