Normal Pregnancy

Question 1

Physiological changes in pregnancy (+modifications to care)

Answer 1

A
- Airway swelling/friability (progesterone) - size down tube

B
- Aspiration risk from sphincter tone, IAP, delayed gastric emptying, reduced motility.
- Ventilation tricky:
–> Reduced compliance (belly)
–> No permissive hypercapnoa = fetal acidosis
- Higher chest drain (up to 4cm)
- FRC down 20% and O2 consumption up 20%/ less safe apnoea time
- Minute volume up 50% (as VT) (Tachypnoea not normal)
- Chronic resp alkalosis NORMAL ^

C
haemodilution = relative anaemia of pregnancy
- Aortacaval compression
- CVP same
- Can get q waves and TWI on ECG from heart being pushed up/L
- Flow murmur + 3rd HS
- 5x clot risk
- Thrombocytopaenia
- Hypoalbuminaemia
- Fluid retention
- 10% of CO to uterus (at term)

Other:
- GFR up 50%
- Fluid retention
- Hypoalbuminaemia

Question 2

Normal trajectory of BHCG:

Answer 2

Nearly doubles (1.66x) every 48 hours until 10/40 –> plateau –> falls 12/40

Too rapid: trophoblastic
Too slow: ectopic, inevitable miscarriage
Falling: inevitable miscarriage

Question 3

What are the 3 stages of labour?

Answer 3

1- Dilation
2- Pushing/ delivery of baby
3- Delivery of placenta

Question 4

What factors indicate imminent delivery?

Answer 4

• 10cm dilated/ fully effaced
• Urge to push or defecate
• Perineal bulge (or crowning)

Should NOT transport from rural facility at this point

Question 5

Management of a Precipitous Delivery in ED:

Answer 5

Set up for DELIVERY and NEORESUS.

• O2 on Mum
• Brief history (number babies, gestation)
• USS for ?presenting part
• Clean + drape perineum (if time)
• Support perineum with one hand + gauze, crown with other
• Encourage 3x10sec pushes per contraction

HEAD OUT

• Sweep cord off neck
  –> (if can’t, clamp x2 and cut then deliver ASAP!!)
• Gentle downwards to deliver ANTERIOR shoulder, upwards to deliver POSTERIOR shoulder
• Clamp cord x2 3cm from umbi once not pulsating

THIRD STAGE
- CHECK NO TWIN
- OXYTOCIN 5units IV (or 10 IM)
- Gentle cord traction
- Massage uterus after plac out
- Monitor for PPH, repair perineum, analgesia

MUM: AntiD +-, GBS: double-dose BenPen, monitor losses