O&G Flashcards
What fluids are given in hyperemesis gravidarum?
IV saline + KCl + cyclizine
What drugs are used in hyperemesis gravidarum?
Anti-histamine = promethazine Anti-emetic = cyclizine, ondasetron, metoclopramide
Which position are pregnant women put in during distress?
Left lateral position - prevents uterine compression of IVC
How do you calculate Parity?
Number of viable pregnancies over 24w - e.g. stillbirth still counts
What does Parity 1+1 mean?
1 pregnancy before 24w
1 miscarriage before 24w
What dates are anti-D given?
28 and 34 weeks to Rh-ve mothers
Which analgesia is used in LS C-section?
Spinal anaesthesia
What are the 4 grades of C-section?
1 - emergency
2 - urgent
3 - scheduled
4 - elective
What are 2 risks of breech?
Cord prolapse
DDH
How do you do induction of labour?
- Membrane Sweep to stimulate natural prostaglandins
- PGE-2 gel
- Amniotomy + oxytocin
What are the 3 treatments for shoulder dystocia?
- McRoberts
- Episiotomy + rotational manoeuvre
- Hands and Knees Position
For which patients is prophylaxis for pre-eclampsia given?
75mg Aspirin from 12w
1 high risk: CKD, DM, previous HTN in pregnancy, HTN normally, autoimmune (APS, SLE)
2 medium risk: obesity, 10 year gap, multiple pregnancy, over 40, nuliparity
When do obstetric cholestasis / acute fatty liver of pregnancy present?
3rd trimester, after 30 weeks
What are LFTs in obstetric cholestasis / acute fatty liver of pregnancy?
Obstetric cholestasis - high ALP, high GGT
Acute fatty liver - high ALT
What is a common feature of HEELP urine?
Coca Cola Urine
How long is LMWH given in pregnancy?
High risk (e.g. APS, hyperemesis, previous VTE) - start until 6 weeks post partum
Medium risk - 28 weeks to 6 weeks post partum
Low risk - 10 days post partum
Ix for APS
Cardiolipin Ab
Level of platelets in APS
Low platelets (Thrombocytopaenia)
What should be given to epileptic patients from 36w?
Vitamin K
What is given if there is a seizure during pregnancy?
Benzos
What is the difference between PROM and PPROM?
PROM is rupture with absence of uterine contractions, after 37 weeks.
PPROM is rupture with absence of uterine contractions, before 37 weeks
What is Mx of PPROM?
(If before 34w)
48h - keep in hospital, erythromycin + steroids + dexamethasone
Discharge if no spontaneous labour
What is Mx of PROM?
(After 37w)
24h - wait for spontaneous labour
Induce if not
3 common causes of premature birth?
Bacterial vaginosis
IUGR
Gestational diabetes
Describe threatened miscarriage
Bleeding
No pain
Cervical os closed
Describe what is unique about inevitable miscarriage
Only one with cervical os OPEN
Describe completed miscarriage
Bleeding
Complications of Oligohydramnios and Polyhydramnios
Oligo = pulmonary hypoplasia + clubbed feet (Potter) Poly = cord prolapse + PROM
In which situations are anti-Ab given apart from sensitising events?
ALL Rh-ve women at 28w and 34w
Reasons for maternal IV benpen during birth for GBS prophylaxis
GBS in previous pregnancy
GBS detected earlier
Fever during labour
Premature
Reasons for fetal IV benpen after birth
High risk:
- Chorioamnionitis
- PROM
- Premature
Complications of Multiple Pregnancy
Hyperemesis (more BHCG)
Pre-eclampsia
PROM
DM
How do you Mx ‘small for gestational age’
USS every 2w
If normal uterine artery doppler, no Mx
How do you Mx IUGR
If at term, deliver
Cause of IUGR
Pre-eclampsia
Placental abruption
Cocaine, smoking
Maternal age > 40
2 main organisms of maternal sepsis
Group A Strep
E.coli
GBS causes NEONATAL sepsis, not maternal!
