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Obs & Gyn > Normal pregnancy, antenatal care and screening > Flashcards

Normal pregnancy, antenatal care and screening Flashcards

1
Q

state nageles rule

A

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).

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2
Q

regarding respiratory changes during pregnancy:
how does respiratory rate change

A

increased

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3
Q

regarding respiratory changes during pregnancy:
how does oxygen consumption change

A

increased by 20%

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4
Q

regarding respiratory changes during pregnancy:
how does residual capacity change

A

decreased by 25%

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5
Q

regarding respiratory changes during pregnancy:
how does arterial PCO2 change

A

decreased

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6
Q

regarding respiratory changes during pregnancy:
how does laryngeal oedema change

A

increased

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7
Q

overview of respiraoty system changes during pregnacy 5

A

RR - increased

O2 consumption - increased by 25%

redisual capacity decreased by 25%

arterial PCO2 decreased

laryngeal odeam increased

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8
Q

how does pregnacy affect the cardiovascular system 5

A

HR- increasd

Stroke volume- increased

cardiac output- increased

systemic vascular resisitance/decreased afterload- decreased

plasma volume and preload- increased

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9
Q

how does blood pressure change during pregnancy

A

may fall in second trimester and rise slightly in late pregnancy

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10
Q

when are pregnant women at an increased risk of CVD

A

when cardiac output high or cahnging rapidly

this includes:
-early pregnancy
-second stage
-immediately postpartum

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11
Q

haematoligcval changes in pregnancy 6

A

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

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12
Q

Urinary system changes

A

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

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13
Q

GI tract changes 4

A

decreased lower oesophageal sphincter pressure

decreased gastric peristalsis

delayed gastric emptying

increased small and large bowel transit times

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14
Q

skin changes in pregnacy 4

A

hyperpigmentaiton of umnilicus, nipples, abominal midline and face

spider naevie and palmar erythema

stretch marks

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15
Q

MSK changes in pregnnacy 2

A

increased ligamental laxity-> back pain and pubic symphis dysfunction

exaggerated lumbar lordosis in late pregnancy

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16
Q

changes to calcium in perngnacy 3

A

increased intestinal calcium absopriton

increased urinary excretion of calcium

increased bone turnover

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17
Q

purpose of antenatal care

A

maximise chance of positive outcome from pregnancy for mother and baby

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18
Q

what does antenatal care include 4

A

regular contact w healthcare pros

promote positive health and wellbeing

provide education and guidance

screen for risks, emerging problems and complications

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19
Q

how many antenatal visits for prims and previous parents

A

prims- 10

previous child- 7

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20
Q

when is the first appointment for uk pregnancies

A

by 10 weeks

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21
Q

aims of first antenatal appoitment 5

A

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

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22
Q

what are some risk factors screened for at the first antenatal visit 7

A

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

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23
Q

what is screened for at first trimester antenatal visits (mother conditions) 4

A

FBC- anaemic /thrombocytopenia

blood gorup (ABO/Rhesus)

sickle cell nd thalassaemia

Hep B/ Syphilis/ HIV

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24
Q

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

A

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)

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25
Q

when does a fetal anaomly scan take place

A

18-22 weeks

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26
Q

what do second trimester antenatal visits consist of 4

A

fetal anaomly scan

BP/urinarlysi/asculation of fetal heart

ask about pain/vaginal loss

ask about common pregnancy problems

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27
Q

state some common pregnancy problems 11

A

N+V

heartburn

haemorhoid/ constipation

pelvic firlde pain/siatica/ back pain

anaemia

carpal tunnel Sx

bleeding gums

fatigue

itching

rashes

vaginal discharge

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28
Q

for the following pregnancy problem what adivce/possible treatment is offered:
N+V

A

exclude UTI
admit if severe

antiemetics are ok

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29
Q

for the following pregnancy problem what adivce/possible treatment is offered:
heartburn

A

antacids

consider PPI

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30
Q

for the following pregnancy problem what adivce/possible treatment is offered:
haemorrhoids/contipation

A

avoid constipation using diet and fluid intake

over the counter remedies

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31
Q

for the following pregnancy problem what adivce/possible treatment is offered:
pelvic girdle pain/sciatica/back pain

A

physio
-may need mobility aids if severe

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32
Q

for the following pregnancy problem what adivce/possible treatment is offered:
anaemia

A

usually IDA- prescribe iron

diet

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33
Q

for the following pregnancy problem what adivce/possible treatment is offered:
carpal tunnel Sx

A

exclude pre-eclampsia

physio

splints

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34
Q

for the following pregnancy problem what adivce/possible treatment is offered:
bleeding gums

A

dental check up

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35
Q

for the following pregnancy problem what adivce/possible treatment is offered:
fatigue

A

screen for anaemia

encourgae physical acitivty to improve sleep

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36
Q

for the following pregnancy problem what adivce/possible treatment is offered:
itching

A

conisder obstetic cholestasis

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37
Q

for the following pregnancy problem what adivce/possible treatment is offered:
rashes

A

polymorphic eruption of pregnnacy - periumbilcal sparing- antihistamines

pemphigoid gestation- fetal compormise- steroids/antihistamines

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38
Q

for the following pregnancy problem what adivce/possible treatment is offered:
vaginal discharge

A

common -swach if malodorous/itch

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39
Q

what happens during third trimester antenatal visits

A

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 +)

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40
Q

how is fetal growth measured

A

symphyseal-fundal height
-measured in cm from pubic symphysis to top most portion of the uterus

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41
Q

state some common antenatal complications 6

A

polyhydramnios

oligohydramnios

hypertension and pre-eclampsia

anaemia

impaired glucose tolerance

mental health problems

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42
Q

define polyhydramnios

A

too much amniotic fluid

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43
Q

what would prompt referral for possible polyhydreamnios and where is it referred to

A

large for dates/ tense abdomen/ unable to feel fetal parts

-refer for USS

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44
Q

what is measured at USS for poolyhydraeminios

A

single deepest vertical pool (>8cm)

and

amniotic fluid index (>90th centile)

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45
Q

what is polyhydramnios associated with 7

A

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)

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46
Q

define oligohydramnios t

A

too little amniotic fluid

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47
Q

how is oligohydramnios defined using USS 2

A

amniotic fluid index <5th

single deepest vertical pool <2cm

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48
Q

what is oligohydramnios assocaited with 6

A

poor perintatl outcomes

proloned pregnancy

ruptured membranes

IUGR

fetal renal congential abnormalities

may cause hypoxia due to cord compression

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49
Q

what syx during pregnancy could suggest. pre-eclampsia or hypertension 4

A

headache

visual distrubance

severe RUQ or epigastric pain

significant facial/hand/ankle oedema

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50
Q

risk factors for hypertension/preeclampsia during pregnnacy 6

A

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

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51
Q

when shoudl anaemia be tested for in pregnancy

A

FBC in third trimaster

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52
Q

what is defined as anaemia in pregnacy

A

Hb <105 g/L

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53
Q

Mx of anaemia in pregnancy

A

start iron therapy -oral or parental if concerns about ocmplicant/ prohibitive side effects with oral

test folate B12 and ferritin

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54
Q

how is impaired glucose tolerance tested for in pregnancy 2

A

urinalysis for glycosuria at antenatal appoitments

GTT at 24-28 weeks if glycosuria or risk factors

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55
Q

risk factors for impaired glucose tolerance in pregnancy 5

A

FHx of diabetes

BMI >30

previous macrosomic baby (>4.5kg)

previous GDM

ethnciity with high prevalence

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56
Q

mental health problesm during pregnancy

A

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

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57
Q

what does the fetal skull consist of 6

A

occiptal bone, parietal bone, frontal bone

anterior and posterior fontanelle

sagittal suture [10]

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58
Q

breif overview of the mechanism of a normal labour and delivery

A

effacement and then dilation of the cervix

expulsion of the fetus by uterine contractions

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59
Q

how is labour initiated

A

largely unknown

-co=ordinated inhibition of ‘pro-pregnancy’ factors and activation of ‘pro-labour’ factors

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59
Q

how is labour initiated

A

largely unknown

-co=ordinated inhibition of ‘pro-pregnancy’ factors and activation of ‘pro-labour’ factors

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60
Q

state some pro-pregnancy factors 4

A

progestetrone

nitric oxide

catecholamies

relaxin

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61
Q

state some pro-labour factors 5

A

oestrogens

oxytocin

prostaglandins and prostglandin dehydrogenase

corticotrophin-releasing hormone

inflammaotry mediators

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62
Q

define CUBS testing

A

cmobined ultrasound and biochemical testing

happesna t 11-14 weeks

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63
Q

define the first stage of labour

A

from onset of labour (true contractions) until 10cm cervical dilatation

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64
Q

define the second staeg of labour

A

from 10cm cervical dilatation until delivery of the baby

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65
Q

define the third stage of labour

A

from delivery of the baby until delivery of the placenta

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66
Q

describe cervical ripening

A

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

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67
Q

how is cervical ripening assessed

A

Bishop score [11]

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68
Q

what is used to diagnose labour 3

A

uterine contractions

effacement (thinning)

dilation of the cervix

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69
Q

define effacement

A

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

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70
Q

what does dilation refer to

A

only to the dilation of the external os

71
Q

when does effacement and dilation occur in a prim vs parous mother

A

prim- effacement before dilation

parous -effacement and dilation can occur simultaneously

72
Q

two ways said to be diagnoistic of labour

A

regular contractions and a fully effaced cervix
or
spontaneous rupture of membrane plus regular uterine activity

73
Q

what can be assocaited with rupture of membranes in labour

A

risk of ascending infection and chorioamnionitis
-can rarely progress to rapid overwhelming fetal and maternal sepsis

74
Q

what is used to define if a mother is at low risk of ascending infection with a rupture of her membranes in labour 4

A

if mother apyrexial

baby cephalic

clear liquor

normal fetal monitoring

75
Q

describe the two phases of the first stage of labour

A

a- latent- onset of contractions until cervix is fully effaced and 3-4cm dilated

b- active- cervical dilation to 10cm

76
Q

describe the two phases of the second stage of labour

A

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

77
Q

how is placental separation recognised

A

by apparent cord lenghening and a gush of dark blood per vagina

78
Q

what risk is associated with placental delivery

A

uterine inversion

79
Q

what is assessed when labour is diagnosed 9

A

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

80
Q

when are women with a ruptured membrane offered an induction of labour

A

24 hours

81
Q

components of the abdominal exam when women in labour 4

A

fundal height, lie, presentation, engagement of presenting part, ascultation of fetal heart (doppler/Pinard)

82
Q

how often should a vaginal exam take place when women in labour

A

every 4 hours

83
Q

components of a vaginal exam with a women in labour

A

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

84
Q

what does meconium straining suggest in a labouring women

A

fetal distress

85
Q

what does caput or moulding suggest in a labouring women

A

if excessive may be obstructed labour

86
Q

how is the station of the presenting part assessed in a labouring women

A

recorderd with aspect to the ischial spines with the spines being zero station [12]

87
Q

define caput with regards to labour

A

oedema of the scalp owing to presure of the head against the side of the cervix
-classified +,++, +++

88
Q

define moulding with regards to labbour

A

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

89
Q

what is a thick meconium a possible sign of

A

fetal hypoxia or acidosis

90
Q

define a partogram

A

provides grpahic record of cliniclal findings and any relevant events during labour

91
Q

what does a partogram record 6

A

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

92
Q

define preceipitous labour

A

expulsion of fetus within less than 2-3hrs of onset of contractions

93
Q

what can cause a precipitious labour

A

uterine ovaractiivty (hyperstimulation >5contractions/ 10 minutes)

spontenous (placentla abruption)

use of oxytocics

94
Q

what is the risk with a preciptious labour

A

may lead to fetal distress

95
Q

define slow labour

A

cervical dilation of less than 2cm in 4 hours

96
Q

what can cause a slow labour

A

inadequate uterine activity

cephalopelvic disproportion (CPD)

true/relative (malposition)

pelvic bnormlaity

97
Q

what can be considered in a slow labour for management

A

ARM (artifical rupture of the amniotic membrane)
±
oxytocin infusion

98
Q

define malpresenation

A

any non-vertex position
face/brow/breech/shoulder

99
Q

what is malpresenation associated with

A

multiple prenancies, bicoruate uterus, fiborids, placenta praevia, polhydramnios, oligohydramnios

and
fetal anoamlies- NTDs, NMDs(neuromuscular diseases), trisomies

100
Q

Mx of malpresenation

A

consueling regarding delivery
-term breech trial/ elective C section

all women offered external cephalic version (ECV) from 36-37 wks 50% success rate

101
Q

define malposition

A

abnormal position of the vertex relative to the maternal pelvis

102
Q

most common malposition

A

occipitoposterior [13]

103
Q

Mx of occipitoposterior malposition

A

10% at term
longer labour
may require augmentation of labour with oxytocin

delivery- C section, spontaneous ‘face to pubes’, operative vaginal delivery

104
Q

define prolonged pregnancy

A

preganncy ebyond 42wks

apporx 10% of pregnacies

105
Q

what is prolonged labour assocaited with

A

significant increased risk of intrauterine death and intrapartum hypoxia

106
Q

what is offered to prolonged labour mothers and when

A

induction of labour offered between 41 and 42 weeks

107
Q

what happens if a women at 42weeks gestation refuses an induction of labour

A

offerd twice weekly CTG and USS estimation of amniotic fluid volumes

108
Q

what is offered to women prior to an induction of labour

A

membrane sweep -sweep finger circulrarly inside cervix- try stimulate prostaglandin release and labour

109
Q

potential indications for induction of labour 7

A

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

110
Q

contraindications to induction of labour 3

A

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

111
Q

methods for induction of labour

A

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

112
Q

define uterotonic

A

medications used to induce or augment uterine contractions

113
Q

define tocolytics

A

medicatiosn that reduce or arrest uterine contractions

114
Q

define oxytocin and what it does

A

stimulated ripening of cervix and contractions of uterus
-also has role in lactation during breastfeeding

115
Q

what are infusions of oxytocin used for4

A

to induce labour

progress labour

improve frequency and strength of uterine contractiosn

prevent or treat postpartum haemorrhage

116
Q

define ergometrine

A

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

117
Q

what prostaglandin is used for induction of labour

A

dinoprostone
-prostaglandin E2
-comes as pessaries, tablets and gels

118
Q

what is prostagandisn role in pregnancy and labour

A

stimulate the contraction of the uterine muscles

also ripen cervix before delivery

119
Q

when is nifedipine used in labour

A

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

120
Q

when is terbutaline used in labour

A

used for tocolysis in uterine hyperstimualtion when uterine contractions beomce excessive during induction of labour

121
Q

examples of uterotonic drugs 2

A

oxytocin (synthetic syntocinon)

prostagladins

122
Q

examples of tocolytiic agents used in labour

A

nifedipine

terbutaline

123
Q

risks of induction of labour

A

related mainly to use of oxytocics

prostglandins can cause labour hypersitmulation

124
Q

define augmentation of labour

A

process of accelerating labour which is already underway

125
Q

non-pharmacolgical methods of pain relief in labour 4

A

maternal support 1:1 support in labour

environmet - music, diff positions, mobilise

birthing pools

education

126
Q

pharmacolgical methods for pain relief in labour 5

A

inhald analgeisc - entonox

systemic opido analgesia - IM diamorphine give with antiemetic

pudenal analgesia

reginal analgesita- epidural, spinal

general anaestheia - RISKs greater than non-pregnant

127
Q

when is epidural analgesia vs spinal anaesethic used

A

epidural- labour- topped up with instrumental delivery

spinal anasethetic- used for operative delivery/surgical management of post-partum complications

128
Q

pros and cons of epidural analgesia

A

pros- cannula allows for top up

cons
-analgesic affect may be patchy
-causes prolonged second stage
-higher rate of instrumental delivery

129
Q

pros and cons of spinal anaesthetic

A

pros- one off injection lsts 2-4 hrs
dense and relatively reliable anaethetic blockade

cons
-associatd with long term backache

130
Q

complications of regional analgesia 6

A

dural puncture headache

hypotension

local anaeethetic toxicity

accidental total spinal block

neurological complications (direct needle trauma-> peripheral nerve injury), nerve ischaemia

bladder dysfunction

131
Q

increased risk of a general anaesthetic in labour 5

A

reduced gastro-oesphafeal tone

increased intra-abdo mass

reduced gastric emptying

regurg of gastric contents & aspiration-> pneumonitis

difficult and failed intubation more likely

132
Q

define spontaneous perineal tears

A

any type of damage to the female genitalia during labour which can occur spontaneously or iatrogenically (via episiotomy or instrumental delivery)

133
Q

define episiotomy

A

surgical incision of [erineum and posterior vaignal wall
-performed at second stage of labour to quickly enlarge opening for baby to pass through

134
Q

inidcations for a episiotomy 5

A

rigid perineum preventing delivery

judged that a large tear is imminent

instrumental deliveries

suspected fetal compromise

shoulder dystocia (improve access to birth canal)

135
Q

steps of an episitomy

A

1- infiltrae local anaethetic -unless effective regional block

2- perform right medio-lateral episitioomy

136
Q

who provides postnatal care

A

midwives in materinity units and womens homes between 10-28 days

following this health visitor

complications-obstetrician

137
Q

immediate post-birth care 6

A

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

138
Q

specific post-birth care for neonate 6

A

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

139
Q

specific mother care postbirth 6

A

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

140
Q

benefits of breastfeeding for baby 7

A

reduced risk of:
-infections
-vomiitng and diarrhoea
-childhood leukaemia
-risk of obesity
-CVD disease in adulthood

-available when needed
-strong emotional bond

141
Q

benefits of bresatfeeding for mum 5

A

lower risk of :
-breast ca
-ovarian ca
-osteoporosis
-CVD disease
-obesity

142
Q

what is asssessed in first 10 days post birth 5

A

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

143
Q

when does the late postnatal examination happen

A

6 weeks

144
Q

what happens at the late post natal examination 5

A

review birth, address questiosn, discuss future births

discuss physical syx: perinela pain, pain during intercourse

FBC

cervical smear

discuss contraception

145
Q

postnatal complciaions 8

A

anaaemia

bowel probelms

breasrt probelsm

perineal breakdown

inconteniece

peurperal pyrexia

VTE

mental health problems

146
Q

state the treatment for the following postnatal complications:
anaemia 2

A

oral iron if asympotmatic

consider blood transfusion if Hb <70 g/l

147
Q

state the treatment for the following postnatal complications:
bowel problems

A

consitpation common
causes by fear of defacation, reduced mobitly , iron/opiates

conservative management

148
Q

state the treatment for the following postnatal complications:
breast problems 3

A

nipple pain/cracks/bleeding

breast engorgement, mastits, breast abscess

adise baby position

mastitisi- ABx

breast absecess- refer to breast/srugical team

149
Q

state the treatment for the following postnatal complications:
perineal breakdown 2

A

usually heal by secondary intentin with ABx if infection present on culture

150
Q

state the treatment for the following postnatal complications:
incontinence 3

A

commonly resolves spontaenously

physio if not resolving

Ix and Rx if syx persist past initial postntal weeks

151
Q

for the following postnatal complications:
define puerperal pyrexia

A

temp >38C on any occasion in first 14 days after birth

152
Q

causes of puerperal pyrerxia 4

A

commonly genital tract (endometritis) or UTI

consider breast/chest, DVT/PE

153
Q

state the investigaions and treatment for the following postnatal complications:
puerperal pyrexia

A

Ix- clinical exam full body
-send MSSU
-vaginal/wound swabs

CONISDER SEPSIS

treat immediatly if sepssi suspected

154
Q

risk facotrs for puerperal pyrexia 2

A

maternal obesity

delivery by C section

155
Q

define secondary PPH (post partum haemorrhage)

A

usually due to infection of uterine cavity or reatined products of conception or both

156
Q

investigations and treatment for secondary PPH (post partum haemorrhage)

A

measure HR, BP, Temp

palpate uterus for tenderness

send vaginal swabs for culture

ABx/remove retained POC

157
Q

Ix and treatment of VTE in post partum

A

puerperium (6weeks post partum) - highsest risk

risk facotr analysis and trhmoboprophylaxis Id required

LMWH

early mobilisation

158
Q

DVT syx 3

A

asymptomatic

swelling

redness

pain in legs

159
Q

PE syx 3

A

dyspnoea

chest pain

cardiorespiroaty collapse

160
Q

superfical thrombophlebitis syx and treatemnt

A

painful, erythematous, tender

treatemnt- support stockigns and anti-inflammaotry drugs

161
Q

mental health problems post partum

A

depressive illness- any time first year peaks 3-4 months postpartum

postpartum psychosis more acute onset - within first few days

162
Q

signs of post partum depression 6

A

persistent low lood 10-14 days

lack ofintrest/pleasure

decreased energy

lack of concenrtaiton

thoughotus of hearing baby

lackk of love for baby

163
Q

syx and sx of post partum psychosis 4

A

perplexiity, fear, restless agitation, insomia

164
Q

risk factors of post partum psychosis 3

A

pervious PP, bipolar , FHx

165
Q

treatment for post partum psychossi

A

admit ot mother and baby uni

antipsucot or mood stabliing drugs

consider breastfeeding when itnitnaing medications

166
Q

define a still birth

A

baby deliver with no signs of life that is known to have died after 24 weeks of pregnancy

167
Q

casues of stillbirth 6

A

50% unkown
advanced maternal age
maternal obesity
social deprivation
smoking
non-white ethinitcity
domestic violence

168
Q

diagnosis of stillbrith 3

A

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

169
Q

delivery optinos for stillbirths

A

most undego vaginal birth

some request C section
-alwasy discuss risk and consideration for future pregnancy

special delveiing room in labour ward

170
Q

aftercare for stillbirth 5

A

psychoigcal care

memory box w phots, hand and footprints

suppresion of lactation

maternal investgaitons

post mortem

171
Q

next pregnancy after still birth

A

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

172
Q

what can be used as prophylaxis for preterm labour

A

progesterone

173
Q

how does progesterone work as prophylaxis for preterm labour

A

given vaginally via gel or pessary

-decreases acitivy of myometrium and prevents cervix remodelling in preparino for delviey

174
Q

who is offered progesterone for preterm labour prophylaxis

A

women witha. cervical length <25mm on vaginal USS between 16-24wk gestation

175
Q

define atonic post partum heamoreaeg

A

excessive bleeding when uterus is not weel contracted after delivery - soft distend and lacking muscular tone

176
Q

describe remifentanil PCA

A

opiate pain-reliveing drug that is very short acting

Obs & Gyn (23 decks)

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