Normal pregnancy, antenatal care and screening Flashcards
state nageles rule
Naegele’s rule involves a simple calculation: Add seven days to the first day of your LMP and then subtract three months. For example, if your LMP was November 1, 2017: Add seven days (November 8, 2017). Subtract three months (August 8, 2017).
regarding respiratory changes during pregnancy:
how does respiratory rate change
increased
regarding respiratory changes during pregnancy:
how does oxygen consumption change
increased by 20%
regarding respiratory changes during pregnancy:
how does residual capacity change
decreased by 25%
regarding respiratory changes during pregnancy:
how does arterial PCO2 change
decreased
regarding respiratory changes during pregnancy:
how does laryngeal oedema change
increased
overview of respiraoty system changes during pregnacy 5
RR - increased
O2 consumption - increased by 25%
redisual capacity decreased by 25%
arterial PCO2 decreased
laryngeal odeam increased
how does pregnacy affect the cardiovascular system 5
HR- increasd
Stroke volume- increased
cardiac output- increased
systemic vascular resisitance/decreased afterload- decreased
plasma volume and preload- increased
how does blood pressure change during pregnancy
may fall in second trimester and rise slightly in late pregnancy
when are pregnant women at an increased risk of CVD
when cardiac output high or cahnging rapidly
this includes:
-early pregnancy
-second stage
-immediately postpartum
haematoligcval changes in pregnancy 6
plasma volume increases
elevated eryhtropoeitin increased red cell mass but haemoglobin concentration never reach pre-pregnancy levels
MCV and MCHC are usually unaffected
increased demand (around 1000mg) of additional iron
serum iron falls but transferrin and TIBC rise
all coagulation factors increase bar platelets and protein S
Urinary system changes
50-60% increase in renal blood flow and GFR
-increased exertion and reduced blood levels of urea,creatitne,urate and bicarb
mild glycosuria and or proteinuria
increased water retention
kidneys increase in length, ureteres become longer
GI tract changes 4
decreased lower oesophageal sphincter pressure
decreased gastric peristalsis
delayed gastric emptying
increased small and large bowel transit times
skin changes in pregnacy 4
hyperpigmentaiton of umnilicus, nipples, abominal midline and face
spider naevie and palmar erythema
stretch marks
MSK changes in pregnnacy 2
increased ligamental laxity-> back pain and pubic symphis dysfunction
exaggerated lumbar lordosis in late pregnancy
changes to calcium in perngnacy 3
increased intestinal calcium absopriton
increased urinary excretion of calcium
increased bone turnover
purpose of antenatal care
maximise chance of positive outcome from pregnancy for mother and baby
what does antenatal care include 4
regular contact w healthcare pros
promote positive health and wellbeing
provide education and guidance
screen for risks, emerging problems and complications
how many antenatal visits for prims and previous parents
prims- 10
previous child- 7
when is the first appointment for uk pregnancies
by 10 weeks
aims of first antenatal appoitment 5
identify risks, incld domestic abuse
screen for abnormalites or illness
develop rapport and encourage future attendance
provide health promotion message: smoking, dieticican, dental care, folic acid, alcohol, food hygiene
social work invovelmtn if required
gain initial observations: BMI, BP,HR , abdo exam, urinalyssi
determine likely gestation - NAEgels rule
what are some risk factors screened for at the first antenatal visit 7
age >40 or <18
Para 6+ or Para 0
extremes of BMI
low socio-econmic status
drug/alochol misuse
previous obtetic problems
vulnerable groups
pre-exisiting medical problem: diabetes, epilepsy, hypertension
what is screened for at first trimester antenatal visits (mother conditions) 4
FBC- anaemic /thrombocytopenia
blood gorup (ABO/Rhesus)
sickle cell nd thalassaemia
Hep B/ Syphilis/ HIV
when are trisomies screened for in pregnacy
-if after initial combined screening women has high risk result what is offered
-what is offered if that test is positive and when
combined test at 11-14 weeks for downs (21), edwards (18) and patau (13)
-offered NIPT- cell free fetal DNA- identifies fetal DNA in maternal circulation
-if NIPT +ve- chorionic villus sampling (11weeks) or amniocentesis (15 weeks)
when does a fetal anaomly scan take place
18-22 weeks
what do second trimester antenatal visits consist of 4
fetal anaomly scan
BP/urinarlysi/asculation of fetal heart
ask about pain/vaginal loss
ask about common pregnancy problems
state some common pregnancy problems 11
N+V
heartburn
haemorhoid/ constipation
pelvic firlde pain/siatica/ back pain
anaemia
carpal tunnel Sx
bleeding gums
fatigue
itching
rashes
vaginal discharge
for the following pregnancy problem what adivce/possible treatment is offered:
N+V
exclude UTI
admit if severe
antiemetics are ok
for the following pregnancy problem what adivce/possible treatment is offered:
heartburn
antacids
consider PPI
for the following pregnancy problem what adivce/possible treatment is offered:
haemorrhoids/contipation
avoid constipation using diet and fluid intake
over the counter remedies
for the following pregnancy problem what adivce/possible treatment is offered:
pelvic girdle pain/sciatica/back pain
physio
-may need mobility aids if severe
for the following pregnancy problem what adivce/possible treatment is offered:
anaemia
usually IDA- prescribe iron
diet
for the following pregnancy problem what adivce/possible treatment is offered:
carpal tunnel Sx
exclude pre-eclampsia
physio
splints
for the following pregnancy problem what adivce/possible treatment is offered:
bleeding gums
dental check up
for the following pregnancy problem what adivce/possible treatment is offered:
fatigue
screen for anaemia
encourgae physical acitivty to improve sleep
for the following pregnancy problem what adivce/possible treatment is offered:
itching
conisder obstetic cholestasis
for the following pregnancy problem what adivce/possible treatment is offered:
rashes
polymorphic eruption of pregnnacy - periumbilcal sparing- antihistamines
pemphigoid gestation- fetal compormise- steroids/antihistamines
for the following pregnancy problem what adivce/possible treatment is offered:
vaginal discharge
common -swach if malodorous/itch
what happens during third trimester antenatal visits
BP/urinalysis/ asculation of fetal heart
ask about pain/vaignal loss
ask about common preg problems
enquire about fetal movement s
abdo exam -
evaluate fetal growth (24wks +)
how is fetal growth measured
symphyseal-fundal height
-measured in cm from pubic symphysis to top most portion of the uterus
state some common antenatal complications 6
polyhydramnios
oligohydramnios
hypertension and pre-eclampsia
anaemia
impaired glucose tolerance
mental health problems
define polyhydramnios
too much amniotic fluid
what would prompt referral for possible polyhydreamnios and where is it referred to
large for dates/ tense abdomen/ unable to feel fetal parts
-refer for USS
what is measured at USS for poolyhydraeminios
single deepest vertical pool (>8cm)
and
amniotic fluid index (>90th centile)
what is polyhydramnios associated with 7
placental abruption
malpresentaion
cord prolapse
large for gestational age infant (assoc w DM)
requiring CT section
post-partum haemorrhage
premature birth and perinatal death (INCREASE ANTENTAL SCREENING)
define oligohydramnios t
too little amniotic fluid
how is oligohydramnios defined using USS 2
amniotic fluid index <5th
single deepest vertical pool <2cm
what is oligohydramnios assocaited with 6
poor perintatl outcomes
proloned pregnancy
ruptured membranes
IUGR
fetal renal congential abnormalities
may cause hypoxia due to cord compression
what syx during pregnancy could suggest. pre-eclampsia or hypertension 4
headache
visual distrubance
severe RUQ or epigastric pain
significant facial/hand/ankle oedema
risk factors for hypertension/preeclampsia during pregnnacy 6
parity 0
FHx
extremes of maternal age
obestity
SMOKING PROTECTIVE
medical - HT, renal disease, thrmonbophillia, SLE, DM
obestric- multiple pregnancy, previous pre-eclampisa, hydatidiform mole, hydrops
when shoudl anaemia be tested for in pregnancy
FBC in third trimaster
what is defined as anaemia in pregnacy
Hb <105 g/L
Mx of anaemia in pregnancy
start iron therapy -oral or parental if concerns about ocmplicant/ prohibitive side effects with oral
test folate B12 and ferritin
how is impaired glucose tolerance tested for in pregnancy 2
urinalysis for glycosuria at antenatal appoitments
GTT at 24-28 weeks if glycosuria or risk factors
risk factors for impaired glucose tolerance in pregnancy 5
FHx of diabetes
BMI >30
previous macrosomic baby (>4.5kg)
previous GDM
ethnciity with high prevalence
mental health problesm during pregnancy
pre-conception counselling (contraindicated medications/ high risk (sodium valporate))
pre-exisitng mental illness -referred to mental health team
ask about mental health at antenatal clinics
risk of postnatal depression
what does the fetal skull consist of 6
occiptal bone, parietal bone, frontal bone
anterior and posterior fontanelle
sagittal suture [10]
breif overview of the mechanism of a normal labour and delivery
effacement and then dilation of the cervix
expulsion of the fetus by uterine contractions
how is labour initiated
largely unknown
-co=ordinated inhibition of ‘pro-pregnancy’ factors and activation of ‘pro-labour’ factors
how is labour initiated
largely unknown
-co=ordinated inhibition of ‘pro-pregnancy’ factors and activation of ‘pro-labour’ factors
state some pro-pregnancy factors 4
progestetrone
nitric oxide
catecholamies
relaxin
state some pro-labour factors 5
oestrogens
oxytocin
prostaglandins and prostglandin dehydrogenase
corticotrophin-releasing hormone
inflammaotry mediators
define CUBS testing
cmobined ultrasound and biochemical testing
happesna t 11-14 weeks
define the first stage of labour
from onset of labour (true contractions) until 10cm cervical dilatation
define the second staeg of labour
from 10cm cervical dilatation until delivery of the baby
define the third stage of labour
from delivery of the baby until delivery of the placenta
describe cervical ripening
cervix composed of network fo collagen fibres
-during latter stages of pregnancy it softens and begins to efface so that delivery can occur
-effacement=thin out
prostaglgains - increased cervical ripening by inhibiting collagen synthesis and stimulating collagenase actiivyt to break down the collagen
concenttrationof collagen decreases and the service beomces softer and ready to dilate
how is cervical ripening assessed
Bishop score [11]
what is used to diagnose labour 3
uterine contractions
effacement (thinning)
dilation of the cervix
define effacement
when the lengthe of the cervix has been taken up into the lower segment of the uterus
-begins with internal os-> downwards to external os until cervical tissue becomes continuous with the uterine walls
what does dilation refer to
only to the dilation of the external os
when does effacement and dilation occur in a prim vs parous mother
prim- effacement before dilation
parous -effacement and dilation can occur simultaneously
two ways said to be diagnoistic of labour
regular contractions and a fully effaced cervix
or
spontaneous rupture of membrane plus regular uterine activity
what can be assocaited with rupture of membranes in labour
risk of ascending infection and chorioamnionitis
-can rarely progress to rapid overwhelming fetal and maternal sepsis
what is used to define if a mother is at low risk of ascending infection with a rupture of her membranes in labour 4
if mother apyrexial
baby cephalic
clear liquor
normal fetal monitoring
describe the two phases of the first stage of labour
a- latent- onset of contractions until cervix is fully effaced and 3-4cm dilated
b- active- cervical dilation to 10cm
describe the two phases of the second stage of labour
propulsive- from full dilation until the head has descended onto the pelvic floor
expulsive- from the time the mother has an irresistible urge to bear down and push until the baby is delivered
how is placental separation recognised
by apparent cord lenghening and a gush of dark blood per vagina
what risk is associated with placental delivery
uterine inversion
what is assessed when labour is diagnosed 9
risk assess- midwife or need obsterician
review PMHx and obsterix Hx
baseline- maternal HR, BP, temp & urinalysis
-record on partogram during labour
assess length, strength and frequency of contractions
has spontaneous rupture of membranes occurs- what colour?, meconium?
vaginal bleeding?
fetal movements
abdominal exam
CTG
vaginal examination
when are women with a ruptured membrane offered an induction of labour
24 hours
components of the abdominal exam when women in labour 4
fundal height, lie, presentation, engagement of presenting part, ascultation of fetal heart (doppler/Pinard)
how often should a vaginal exam take place when women in labour
every 4 hours
components of a vaginal exam with a women in labour
check for presence or absence of meconium
dilatation of the cervix
station of the presenting part
position o f the head
presecent of caput or moulding
what does meconium straining suggest in a labouring women
fetal distress
what does caput or moulding suggest in a labouring women
if excessive may be obstructed labour
how is the station of the presenting part assessed in a labouring women
recorderd with aspect to the ischial spines with the spines being zero station [12]
define caput with regards to labour
oedema of the scalp owing to presure of the head against the side of the cervix
-classified +,++, +++
define moulding with regards to labbour
changes in the head shape
-which occurs during labour, made possible by movement of the individual scap bones
+= if bones are opposed
++= bones overlap but can be reduced
+++=bones overlap but cannot be reduced
what is a thick meconium a possible sign of
fetal hypoxia or acidosis
define a partogram
provides grpahic record of cliniclal findings and any relevant events during labour
what does a partogram record 6
maternal observations- BP,HR, temp
fetal heart rate
progressive cervical dilatation
descent of presenitng part
strenght and freuqncy of contractions
colour of amniotic fluid
uterine activity is recorded over a 10 minute period
define preceipitous labour
expulsion of fetus within less than 2-3hrs of onset of contractions
what can cause a precipitious labour
uterine ovaractiivty (hyperstimulation >5contractions/ 10 minutes)
spontenous (placentla abruption)
use of oxytocics
what is the risk with a preciptious labour
may lead to fetal distress
define slow labour
cervical dilation of less than 2cm in 4 hours
what can cause a slow labour
inadequate uterine activity
cephalopelvic disproportion (CPD)
true/relative (malposition)
pelvic bnormlaity
what can be considered in a slow labour for management
ARM (artifical rupture of the amniotic membrane)
±
oxytocin infusion
define malpresenation
any non-vertex position
face/brow/breech/shoulder
what is malpresenation associated with
multiple prenancies, bicoruate uterus, fiborids, placenta praevia, polhydramnios, oligohydramnios
and
fetal anoamlies- NTDs, NMDs(neuromuscular diseases), trisomies
Mx of malpresenation
consueling regarding delivery
-term breech trial/ elective C section
all women offered external cephalic version (ECV) from 36-37 wks 50% success rate
define malposition
abnormal position of the vertex relative to the maternal pelvis
most common malposition
occipitoposterior [13]
Mx of occipitoposterior malposition
10% at term
longer labour
may require augmentation of labour with oxytocin
delivery- C section, spontaneous ‘face to pubes’, operative vaginal delivery
define prolonged pregnancy
preganncy ebyond 42wks
apporx 10% of pregnacies
what is prolonged labour assocaited with
significant increased risk of intrauterine death and intrapartum hypoxia
what is offered to prolonged labour mothers and when
induction of labour offered between 41 and 42 weeks
what happens if a women at 42weeks gestation refuses an induction of labour
offerd twice weekly CTG and USS estimation of amniotic fluid volumes
what is offered to women prior to an induction of labour
membrane sweep -sweep finger circulrarly inside cervix- try stimulate prostaglandin release and labour
potential indications for induction of labour 7
maternal diabetes- incld gestational diabetes
twin pregnacy
pre-labour rupture of. membranes
fetal growth restrction and suepcted fetal compormise
hypertensive disorders like pre-eclampsia
deteriorating maternal medical conditions (cardiac or renal disease)
maternal request
contraindications to induction of labour 3
situations were vaginal delivery is contraindicated
-placenta praevia
-transervse lie
caution in previous C section or uterine surgery (increased risk of scar rupture)
risk of hyperstimulation in those who have had a previous precipitate labour
methods for induction of labour
unfavourable cervix (bishop score ≤6)
-prostaglandins
-cooks balloon- inserted intocervix puts pressure on internal os
favourable cervix (bishop score>6)
artifical ruptue of membrnaes
-syntocinon (after ARM) -syntehtic oxytocin
define uterotonic
medications used to induce or augment uterine contractions
define tocolytics
medicatiosn that reduce or arrest uterine contractions
define oxytocin and what it does
stimulated ripening of cervix and contractions of uterus
-also has role in lactation during breastfeeding
what are infusions of oxytocin used for4
to induce labour
progress labour
improve frequency and strength of uterine contractiosn
prevent or treat postpartum haemorrhage
define ergometrine
stimulates smooth muscle contraction both in the uterus and blood vessels
-makes it useful for delivery of placenta and to reduce post partum bleeding
-used in third stage of labour or post partum to prevent and treat postpartum haemorrhage
-ONLY USED AFTER DELIVERY OF BABY
what prostaglandin is used for induction of labour
dinoprostone
-prostaglandin E2
-comes as pessaries, tablets and gels
what is prostagandisn role in pregnancy and labour
stimulate the contraction of the uterine muscles
also ripen cervix before delivery
when is nifedipine used in labour
calcium channel block -reduces smooth muscle ocntraction in blood vessels and the uterus
-reduces blood pressure in HT and pre-eclampsia
-tocolysis in premature labout
when is terbutaline used in labour
used for tocolysis in uterine hyperstimualtion when uterine contractions beomce excessive during induction of labour
examples of uterotonic drugs 2
oxytocin (synthetic syntocinon)
prostagladins
examples of tocolytiic agents used in labour
nifedipine
terbutaline
risks of induction of labour
related mainly to use of oxytocics
prostglandins can cause labour hypersitmulation
define augmentation of labour
process of accelerating labour which is already underway
non-pharmacolgical methods of pain relief in labour 4
maternal support 1:1 support in labour
environmet - music, diff positions, mobilise
birthing pools
education
pharmacolgical methods for pain relief in labour 5
inhald analgeisc - entonox
systemic opido analgesia - IM diamorphine give with antiemetic
pudenal analgesia
reginal analgesita- epidural, spinal
general anaestheia - RISKs greater than non-pregnant
when is epidural analgesia vs spinal anaesethic used
epidural- labour- topped up with instrumental delivery
spinal anasethetic- used for operative delivery/surgical management of post-partum complications
pros and cons of epidural analgesia
pros- cannula allows for top up
cons
-analgesic affect may be patchy
-causes prolonged second stage
-higher rate of instrumental delivery
pros and cons of spinal anaesthetic
pros- one off injection lsts 2-4 hrs
dense and relatively reliable anaethetic blockade
cons
-associatd with long term backache
complications of regional analgesia 6
dural puncture headache
hypotension
local anaeethetic toxicity
accidental total spinal block
neurological complications (direct needle trauma-> peripheral nerve injury), nerve ischaemia
bladder dysfunction
increased risk of a general anaesthetic in labour 5
reduced gastro-oesphafeal tone
increased intra-abdo mass
reduced gastric emptying
regurg of gastric contents & aspiration-> pneumonitis
difficult and failed intubation more likely
define spontaneous perineal tears
any type of damage to the female genitalia during labour which can occur spontaneously or iatrogenically (via episiotomy or instrumental delivery)
define episiotomy
surgical incision of [erineum and posterior vaignal wall
-performed at second stage of labour to quickly enlarge opening for baby to pass through
inidcations for a episiotomy 5
rigid perineum preventing delivery
judged that a large tear is imminent
instrumental deliveries
suspected fetal compromise
shoulder dystocia (improve access to birth canal)
steps of an episitomy
1- infiltrae local anaethetic -unless effective regional block
2- perform right medio-lateral episitioomy
who provides postnatal care
midwives in materinity units and womens homes between 10-28 days
following this health visitor
complications-obstetrician
immediate post-birth care 6
skin-to-skin contact if no neonatal resus required
neonatal thermoregulation, respiratory regulation, increases successful breastfeeding
maternal stimulation of oxytocin- increases uterine contractions and milk production
rhesus bloods and anti-D if required
assessment of postpartum psychosis/depression, child protection or social concerns
6-hr discharge if mother and baby well
specific post-birth care for neonate 6
apgar score 1,5,
-repeat at 10 mins if low
clamp and cut umbililcal cord after 1 min
measure birth weight and temp
physical exam -
record micturition and feed
Vit K consent and administer
specific mother care postbirth 6
obserev vaginal blood loss, palpation of uterine fundus assess contraction
examine for perineal, labial and vaginal trauma
support skin to skin
colour, BP, HR RR, temp
recurd first micturition after birth
categorise VTE risk and commence prophylaxis
benefits of breastfeeding for baby 7
reduced risk of:
-infections
-vomiitng and diarrhoea
-childhood leukaemia
-risk of obesity
-CVD disease in adulthood
-available when needed
-strong emotional bond
benefits of bresatfeeding for mum 5
lower risk of :
-breast ca
-ovarian ca
-osteoporosis
-CVD disease
-obesity
what is asssessed in first 10 days post birth 5
discuss birth, PTSD
risk of deression, suicide
physical exam0 HR, BP, Temp
abdo exam
discuss contraception
physical exam of baby- feeding. winding,changing and washing ,safe sleeping
when does the late postnatal examination happen
6 weeks
what happens at the late post natal examination 5
review birth, address questiosn, discuss future births
discuss physical syx: perinela pain, pain during intercourse
FBC
cervical smear
discuss contraception
postnatal complciaions 8
anaaemia
bowel probelms
breasrt probelsm
perineal breakdown
inconteniece
peurperal pyrexia
VTE
mental health problems
state the treatment for the following postnatal complications:
anaemia 2
oral iron if asympotmatic
consider blood transfusion if Hb <70 g/l
state the treatment for the following postnatal complications:
bowel problems
consitpation common
causes by fear of defacation, reduced mobitly , iron/opiates
conservative management
state the treatment for the following postnatal complications:
breast problems 3
nipple pain/cracks/bleeding
breast engorgement, mastits, breast abscess
adise baby position
mastitisi- ABx
breast absecess- refer to breast/srugical team
state the treatment for the following postnatal complications:
perineal breakdown 2
usually heal by secondary intentin with ABx if infection present on culture
state the treatment for the following postnatal complications:
incontinence 3
commonly resolves spontaenously
physio if not resolving
Ix and Rx if syx persist past initial postntal weeks
for the following postnatal complications:
define puerperal pyrexia
temp >38C on any occasion in first 14 days after birth
causes of puerperal pyrerxia 4
commonly genital tract (endometritis) or UTI
consider breast/chest, DVT/PE
state the investigaions and treatment for the following postnatal complications:
puerperal pyrexia
Ix- clinical exam full body
-send MSSU
-vaginal/wound swabs
CONISDER SEPSIS
treat immediatly if sepssi suspected
risk facotrs for puerperal pyrexia 2
maternal obesity
delivery by C section
define secondary PPH (post partum haemorrhage)
usually due to infection of uterine cavity or reatined products of conception or both
investigations and treatment for secondary PPH (post partum haemorrhage)
measure HR, BP, Temp
palpate uterus for tenderness
send vaginal swabs for culture
ABx/remove retained POC
Ix and treatment of VTE in post partum
puerperium (6weeks post partum) - highsest risk
risk facotr analysis and trhmoboprophylaxis Id required
LMWH
early mobilisation
DVT syx 3
asymptomatic
swelling
redness
pain in legs
PE syx 3
dyspnoea
chest pain
cardiorespiroaty collapse
superfical thrombophlebitis syx and treatemnt
painful, erythematous, tender
treatemnt- support stockigns and anti-inflammaotry drugs
mental health problems post partum
depressive illness- any time first year peaks 3-4 months postpartum
postpartum psychosis more acute onset - within first few days
signs of post partum depression 6
persistent low lood 10-14 days
lack ofintrest/pleasure
decreased energy
lack of concenrtaiton
thoughotus of hearing baby
lackk of love for baby
syx and sx of post partum psychosis 4
perplexiity, fear, restless agitation, insomia
risk factors of post partum psychosis 3
pervious PP, bipolar , FHx
treatment for post partum psychossi
admit ot mother and baby uni
antipsucot or mood stabliing drugs
consider breastfeeding when itnitnaing medications
define a still birth
baby deliver with no signs of life that is known to have died after 24 weeks of pregnancy
casues of stillbirth 6
50% unkown
advanced maternal age
maternal obesity
social deprivation
smoking
non-white ethinitcity
domestic violence
diagnosis of stillbrith 3
50% women expeirece reduced fetal movemetns days preceding Dx
bleeding or abdo pain
need USS- second opinion asweel
look for
-asbecen of fetal heart
-spalding sign (overlaping fetal skull bones), hydrops
delivery optinos for stillbirths
most undego vaginal birth
some request C section
-alwasy discuss risk and consideration for future pregnancy
special delveiing room in labour ward
aftercare for stillbirth 5
psychoigcal care
memory box w phots, hand and footprints
suppresion of lactation
maternal investgaitons
post mortem
next pregnancy after still birth
no clear evidence when should conecve again
-personal choid-
medical care guided by specific cause of previous losses
may need more antenatal visits- regular growth scnas
what can be used as prophylaxis for preterm labour
progesterone
how does progesterone work as prophylaxis for preterm labour
given vaginally via gel or pessary
-decreases acitivy of myometrium and prevents cervix remodelling in preparino for delviey
who is offered progesterone for preterm labour prophylaxis
women witha. cervical length <25mm on vaginal USS between 16-24wk gestation
define atonic post partum heamoreaeg
excessive bleeding when uterus is not weel contracted after delivery - soft distend and lacking muscular tone
describe remifentanil PCA
opiate pain-reliveing drug that is very short acting
