dr clark OBS Flashcards
what are the types of lie?
longitudinal
transverse
oblique
what are the types of presentation?
cephalic
breech
shoulder
what is the best way to estimate the gestational age of a pregnancy?
1st trimester US (12/40)
crown rump length
what is the risk of footling breech?
cord prolapse
what is polyhydramnios?
excessive accumulation of amniotic fluid
causes of polyhydramnios?
a twin or multiple pregnancy
diabetes in the mother – including diabetes caused by pregnancy
(gestational diabetes)
a blockage in the baby’s gut (gut atresia)
a problem with the placenta
the baby’s blood cells being attacked by the mother’s blood cells (rhesus disease)
a build-up of fluid in the baby (hydrops fetalis)
a genetic problem in the baby
what is Oligohydramnios?
a deficiency of amniotic fluid
is a partogram what is the rate of cervix dilation rate?
1cm per hour
reasons to induce labour?
growth problems in baby.
lack of amniotic fluid surrounding baby.
diabetes.
high blood pressure.
preeclampsia.
uterine infection.
placental separation from the uterus.
Rh-blood disease.
what is increased Nuchal translucency (NT) an indication of?
down symdrom
when is nichal translucency test done?
between 11 weeks and 14 weeks of pregnancy. unreliable after this time.
1st trimester
what is the combined screening test in the 1st trimester?
NT ultra sound scan and 2 serum markers
hCG and Pregnancy associated protein
what is the quadruple test?
alpha-fetoprotein
hCG
unconjugated oesteriol
inhibin-A
what is terbutalin used in pregnancy?
Terbutaline is a medication used to delay preterm labor. It is in a class of drugs called betamimetics, which help prevent and slow contractions of the uterus.
what is preterm pre-labour rupture of membranes?
rupture <37 weeks
gestational diabesties causes what?
SMASH
shoulder dystonia macrosomia amniotic fluid excess stillbirth hypertension/hypoglycasmia
what are the risk factors for down symdrom>
maternal age, especially over 45
crown rump length is unreliable at what week?
less accurate >20/40 weeks
nuchal translucency is less acurate beyond what week?
2nd trimester
external cephalic version contraindications?
< 37 weeks gestation, dont wanna induce labout
previous c-section
placenta praevia
multiple preganancy
what is the detection of polyhydramnios?
increased symphysiofundal height
large amniotic fluid index
polyhydramnio causes
DITCH
diabetes idiopathic twins congential heart failure
polyhydramnio risks?
Px6
placenta abruption pretty unsual lie premature labour prolapse cord PPH perinatal mortality
stages of labour?
Stage 1: from painful contraction to full cervical dilation ~8hrs
> latent phase to 4cm
active phase to 10 cm
stage 2: from full dilation to fetal delivery~1-2 hrs
stage 3: from fetal delivery to placenta delivery~30 mins
mechamism of labour
every decent female I crown rules lovingliy
Engagemet D decent F flexsion I inversion Crown, extension of head R resitution (external rotation) L lateral flextion of head to deliver shoulders
4 main indications of induction?
Px4
post date
pre-labour reupture of membranes
pre-eclampsia
plue diabeties
induction of labour in PROM
after membrame rupture most go into labout within 24 hrs, to reduced the risk of ascending infection induction of labour should commence
the guidence is less clear in pre-term (<37 weeks)
what are the options of induction of labour?
- Membrane sweep (can increase the chance of natural labour)
- AROM
three stage of labour induction? (monitor with CTG)
1.cervical ripening (akin to latent phase). Prostin (prostaglandin)
risk of hyperstimulation
- AROM
- cervical dilation(akin to active phase). IV oxytocin used to generate uterine contractions
risk of hyperstimulation, can be reversed with terbutaline (relaxes smooth muscles)
when does getational diabetes show in pregnancy?
unlikely until 2nd trimester
does gestational diabeties have micro/macrovascular complications?
no
risk factors for pre-eclampsia?
previous pre-eclampsia 1st pregnenacy chronic hypertension renal disease obsety/smoking family history
drug not to be used in the treatment of pre-eclampsia
ACEI–> risk of congential malformation
diuretics–> reduce maternal plasma volume
red flag symptoms in pre-eclampsia?
headache
visual disturbances
Epigastric pain (hepatic infarction/distension)
breathlessness(pulmonary oedema)
red flag signs of pre-eclampsia?
peri-orbital oedema
hyper-reflexia
clonus
fits (eclampsia)
diagnosis of pre-eclampsia?
> =140/90
proteinuria>300mg/24hr
no UTI
how long do you treat pre-eclampisa for after birth?
6 weeks post partum.
what is antepartum haemorrhage?
bleeding in pregnancy after 24 weeks
what is bleeding < 24 weeks called?
threatened miscarriage
what are the causes of antepartum haemorrhage?
Uterine:
placental abruption
placenta praevia/ vase praevia
marginal bleeding (bleeding from placental edge)
Cervical:
“show” loss of mucus plug from cervix
cervical cancer
cervical polyp/ectropion
Vaginal:
Trauma/infection
what is placenta abruption?
premature separation of the placenta from the uterus (occurs in 1%)
what are the causes of placental abruption?
smoking, previous abruption, hypertensive disorder, cocaine, thrombophilias
what colour id the bleeding from placental abruption?
usually dark red.
what does the uterus of placental abruption feel like?
woody hard uterus 9blood in the myometrium)
what is placenta praevia?
a placenta that is wholly/partially implanted in the lower segment of the uterus.
what is vasa praevia?
placental vessels running over the cervical os in the membrane (rare)
why do yu need to give anti d in placental praevia?
If the woman with a placenta previa is bleeding and she is Rh-negative she might receive a dose of RhoGam (anti-D immunoglobulin) to prevent Rh sensitization or the formation of antibodies in response to the fetus’s Rh-positive blood cells.
what is primary post partum haemorrhage?
loss of >500ml within 24 hrs
is when you lose 500ml (a pint) or more of blood within the
first 24 hours after the birth of your baby.
Primary PPH can be minor, where you lose 500–1000ml (one or two pints), or major, where you lose more than 1000ml (more than two pints)
what si secondary post partum haemorrhage?
abnormal or heavy vaginal
bleeding between 24 hours and 12 weeks after the birth
what cause primary post partum haemorrhage?
4 Ts
Tone
Tissue
Trauma
thrombin
what causes srawberry cervix?
trichomonas vaginalis
