monday 9th Flashcards
When is anti D given?
28 and 34 weeks
When is an USS done in placenta praevia?
32 weeks
what are 4 things looked at on CTG?
baseline rate (110-160 is reassuring)
variaibility (5-25 is reassuring)
accelerations (good)
descelerations (prolonged are bad)
what are the movements of the fetus in labour
descent
engagement
neck flexion
internal rotation
crowning
extension of the presenting part
restitution
external rotation
lateral flexion
what are the two stages of the first stage of labour?
latent (0-3cm)
active (3-10cm)
how is active management of the third stage managed?
IM oxytocin and controlled cord traction- when the placenta is detached there will be lengthening of the umbilical cord, explusion of blood and ascension of the uterus in the abdomen
what are 2 definite indications for active management of the third stage?
haemorrhage or passive management taking over 60 minutes
what are the 5 things considered in bishops scoring and what score indicates induction is needed
cervical effacement
cervical consistency
cervical position
cervical dilation
fetal station
what antibiotics will be given for asymptomatic bacteriuria in the first trimester and in the third trimester
first- nitrofuratoin
third- amoxicilin
what test for syphilis is done at booking appointment
VDRL test
what three things will be assessed in determining the risk of premature birth?
- part history of premature birth
- cervical length on transvaginal USS (if less than 25mm it is likely)
- fetal fibronectin (if <50 then unlikely
what two things can be done to prevent premature birth and why would one be chosen?
- vaginal progesterones
- cervical clerclage
Cervical clerclage will be done if previous premature labour, or if cervical trauma such as cone biopsy
when should someone with gestational diabetes be delivered?
38 weeks
when should someone with obstetric cholestasis be delivered?
37 weeks
what are some indications for induction of labour
post maturity
decreased fetal movements
conditions such as gestational diabetes (38) and obstetric cholestasis (37 weeks)
pre-eclampsia
fetal death
PPROM
What bishops score needs induction of labour ?
5 or below
what are 4 methods that will be used in induction of labour
Membrane sweep
Vaginal prostoglandins E2
Balloon catheter
Amniotomy and IM syntocinon
what is the main complication of induction of labour and what would it be characterised?
uterine hyperstimulation (indicated by >5 contractions in 10 mins)
what defines miscarriage, what is early and what is late?
spontaneous termination of a pregnancy before 24 weeks
early = <12 weeks
late= 12-24 weeks
before what gestation can medical management of a miscarraige be used?
before 13 weeks
what defines recurrent miscarriages ?
3+ miscarriages
what are the main causes of recurrent miscarriage
anti-phospholipid syndrome
endocrine - poorly controlled diabetes
smoking
uterine abnormality
what may be given to those with recurrent miscarraiges ?
low molecular weight heparin and aspirin
what sign may be seen on transvaginal USS of ectopic
blob sign
criteria for expectant management of a ectopic?
<35mm, no heartbeat, asymptomatic, hCG < 1000, not ruptures
criteria for medical management of an ectopic?
<35mm, no heartbeat, asymptomatic/no significant pain, hCG <1500, not ruptures
when should surgical management of an ectopic be used?
> 35mm, heartbeat visible, ruptures, symptomatic, hCG>5000
what are some risk factors for molar pregnancy?
extremes of maternal age, multiple pregnancy, oral contraceptive, previous
how is molar pregnancy treated?
surgical evacuation
what two different surgical options are there for termination of a pregnancy and when can each be done?
cervical dilation and suction-> before 14 weeks
cervical dilation and forceps removal-> before 24 weeks
when should anti-D be given in termpination of a pregnancy?
if the mother is rhesus negative and it was terminated after 10 weeks
what is antepartum haemorrhage?
vaginal bleeding after 24 weeks gestation
what are some causes of painless vaginal bleeding in pregnancy?
placenta praevia
vasa praevia
what are some causes of painful vaginal bleeding in pregnancy ?
placental abruption
placental accreta/percreta
uterine rupture
what are the different classifications of antepartum haemorrahge
spotting
minor- <50ml
major- 50 to 1000ml
massive >1000ml or signs of shock
when should USS be done done for placenta praevia?
at 32 weeks then again at 36 weeks
what are some RF of placenta praevia?
previous placenta praevia
previous caesarean
increased maternal age
smoking
structural uterine abnormalities
IVF
RF of placental abruption
pre-eclampsia
smoking
polyhydramnios
abnormal fetal lie
increasing maternal age
maternal trauma
multiple pregnancy
multigravity
who is given intrapartum ABx during labour
any woman in preterm labour
women who are GBS positive
women with a previous baby with early or late onset GBS disease
women with pyrexia during delivery
what antibiotic is given for intrapartum Abx
benzylpenicillin
when is low molecular weight heparin given for VTE prophylaxis in pregnancy
from 28 weeks if 3 RF
from 12 weeks if 4+ RF
RF for VTE in pregnancy
smoking
parity over 3
BMI>30
age >35
reduced mobility
family history of DVT
multiple pregnancy
pre-eclampsia
varicose veins
immobility
IVF
thrombophilia
