LOs - Management Plan Flashcards
What is the appropriate management plan for a patient with amniotic fluid embolism?
Critical care unit by MDT, management predominantly supportive
In event of peri-arrest (like heart attack) then do a category 1 c-section (aiming to save baby and help mum’s resus)
What is the management plan for anaemia in pregnancy?
Oral ferrous sulfate (or ferrous fumarate)
- 100-200mg
- Re-check Hb in 2-3 weeks
Treatment should be continued for 3 months after iron deficiency is corrected (+6 weeks postpartum) to allow iron stores to be replenished
What is the management plan for Asherman’s Syndrome?
Hysteroscopic adhesiolysis (surgical breakdown of adhesions) + insertion of Foley catheter or IUCD to prevent re-formation
Then 2 cycles of cyclical oral oestrogen and progesterone to aid endometrial proliferation (restore fertility)
What is the management plan for asthma in pregnancy?
Antenatal
- Conservative – re-educate on inhaler technique, stopping smoking, avoiding triggers, controlling hay fever with antihistamines, continue to exercise and eat a healthy diet, have the flu jab in pregnancy
- Medical – continue pre-existing asthma treatment regimen as normal
Intrapartum
- Avoid use of ergometrine (bronchoconstrictor)
- Regional anaesthesia is preferable over general anaesthesia, in case of C-section
What is the management plan for atrophic vaginitis?
TLDR – vaginal lubricant/moisturiser then topical oestrogen
- Must exclude endometrial cancer
- Vaginal lubricants (esp before intercourse) + regular moisturisers
- Topical oestrogen (cream, pessaries, tablets, ring)
- Ring only needs changed every 3 months
- Systemic HRT if there are co-existent menopausal symptoms
- Reconsider diagnosis if continued treatment failure
- Aim to stop treatment whenever condition improves sufficiently to do so
What is the management plan for Bartholin’s Cyst/Abscess?
Conservative – good hygiene, sitz bath, analgesia, warm compress
Surgical (requires local anaesthetic) – marsupialisation/Word catheter drainage +/- oral broad-spectrum antibiotics
Marsupialisation – suturing abscess open allowing continuous drainage + prevent recurrence
What is the management plan for cardiac disease in pregnancy?
Pre-conception
- Adjust medications (advise to stop all teratogenic drugs)
- These include ACEi, ARBs, thiazide diuretics, statins, warfarin
Antenatal
- Arrange contact with joint cardiac and obstetric clinic (every 2-4 weeks until 20w, every 2 weeks until 24w, weekly thereafter)
- Monitoring - Maternal echocardiogram at booking + 28 weeks. Specialist foetal cardiac scan at 22 weeks
- Medical - VTE prophylaxis with LMWH SC
Intrapartum
- Aim for spontaneous labour + avoid induction where possible
- Advise epidural anaesthesia to reduce pain-related cardiac strain
- Use prophylactic antibiotics if structural heart defect present (reduce risk of bacterial endocarditis)
- Minimise length of 2nd stage of labour (using forceps or ventouse, aim to reduce maternal effort and cardiac output)
- Active management of 3rd stage of labour with syntocinon alone (introduce slowly, avoid ergometrine)
Postnatal
- Monitoring – transfer to HDU for close monitoring in first 12-48 hrs and arrange obstetric and cardiac follow-up
What is the management plan for cervical cancer/CIN?
Urgent 2 week referral for colposcopy or gynaecological oncology (all women with unexplained postmenopausal bleeding should be referred this way)
Punch or excisional biopsy of suspicious lesions (LLETZ or cone biopsy) to test for malignancy
Staging – uses clinical, radiological, or pathological findings to direct specialist treatment plan (1-4)
Depends on stage
- CIN – colposcopy then if moderate/severe abnormalities excise or ablate the region with LLETZ. Test of cure 6mo later with smear test. Can offer simple hysterectomy if woman isn’t bothered about fertility.
- IA1 (microinvasive) – conservative approach (LLETZ or cone biopsy)
- IA2-IIA (early) - <4cm = radical hysterectomy + lymphadenectomy. >4 cm = add chemoradiation
- IIB-IVA (locally advanced) – chemoradiation with external beam or brachytherapy and cisplatin (improves cure rates)
- IVB (metastatic) – systemic/combination chemotherapy (alt single agent therapy palliative care)
If pregnant – MDT approach + delivery post-35w
Recurrent – surgery, palliative chemo, supportive care
What are the management plans for the 3 types of depression in pregnancy?
Baby blues – reassurance and support
Postnatal depression – reassurance and support + CBT + sertraline/paroxetine (SSRI)
Puerperal psychosis – admission into Mother and Baby Unit + CBT + antidepressants/antipsychotics/mood stabiliser
