General Pregnancy Flashcards
Risk factors with AMA
chromosomal abnormalities miscarriage PTL PET IUGR GTN HTN GDM Praevia PPH SB
Risk factors with multiple pregnancy
miscarriage chromosomal abnormalities PTL IUGR HTN/PET/HELLP SB Anaemia PPH TTS/TAPS/TRAP PND Feeding difficulties
lambda sign
DIDI
T sign
MCDA
Additional management with twins
Early USS
additional anaemia screening at 24 weeks
8 antenatal appointments
MDT input for twin pregnancy
Obsetrics Tertiary scanning/experience sonographers Perinatal mental health professional PT Lactation consultant Dietician MFM if any complications
MCDA twin monitoring
2 weekly scans from 16 weeks
Increase to weekly if differences in AFI (DVP >4cm or more)
MCA PSV to monitor for TAPS - weekly for those at risk (TTTS treated w laser, sFGR)
Complications of MCDA pregnancies
TTTS
TAPS
sFGR
TRAP (pump twin)
Twin intrapartum considerations
Centre of care/NICU capabilities Timing of birth Mode of birth analgesia during labour continuous fetal monitoring
Timing of birth twin pregnancies
DCDA - 37
MCDA 36
MCMA 32-34
Triplets 35
Ok to try for vag birth for twins
> 32 weeks gestation and uncomplicated
cephalic lead twin
no significant size discordance between twins
no obstetric contraindications to labour
Women with cervical risk factors but no previous hx loss managment
HVS & MSU - treat any infection
cervical length at 16/40 - if >3cm no further scans
25mm-30mm - commence two weekly scans
<25mm prog +/- cerclage if ongoing shortening
women with previous 2nd trimester loss or delivery before 34 weeks
HVS & MSU - treat any infection
consider progesterone
cervical length at 14/40 - two weekly scanning
<25mm prog +/- cerclage if ongoing shortening
3 or more preterm births <34 weeks
HVS & MSU - treat any infection
history indicated cerclage at 12-14 weeks
two weekly scans until 24 weeks
cervical os fully effaced & more than 1cm dilated
consider emergency cervical cerclage
consider steroids depending on gestational age
if contracting - manage as TPTL
Instrumental delivery ABCs
Anaesthesia/Assistance (prep for SD) Bladder empty Cervix fully-dilated Determine position Explain to patient/exit plan if fails Fontanelle - to recheck position Gentle traction Hand elevated for forceps Halt if vacuum and no descent or 3x pop offs Incision/Episiotomy Jaws visible remove forceps
Causes of maternal collapse
Eclampsia Abruption Uterine rupture AFE Anaesthesia related complications PE sepsis Epilepsy MI Hypoglycaemia
Maternal collapse resus
call for help
lie supine with left lateral tilt
open airway and look/listen/feel for breathing-if none
CPR
Attach defibrillator
Secure airway and oxygenate.
Secure 2x large bore IV access.
Send blood for FBC, U&Es, LFTs, calcium, magnesium, coag screen and crossmatch.
Diagnose and correct reversible causes (4Hs and 4Ts)
Give adrenaline every 3 mins.
Consider amiodarone, atropine, magnesium.
Peri-mortem c/s if 4mins and no return of circulation
4 H’s
hypoxia
hypovolameia
hypo/hyperkaleamia
hypothermia
4 T’s (and obs ones)
Tone Trauma Thrombosis Toxins Tension Pneumothorax Tamponade AND Eclampsia (use mneumonic THE)
Management if cardiac output restored
Transfer to OT for suturing of caesarean section incision
Anticipate PPH/DIC
Investigate causes of collapse (bloods, ABG, ECG, CXR etc).
Consider transfer to ITU.
Swansea diagnostic criteria for AFLP
Symptoms: vomiting, abdo pain, hepatic encephalopathy, polydypsia, polyuria Biochem: Increased bili hypoglycaemia Increased uric acid leukocytosis increased transaminases increased ammonia increased cr coagulopathy
AFLP management
Deliver by C/S - likely GA if coagulopathy
MDT (including members of the obstetrics, infectious disease, gastroenterology, anesthesiology, intensive care, neonatology, and blood transfusion departments/units)
Consider steroids depending on gestation
ICU cares post op
Recurrent UTIs in pregnancy management
Ensure cultures
Monthly MSUs
Hygiene (wipe front to back, empty bladder after sex)
increase fluid intake
Prophylaxis for rest of pregnancy and 6/52 PP
Debrief unexpected NICU admission
Review notes Review notes with other smo/CD arrange MDT meeting with patient and paeds Involvement of quality services empathize with patient explain indication for ventouse explain ph findings Ensure calm non-judgemental communication quality services will review case
Stillbirth investigations
CBC, U/Es, LFTs Kleihauer TORCH screen + parvo bile salts TFTs HbA1c Coags APLS (lupus anticoagulant, anti-cardiolipin antibodies, beta 2glycoprotein 1) vaginal swabs swab placenta (maternal/fetal side) Post mortem - full, partial
ECV absolute contraindications
recent APH uterine abnormality abnormal CTG ruptured membranes multiple pregnancy
ECV relative contraindications
IUGR previous C/S/scarred uterus major fetal abnormalities oligohydramnios PET hyperextended neck nuchal cord unstable lie
Obstetric cholestasis explanation
Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build-up of bile
acids in your body. The main symptom is itching of the skin but there is no skin rash. The symptoms get
better when your baby has been born.
Eclampsia management
Help, DRs ABCDE - maintain open airway, O2
ensure bed rails up and in left lateral position
Commence MgSo4 4g loading dose then 1g per hour - continue until 24 hours PP; monitor reflexes
Consider other anti-hypertensives
auscultate lungs - aspiration risk
Q5min observations
IDC - strict input/output monitoring
fluid restrict to 80mls an hour total
bloods - perform Q6H until patient stable/effective diuresis
involve MDT approach - consider head imaging for ?stroke
