O&G Flashcards
First line drug for pre-eclampsia? Other options and when would you use them?
Lobetolol
Nifedipine (if patient has Hx of asthma)
Hydralazine - more commonly used acutely
Eclampsia with fits - emergency drug management
Magnesium sulphate
Definition of pre-eclampsia
Gestation >20 weeks
Hypertension and proteinuria (>0.3g/24 hours)
Indomethacin MoA and use in obstetrics?
NSAID used as a tocolytic
Salbutamol is also a tocolytic
Can also be used to inhibit prostglandin production and close patent ductus arteriosus
Drug given to facilitate placental delivery
Oxytocin/ergometrin - encourages SM contraction
Primary PPH due to uterine atony management
ABC including two peripheral cannulae, 14 gauge
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
if medical options failure to control the bleeding then surgical options will need to be urgently considered
the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
Signs of acute fatty liver of pregnancy
jaundice, mild pyrexia, hepatitic LFTs, raised WBC, coagulopathy and steatosis on imaging. Clinically, acute fatty liver of pregnancy has predominantly non-specific symptoms (e.g. malaise, fatigue, nausea)
Secondary PPH defined as what?
Bleed (>500ml) in 24hr - 12 weeks postpartum
When should delivery be offered to pre-eclamptic patients?
After 34 weeks once a course of steriods has been completed
HTN in preganancy definition
Systolic > 140, Diastolic > 90
BP usually dips up to 20-24wks, and should return to pre-pregnancy levels after this (this is why pre-eclampsia is defined as HTN & proteinuria post 20 weeks gestation
What is the rule used to calculate expected date of delivery?
Naegele rule
First day of LMP + one year - 3 months + 7 days
Who needs extra folic acid treatment and what is the dose?
On anti-epileptics/obese/diabetics/family history of neural tube defects/ceoliac disease/thalasseamia trait
5mg OD (ideally 3 months before pregnancy) until 12 weeks
What is the normal dose of folic acid and how long/when do you need to take it?
400mcg OD 3 months before to 12 weeks
Drugs to stop in pregnancy
Warfarin NSAIDs ACEi Anti-epileptics: phenytoin, sodium valproate Methotrexate ABx such as trimethoprim (anti-folate) Sulphonylureas Lithium
What teratogenic effect is phenytoin associated with?
Cleft palate
Two anti-epileptic drugs considered safe in pregnancy?
Lamotrigine and carbemazepine
Drugs to avoid when breastfeeding
Barbiturates antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
Pre-eclamptic patient who is fitting - drug of choice and dose
MgSO4 IV
4g bolus over 5-10 mins
1g per hour infusion over next 24hrs
monitor for signs of OD - reduced reflexes/resp rate
What type of antiemetic is used for non severe pregnancy related N&V
Antihistamine antiemetics - e.g. promethazine or cyclizine)
Active management of the third stage of labour involves what 3 things?
1) Admistering of syntometrine (or oxytocin in CI)
2) Deffered cord clamping (after 1 minute but less than 5 minutes)
3) Controlled cord traction
What secretes HCG, what is the purpose of HCG and when do levels peak?
HCG is secreted by the syncitiotrophoblasts 8 days post fertilization to maintain the corpus letuem and its progesterone production. Levels peak at 8-10 weeks
Human chorionic gonadotropin (hCG) is a hormone first produced by the embryo and later by the placental trophoblast. Its main role is to prevent the disintegration of the corpus luteum
hCG levels double approximately every 48 hours in the first few weeks of pregnancy. Levels peak at around 8-10 weeks gestation.
VTE history in a pregnant women - management?
VTE thrombophrophylaxis with LMWH throughout pregnancy and 6 weeks postnatally
What would warrant VTE prophylaxis in a pregnant women without VTE history?
Four of the following: Age > 35 Body mass index > 30 Parity > 3 Smoker Gross varicose veins Current pre-eclampsia Immobility Family history of unprovoked VTE Low risk thrombophilia Multiple pregnancy IVF pregnancy
If three risk factors start LMWH from 28 weeks until 6 weeks postnatal
If diagnosis of DVT is made shortly before delivery, continue anticoagulation treatment for at least 3 month, as in other patients with provoked DVTs.
When would you give anti-D in a termination of pregnancy?
Surgical management - anti D given
Medical management or pregnancy of unknown location - no need for anti D
