Management Flashcards
Antenatal Management
- Supplements - Iodine and Folic Acid
- Vaccine - Influenza, Pertussis
- Lifestyle (SADMA)
- Smoking - Stop
- Alcohol - No Safe Levels
- Diet - Healthy Diet, Limit Caffeine
- Medications - Inform Doctor and Pharmacist with Meds, Avoid X-ray
- Avoid - Soft Cheese, Uncooked Meat,
Pregnancy Check Ups w/ Date
- Antenatal Test
- Dating Scan
- Down Syndrome Screening
- Morphology Scan - 18-20 wks
- OGTT - 26-28 wks
- GBS Swab - 36 wks
Antenatal Test
- FBE, BG and Rh
- Rubella, Varicella
- STI’s
- Syphilis, Hepatitis B, HIV
- Chlamydia and Gonorrhea (<30 y/o) - Mid Stream Urine Sample
- Dating Scan (Irregular) vs. PT (Regular)
- CST (<25y/o)
- BP, Ht, Wt, BMI
- Offer Down Sx Screening
Down Syndrome Screening Dates
Screening
- NIPT - 10 weeks
- Blood Test (PAPP-A, BhCg) - 10-12 weeks
- USD (Nuchal Trans) - 12 weeks
Confirmatory
- CVS - Up to 14 weeks
- Amniocentesis - After 15 weeks
Advance Maternal Age Mx
High Risk Down Syndrome - NIPT
Higher Risk of DM and High BSL - OGTT (Earlier 14-16 weeks)
Consider Low Dose Aspirin Advance Age and BMI
More Freq Growth and Well being USD
More Freq Visits
High BMI - Higher Dose of Folic 5mg
General Advice
Asymptomatic BU or UTI Mx
Diff. If A. BU or UTI or Pyelonephritis
Nitrofurantoin 100mg Q6 5D
Retest UA after 2 weeks
- if still + or If BU is Recurrent - Preventive Antibiotics
Give Intrapartum Antibiotics - High Dose Penicillin
General Advice
Pregnancy HIV Mx
Diagnosis
- Contact Tracing, Notify DOH
- Refer to Pregnancy Clinic
- Check Viral Load
Pregnancy (IDS)
- IDS Specialist - Start Antivirals (Tenofovir), Test VL every 2-4wks until Low then Once every trimester
- Avoid - Amniocentesis, CVS, Cephalic Version
Delivery (OB)
- VL Low - Trial NSD
- VL High - CS
- Avoid Instrumentation, Fetal Scalp Sampling
Post Delivery
- Dry and Clean Gently
- Breast feeding is CI
- Start baby with Antiviral
- F/U Blood Test - 12-18 months
Diabetes Mx Pre-pregnancy
Mothers - P’s
Baby’s - B’s
Diabetes
- Good Sugar Control before Getting pregnant - Offer Contraception
- Concern - Insulin Pumps, Hypoglycemia (Titrate dose) Rule 15
- Lifestyle Modification
Pre-pregnancy Screening
- Complications of DM refer
- High Dose Folic Acid
- Rubella and Varicella Vaccine
Pregnancy (Genetics, Morphology, Sugar)
- If HbA1c Normal
- MDT
- Antenatal Screening
- BSL monitoring - HbA1c and BSL 4x/d
- Aspirin
- Down Sx Screening
- USD - NT, Morphology Scan, Fetal Echocardiogram
Delivery
Delivery (Method)
- Plan Delivery
- USD to check Baby
– Large - CS
– Size <90% - NVD
Post Delivery (Sugar)
- Change insulin dose
- Monitor Baby BSL
- (if GDM) - repeat OGTT after 6weeks
Hyperemesis Gravidarum Mx
Inv - UTZ, BhCg, UEC
Mx - (+) Ketones - Admit
- Non-pharma - Small Freq Feed, Hydrate, Crackers, Avoid Trig
- Pharma
– Pyridoxine + Doxylamine
– Metoclopramide or Ondasetron
Pre-eclampsia Mx
Investigations
- Mother - FBE, UEC, eGFR, Urine ACR LFT
- Baby - USD and CTG
Management - Non-Severe
- Labetalol, Methyl Dopa,
- Target BP <135/85**
- Plan Delivery 37 weeks
- Immediate if with Red Flags
Severe ( BP >160/110)
- IV Meds
- Delivery
Primary Post-Partum Hemorrhage Mx
DRSABCD
Circulation - 2 Large bore IV
- Inv - FBE, Coag Prof, BG CM
- Start 2L of PNSS
- Catheter, Oxygen
- Activate Massive Tx Protocol
- CLAMP the Cord (Cord Snap)
Find & Treat Cause
Tone
- Bimanual Palpation,
- Oxytocin -> Ergometrine -> Misoprostol
Tissue
- Controlled Cord Traction
- Check Placental if Complete
- Uterine Exploration with Anesthesia
Trauma
- Inspection and Speculum
- Check any tears and repair
Thrombin
- Tranexamic Acid
- FFP/Platelets if needed
Theater
- Prepare of Operation - Unterine Exploration
- Balloon Tamponade -> Ligation and Embolectomy
Endometritis Mx
Admit
Investigations
Blood – FBE, ESR, CRP, Blood Culture
Swabs – Low and High Vaginal Swab
Scans – UTZ for RPOC
Then start IV antibiotics
Meds for Pain and Fever
If Severe Bleeding (ROPC)
Uterine Massage
Oxytocin
Exploration and Surgery (D&C)
Placenta Previa Mx
Investigation
- USD, CTG
- FBE, Iron Studies
- (Rh -) Kleugher Test & Anti D
Management
- (Rural & Pre-Term) - Transfer to Hosp
- (Pre-Term) - Corticosteroid
- Planning for CS - Stable - 37 weeks, Unstable - ASAP
- Check for Placenta Accreta
Birth Pain Mx
Non-pharma
- Breathing and Relaxation Techniques
- Moving Around and Position
- Machine Tens - Electrical Pulses
Pharma
- Nitrous Oxide Gas
- Morphine - Baby Sleepy
- Epidural Anesthesia - Preferred
PPROM Complications
Pre-Term Labor
Infections
Position Defects
Cord Prolapse
Breathing Problem
PPROM Mx
Investigation
- USD
- CTG
- Nitralazine Test
- FBE, ESR, CRP
- High and Low Vaginal Swab
Management
- 3 Approach
– Expectant - Admit and Wait
– Active Management - Signs of Inf
– Outpatient - if stable after 3 days
Main Mx
- Admit and observe for at least 3 days
- Antibiotics
- Nifedipine - Delay
- Corticosteroids - Lung
- Close Monitoring
- Induce at 36 weeks
Genital Herpes Mx
1st - Swab for Viral PCR
2nd - Treat Acute Inf - Valcyclovir
3rd - Serology Result
HSV1 = HSV1 Ab - Low Risk
HSV1 = HSV2 Ab or (-) HSV Ab
- <34 weeks - Low risk
- >34 wks - High Risk - Suppression Tx
CS - High Risk or w/ Active Lesion
NVD - Low Risk w/out Active Lesion
Mitral Stenosis Mx
Investigation - 2D Echo, ECG
Mild - Supportive, Monitoring
Mod-Severe
- Fluid and Salt Restriction
- Limit Exercise
- B Blockers
- Intensive Monitoring during delivery and After
- Excellent Pain Relief
Missed Miscarriage Mx
- Expectant, Wait and Watch
Ad - Avoid SE of medication
Dis - Unpredictable time frame, Surgical management if not happens - Medication - Misoprostol
Ad - Avoid SE of Surgery
Dis - Unknown, SE of medication, Chance to fail - Surgery - Surgery - Dilatation and Curretage
Ad - Predicted time Frame, Immediate relief of sx
Dis - Surgery Risk
