Exam Prep Flashcards
What bloods need to be taken if pre-eclampsia is suspected?
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What is reduced fetal movements?
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what are the risk factors of reduced fetal movements?
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what is the management of reduced fetal movements?
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Kerri presented at 30 weeks pregnant with a BP of 140/90 ++protein in her urine her booking bp was 120/68 what is your responsibility as a midwife and management for Kerry?
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What are the impending signs of eclampsia? (8)
Sharp rise in BP Dimished urinary output Increase in proteinuria Headache - severe usually frontal Drowsiness Visual disterbances Epigastric pain abnormal blood picture
Management of pre-eclampsia in pregnancy?
Stabilise
- 10mg nifedipine with further dose 30 mins if no response
- Cannulate
- If BP 170/110 IV hydralazine 5-10mg every 20-30 mins
- Mag Sulphate
- Take blood
- Monitor TPR, BP, Urinalysis
- Fluid Balance
- NBM
Management of pre-eclampsia in labour
Stabilise - 10mg nifedipine with further dose 30 mins if no response - Cannulate - If BP 170/110 IV hydralazine 5-10mg every 20-30 mins - Mag Sulphate Monitor EFM epidural if platelets >100 no ergot Transfer to HDU
Mary Jane is a primip labouring for 12 hours 3-4/10
on palpation she has a baby that is back to back and she is now requesting pain relief. Define this position and outline management options
Occipitoposteria position is the most common of mal positions
results from a lack of rotation prior to birth
Long and painful labour
Back pain
A deflexed head does not provide optimal stimulation to the cervix
First stage
Assist pain managment - massage, shower, entenox as per maternal request
position change - all fours to aid rotation
Monitor obs every 30 mins
Prevent ketosis - rehydrate
Consider oxytocin if incordinate contractions
prevent pushing on undilated cervix
Document throughout
Second stage Confirm by VE encourage women to be upright possible assisted/operative birth Document throughout
Third stage
Consider PPH due to uterine atony
Document throughout
Maria has just been diagnosed as GDM what antenatal care do you need to provide
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What is the difference between caput and cephalahaematoma?
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31 year old woman has been admitted to ward with confirmed PROM what is your plan of care?
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At 12 hours old infant has severe jaundice what care would you provide?
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Twins - describe the care provided at second stage and what are the roles and responsibilities of the midwife?
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Lady has passed a clot the size of a bed pan what is the management?
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Shazza is 16/40 weeks pregnant had has presented to the antenatal clinic for her booking visit. She is a G2P1, BMI = 40, and is an ex-smoker. Shaz reports no family Hx however her grandma Iris passed away suddenly in her sleep last year.
Based on this Hx does Shaz have any risk factors for thromboembolic disease? What are they? (4 marks)
- Pregnant
- Increased BMI
- Ex-smoker
- Family history of sudden death – possible PE
Shazza is 16/40 weeks pregnant had has presented to the antenatal clinic for her booking visit. She is a G2P1, BMI = 40, and is an ex-smoker. Shaz reports no family Hx however her grandma Iris passed away suddenly in her sleep last year.
Outline a possible management plan including preventable strategies. (8 marks)
• Education – discuss S&S of DVT
o Redness
o Swelling
o Heat
o Pain
o Loss of function
o Most commonly in calf, can occur in thigh
o Most commonly in left leg during pregnancy
• Compression stocking (correct fitting and size), if legs swell during daytime, better to remove stockings
• Increase mobility, avoid bed rest or sitting for long periods
Cheryl is a G1P0, 39+6 weeks and has been in established labour for 8 hours, reports a pre-labour of 20+ hours. Following Cheryl request of an epidural for maternal exhaustion, continuous CTG monitoring was applied and you’ve noted the FHR baseline is trending down with occasional late decelerations. On VE, Cheryl is 10cm dilated and the foetal head is at +1 station.
List 4 possible reasons for a vaginal assisted birth? (4 marks)
- Maternal exhaustion
- Malposition/malpresentation
- Foetal distress
- Inadequate foetal descent
The obstetrician has reviewed Cheryl and has agreed on a plan to assist with the birth of her infant using forceps. What are 3 benefits and 3 risk factors associated with a forceps birth?
Benefits:
• More likely to be successful
• Often allows more rapid birth
• Can be used in malpresentations to rotate the foetus
Risk factors:
• Higher rate of maternal complications
• Perineal trauma
• Facial injuries for the baby
Baby Narelle was born at 32+3 weeks via NELUSCS following PPPROM. Apgar’s of 7:9 at birth, Relle required CPAP following birth and was admitted to SCN 2 for continuation of CPAP and preterm observations. She’s now off CPAP and has been SVRA for 3 days.
Outline 4 goals of care for Narelle in order for her to be cleared for discharge?
- Tolerating all feeds (BF or sucking on the bottle)
- Consistent weight gains
- Maintaining temperature
- Sleeping flat on back with minimal reflux
During a booking assessment you note a woman to have a history of hypothyroidism but she states she has not been taking her medication. Define hypothyroidism and the midwifery management for this woman?
- Caused by autoimmune disease of iodine deficiency
- Immune disease such as Hashimoto’s thyroiditis
- May have no symptoms
Some symptoms include: Low energy Feeling cold Hair loss Constipation May lead to pregnancy complications – effects the intellectual development of baby
Management
• Consider diet
Blood test during 1st trimester
NICE guideline recommends woman has serum thyrotropin levels tested at least 4 weekly during 1st half of pregnancy
At least one blood test in 2nd and 3rd trimesters
Goal is to normalise maternal serum TSH to normal parameters depending on gestation
Treatment:
Iodine supplementation 150 units daily
Oral thyroxine mane (oral T4)
Outline the implications of hypothyroidism in pregnancy for the woman and fetus.
Woman
• Difficulty loosing weight
• Hair loss
• Tired and lethargic
Baby
Goitre IUGR Prolonged jaundice Poor weight gain Temperature instability Large fontanelles Developmental delays Constipation Umbilical hernia Oedema Microcephaly Poor feeding Inactivity and sleepy
A 22yr old woman presents to the ANC for her 28/40 appointment and states she’s been feeling tired and lethargic. Describe the risk factors and signs and symptoms for anaemia.
Risk factors
- Depression
- low socio economic
- diet (vego)
- ethnicity
- absorption
- gastric sleeve
Signs/symptoms pallor of the mucous membranes, fatigue, dizziness and fainting, headache, exertional shortness of breath, tachycardia palpitations.
At an AN appointment with a women, you reviewed her bloods and found her hb to be 90 m/mol and ferritin is 9. Explain what this means to the woman and describe the midwifery management.
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