Lecture week 4-RNH Flashcards
What is the 1st thing you should do when reading the OSCE stem and KFP
KNOW YOUR ROLE
e.g I am an RMO….part of the ….. team, can I have a chat to you until my consultant is coming….
When asking about CST, what other questions should be asked
Were there any abnormal reports/reading that came back from those tests?
Naegele rule for EDD
Add seven days to the first day of your LMP and then subtract three months.
MDT for GDM women
You must state MDT
- Diabetic educator
- Dietician
- Physiotherapist
- GP
You must take care of mother’s microvascular and macrovascular complications–> ophthalmology review is a must–> retinal haemorrhages
Why is GDM mother more likely to get an infection
Immunosuppressed
GDM
- definition
- risk factors
- effects on the mother, fetus and pregnancy
- screening guidelines–> what are the values
- monitoring
- labour
Look at the guidelines
Advice for GDM postpartum-3 points
6 weeks review of OGTT
Breastfeeding should be encouraged as it will help with managing the blood sugars
Interpregnancy interval
Pathophysiology of HTN in pregnancy
The placenta fails to invade properly to the level of the spiral arterioles leading to a high resistance placenta
This causes the release of vasculoendothelial substances from the placenta that causes multi-organ problems for the mother
The hormonal consequences result in generalised vasoconstriction. At the same time, endothelial cell damage causes interstitial leakage through which blood constituents, including platelets and fibrinogen, are deposited subendothelially
What are the 3 features of Mg toxicity
what should be done then?
Monitor urine output, tendon reflex and respiratory rate for R depression
o Urine output < 80 mL in 4 hours
o Deep tendon reflexes are absent or
o Respiratory rate < 12 breaths/minute
Serum magnesium level can be checked
Stop the infusion and start them on calcium gluconate
MgSO4 doses
-apparently we need to know doses?
Loading dose Magnesium Sulfate
• 4 g IV over 20 minutes via controlled
infusion device
Maintenance dose Magnesium Sulfate
• 1 g per hour IV via controlled infusion
device for 24 hours after birth
MgSO4 is also used in the fetus for what and before when
Neuroprotection before 30 weeks, prematurity
One sentence for each: stages of labour 1st stage 2nd stage 3rd stage 4th stage
1- 0-4cm and then 4cm to fully dilated
2- 10 cm to delivery
3- Delivery of the placenta, 30-60, 60 min max
4-2-4 hours after delivery, need to monitor(even in a healthy mother with no complications during pregnancy)
Mechanisms of labour
Floating Descent and flexion internal rotation complete internal rotation The complete extension(head is popping out) restitution(external rotation) Delivery of anterior shoulder Delivery of posterior shoulder
Maternal collapse-4H and 4Ts
4H Hypovolemia Hypoxia Hypo/hyperkalaemia Hypothermia
MDT
Major transfusion protocol if needed
Maternal collapse-4Ts
Thromboembolism
Toxicity
Tension pneumothorax
Tamponade
What are some risk factors for cord prolapse
1) Multiparity/Multiple pregnancies
2) Prematurity/PPROM
3) Malpresntations
4) Polyhydramnios
What are the 2 types of cord prolapse
Concealed and revealed
Management of cord prolapse
DO NOT ATTEMPT TO REPLACE THE CORD
Displace the presenting part with the hand
If IDC in, full quickly with 500 ml of saline
CAT1 summoned
Can tocoylse if OT delayed
Cord prolapse vs cord presentation
Rupture of the membrane is the difference
Risk factors for shoulder dystocia
Previous history Obesity(BMI>30) DM Macrosomia>4.5kg IOL Prolonged 1st or 2nd stage of labour Assisted vaginal delivery
Risk factors for shoulder dystocia
and what is the HELPERR
Previous history Obesity(BMI>30) DM Macrosomia>4.5kg IOL Prolonged 1st or 2nd stage of labour Assisted vaginal delivery
3 complications for each shoulder dystocia
Look at slides- lecture week 4
Cord prolapse or presentation, what shouldn’t you do
PUT IT BACK
induce vasospasm, cut off blood to the fetus–> death
IX at your first antenatal visit
1) Blood group and antibody screen
2) FBC
3) Rubella
4) Syphilis
4) STI screen- chlamydia, HIV and Hep B and C
5) Urea, creatinine, uric acid
6) MSU
7) CST
8) Random blood glucose
9) USS dating scan
AT 26 week visit
FBC Antibody screen Syphilis Hep C OGTT
At 34 weeks visit
FBC
Antibody screen
During an Obs OSCE state some of the things you will ask the mother
GA
Foetal movements
Uterine bleeding/leakage/cramping
BP, Weight, Fundal height, foetal lie, FHR
When can nuchal translucency be done
Nuchal Translucency
11 ———–13 +6
When can CVS be done
CVS—> 11-13wk
When can Aminocentesis be done
16-18wk
Which vital sign is really important in these antenatal visits
BP
What should be recommended for women with high BP in early antenatal visit
Low dose aspirin
The woman is 25 years old, should Down syndrome screening be discussed with her
Yes, it should be. Maternal age is irrelevant for having a baby with Down syndrome. Maternal age is a risk factor just like any other condition
CFTS- how much? private? public?
How good
Medicare-funded if high risk, if not it’s private
90%
NIPT
99.5-99.9 sensitive 400$ Harmony test private SCREENING
The test is done after 10 weeks and is more than 99% accurate for Down syndrome
Trisomies 21, 18, 13; sex chromosome conditions*( sex conditions its upto the patient)
What is the risk of miscarriage with these screening a diagnostic test
The screening test is non-invasive hence no risk of miscarriage
However CVS(1 IN 100) and amino(1 in 200)