obgyn Flashcards
forgotten facts
pregnanct woman uti
when is trimethoprim contraindicated
when is nitrofurantoin contraindicated
1st trimester - nitrofurantoin, cefalexin
2nd trimester - nitrofurantoin, trimethoprim
3rd trimester - trimethoprim, cefalexin
nitro is contraindicated in perinatal period due to risk of haemolytic anaemia
anti - htn in preg
1st line; Labetalol - be wary in asthma
be wary in t1dm, because palpitations are their warning system for hypoglycaemia ( also not for Phaeochromocytoma
Not effective for black, afro-Caribbean women)
2nd line: Nifedine MR (very important not to give IR as drop in bp compromise fetal blood flow)Grapefruit juice increases blood levels of medication- so avoid!
3rd line: methyldopa - centrally acting anti htn
increased risk of depression
se of labetalol
scalp tingling, headache, weakness, liver damage, gi disturbances, dizziness
can we use enalapril in pregnancy and breastfeeding?
not in pregnancy - can cause foetal renal damage
during breastfeeding this is fine
when would you use hydralazine in pregn
acute htn
signs symptoms preeclampsia
high bp, proteinuria
severe headaches, blurry vision and halos, epigastric pain, oedema, aph, reduced foetal movements, iugr, reduced liquor, hyperreflexia
doppler may show insuff blood
herpes in a pregnant woman, whats the significance of it being the first time she has ever had it versus a recurrence?
if first time in 3rd trimester, indication for c-section
if previously had herpes, her antibodies will protect baby
pph causes
4 ts tone - uterine atony trauma - episiotomy, tears, bleeds tissue - placenta left behind - infected - late bleeding thrombin - vwd, clotting, dic
pph define primary and secondary
1o = bleed within 24 hours, 500ml vaginal, 1l section
2o = bleeding after 24 hours post partum, up to 6 wks
rx of pph
help abcde
tachycardic? bp?
2 large bore cannulae
bloods - fbc, ue, lft, clotting, gs, xmatch 4 units
fluids- harttmans
pupils concious level
exposure - expose tummy, fundal massage
transexamic acid
ergometrine and oxytocin
carboprost
surgical rx - ex under anaesthetic, remove clots
baloon
brace sutures
last resort - hysterectomy.
htn parameters
High BP stage 1 140-159 / or 90-99 (mild)
• High BP stage 2 160-179 or (moderate)
100-109
• Hypertensive Crisis >180 or 110 (severe)
preg bp changes
Bloodvolumeincreasesby40-50%inpregnancy
• Cardiacoutputincreasesby50%(HRincreasesby
15bpm)
• BPreducesbetween12-26weeksdueto increased progesterone, which relaxes smooth muscle and causes vasodilation. BP returns to pre pregnancy values around 36 weeks
asprin when
ICEguidelines2010
• Commence from 12weeks, until delivery
• 75mgdaily
• One high risk factor, more than one moderate risk factor
se of nifedipine
given as brand name for mr - adipine
Side effects:
May inhibit labour/ headaches/ flushing/ dizziness/
palpitations/fluid retention
postnatal nifedipine is what
long acting
leave for after
adalat
methyldopa contrain
• Not used for:
Severe depressives, methlydopa makes them “dopey and depressive” Not used PN because of risk of PN depression (NICE guidelines stop within 2 days of delivery)
• Side effects:
Depression and tiredness/dry mouth/GI disturbances
Pre-eclampsia
Pre-eclampsia is a multi-system disorder.
• Abnormal placentation in early pregnancy causes an exaggerated maternal
response after twenty weeks.
Maternal response includes:
• high levels of circulating pro-inflammatory cytokines
• endothelial dysfunction
• increased capillary permeability
• release of vasoconstrictive substances such as thromboxane A2 (aspirin selectively inhibits this) and endothelin
• a decrease in prostacyclin synthesis
In pregnancies complicated by pre-eclampsia the placenta produces:
increased levels of sFlt-1, endoglin
and
decreased PIGF in the weeks before the onset of PET
muscles of pelvic floor
levator ani
puborectalis
coccygyeus
cystocoele
prolapse of bladder from upper anterior wall of vagina
rectocoele
prolapse of rectum from posterior wall of vagina
enterocoele
prolapse of small intestine through pouch of douglas
utervaginal prolapse
The degree of uterine descent can also be graded by the Baden-Walker or Beecham classification systems:
1st degree: cervix visible when the perineum is depressed - prolapse is contained within the vagina.
2nd degree: cervix prolapsed through the introitus with the fundus remaining in the pelvis.
3rd degree: procidentia (complete prolapse) - entire uterus is outside the introitus
surgery for bladder/urethral prolapse
Anterior colporrhaphy: involves central plication of the fibromuscular layer of the anterior vaginal wall. Mesh reinforcement may also be used. It is performed transvaginally. Intraoperative complications are uncommon but haemorrhage, haematoma and cystotomy may occur.
Colposuspension: performed for urethral sphincter incontinence associated with a cystourethrocele (open or laparoscopic). The paravaginal fascia on either side of the bladder neck and the base of the bladder are approximated to the pelvic side wall by sutures placed through the ipsilateral iliopectineal ligament.
List physiological changes during pregnancy
diastolic bp decreases in early-mid preg gastric stasis egfr goes up, so serum urea and creatinine come down increased risk of uti respiratory symptoms due to hyperventilation dilutional anaemia increased thyroid hormone decreased insulin sensitivity increased clotting
indications for induction
post term
preeclampsia
prom
plus diabetes
benefits of breastfeeding
mutual gaze, bonding sucking promotes uterine contractions, pph free and clean colustrum has endorphins (mum) antibodies infant mortality reduced
have diagnosed pt with HIV now what
Confirm diagnosis Resistance test to inform therapy Viral load CD4 count Baseline bloods before starting HAART
Education, contact tracing, compliance
contact again in 1-2 days, leaflet
AIDS diseases that you may see?
Kaposis sarcoma - herpes virus 8 candiasis pcp cytomegalovirus - retinitis cryptosporaediasis burkit lymphoma - starry sky bm
