Obs Flashcards
1
Q
DVT / PE
A
- We think you have a blood clot in the leg/lung.
- It’s important to keep you and the baby safe so we want to start some treatment. We will need to admit you, teach you how to give yourself daily injections, give stockings. It’s important to stay mobile in hospital to reduce the risk of further clots. When you go home you should continue injecting yourself daily with the medication we give.
- To confirm the diagnosis, we want to give you a CTPA or V/Q scan. Both use some radiation and there is a risk of fetal exposure to it, but the risk is minimal and needs to be weighed up against the risk of the clot to you and your baby.
- Birth plan: elective induction or caesarean. Stop LMWH 24hrs before.
- I’d like you to make an appointment to see your GP in a week to discuss whether your symptoms have changed. They will also counsel you on the risk of this occurring again in subsequent pregnancies.
- Safety net: return in case of HIT (bruising, weakness, SOB), anaphylaxis, reduced foetal movements, bleeding, symptoms of VTE/PE.
2
Q
hyperemesis gravidarum
A
- Nausea and vomiting in pregnancy is normal but we think you might have something called hyperemesis gravidarum which is when vomiting is severe and leads to weight loss and abnormalities of chemicals in the blood.
- It’s important to keep you and the baby safe so we want to admit you and start some treatment. This will involve some anti-sickness medications to reduce the nausea. Hopefully this will allow you to be able to keep food down. If the medications don’t stay down, we can give them via a drip or by the back passage.
- We will also give you some fluids and vitamins.
- You will also need some blood-thinning tablets to prevent clot formation while you’re in hospital.
- At home you can try ginger, acupressure and eating bland meals.
- Usually, HG resolves by weeks 16-20 but if it continues, you may need extra scans to check on the baby’s growth.
- The risk of HG is a small increased risk of preterm delivery and low birthweight, but most women’s birth plans do not change, and they deliver on time vaginally.
- The group Pregnancy Sickness Support can provide support and advice to you and your partner.
- I’d like to catch-up with you a week after you are discharged from hospital to check that the anti-sickness medication is working and discuss the risk of this happening in future pregnancies.
3
Q
Gestational diabetes
A
- The results show that you have developed diabetes. Do you know what this is?
- GD is high blood sugar and usually develops in the 2nd or 3rd trimester in 3 in 100 women. It happens because the body can’t produce enough of a hormone called insulin to meet the demands of carrying a baby.
- GD can pose risks for both you and the baby: for you, it can cause high blood pressure or difficult delivery due to the baby being big. For the baby it can cause low blood sugar, abnormal development in the womb and in the worst-case scenario, stillbirth.
- However, we have treatments which are very effective in reducing these risks. We recommend a balanced diet and exercise to reduce blood sugar. If these changes don’t lower your sugar enough, we will give you medication to help- this might be tablets or insulin injections.
- We will give you a blood sugar testing kit to monitor your glucose at home and we will show you how to use it.
- You will be seen in joint diabetes and antenatal clinic in 1 week and every 2 weeks after that. You will need extra US scans every 4 weeks from 28-36 weeks.
- It’s best to give birth before 41 weeks. We’d recommend an elective birth by induced labour or caesarean before 41 weeks if labour hasn’t naturally started by then. Earlier delivery may be necessary if there is concern about the baby or your blood sugar is not well controlled.
- Medication will be stopped after delivery, but the GP will follow you up to check if the sugar is still high. In most women, GD goes away after birth but women who have had it are more likely to get it again in future pregnancies and develop lifelong T2DM.
- If you plan on getting pregnant in future, ask your GP for information about the risks.
- Safety net: call 999 if you feel you might collapse because of low blood sugar. Go to DAU if you notice reduced fetal movements last more than 40 minutes.
4
Q
Pre-eclampsia
A
- The results show that you have developed pre-eclampsia. Do you know what this is?
- Pre-eclampsia is a condition affecting some pregnant women in the 2nd trimester. It happens in 6% of pregnancies and is when you have high blood pressure and protein in the urine.
- High blood pressure can pose risks for both you and the baby: for you, it can affect your blood vessels and decrease blood to your organs. It might also cause poor growth for the baby and in the worst-case scenario, stillbirth. The complication we’d really like to avoid is eclampsia; this is a type of seizure caused by the high blood pressure which can be dangerous for you both.
- However, we have treatments which are very effective in reducing these risks and we’d like to admit you to take them. We recommend a balanced diet with low sodium and exercise to reduce blood pressure. We will also start you on some medication to reduce blood pressure- these are safe in pregnancy. The target BP is 135/85.
- The only way to cure eclampsia is to deliver the baby but if your blood pressure comes down you can go home until delivery. You will be seen in antenatal clinic every 2 weeks and will have some extra scans at 28, 32 and 34w. You will need to come back for blood tests twice every week.
- You can give birth vaginally if your blood pressure is well controlled but if it’s not or the baby is having problems, you might need to delivery earlier by caesarean or induction. You should keep taking the blood pressure medication in labour and your BP will be checked hourly. It will also be monitored afterwards. You may need extra treatment in delivery in you have eclamptic fits but these are rare.
- You should be offered an appointment with the GP 2 weeks after birth to check if you need to continue treatment- most women do not. You will again be checked at 6 weeks after birth. You will also be told about the risks of having high blood pressure in a future pregnancy.
- Pre-eclampsia can be difficult to manage so support can be found at Action on Pre-eclampsia.
- Safety net: ask someone to call 999 if you experience blurred vision, severe headache or are seizing.
5
Q
Gestational hypertension
A
- The results show that you have developed high blood pressure.
- High blood pressure can happen in pregnancy in the 2nd trimester in 2 in 100 women. We don’t exactly know why but it’s a combination of several genetic and lifestyle factors.
- High blood pressure can pose risks for both you and the baby: for you, it can affect your blood vessels and decrease blood to your organs. It might also cause poor growth for the baby and in the worst-case scenario, stillbirth. The complication we’d really like to avoid is pre-eclampsia; this is high blood pressure that can cause seizures which be very dangerous for you both. You should take 75mg aspirin daily to reduce this.
- However, we have treatments which are very effective in reducing these risks. We recommend a balanced diet with low sodium and exercise to reduce blood pressure. We will also start you on some medication to reduce blood pressure- these are safe in pregnancy. The target BP is 135/85.
- You can give birth vaginally or by caesarean if your blood pressure is well controlled. You should keep taking the blood pressure medication in labour and your BP will be checked hourly. It will also be monitored afterwards.
- You should be offered an appointment with the GP 2 weeks after birth to check if you need to continue treatment- most women do not. You will again be checked at 6 weeks after birth. You will also be told about the risks of having high blood pressure in a future pregnancy.
- Safety net: call 999 if you experience blurred vision, severe headache or pain under the ribs.
6
Q
Chickenpox
A
- We think you might have chickenpox. Do you know what this is?
- Chickenpox can cause complications for both you and the baby such as an itchy rash, pneumonia and birth defects caused by varicella syndrome.
- We are going to give you something called VZIG since you haven’t had chickenpox before. These are antibodies to fight the virus. They will pass through the placenta to your baby.
- If she presents <24h after rash and ≥20w: we are going to give you antiviral medicine. It doesn’t cure chickenpox but makes symptoms like fever less severe and reduces the risk of complications.
- You can also buy some calamine lotion OTC to help with itching.
- You can normally give birth vaginally but if you go into labour in the next 7 days, you should have a caesarean to reduce the risk of giving the baby chickenpox.
- Your baby may also be given antibodies after birth if he is born in the next 7 days or develops a rash within 7 days of birth.
- You should stay away from other pregnant women and babies for the next month.
- Safety net: go to DAU if you develop chest problems, headache or nausea, vaginal bleeding or a severe or bleeding rash. These might be complications of chickenpox.
7
Q
herpes
A
- We think you might have herpes. Do you know what this is?
- Herpes isn’t harmful to you but there is a small risk your baby could develop a serious illness called neonatal herpes. This can be fatal, but most babies recover with antiviral medication.
- We are going to give you antiviral medicine. It will reduce outbreaks in pregnancy and during birth. You should take in 3x a day (if ≥28w) to protect the baby.
- Most women with herpes will have a vaginal delivery but you may be offered a caesarean if you go into labour in the next 6 weeks. You may be given antivirals intravenously during labour.
- Safety net: in the month after birth, call your GP immediately if your baby is irritable, not feeding, has a fever or develops a rash on the skin, eyes or mouth.
8
Q
Preterm labour
A
- The symptoms you’ve been experiencing might be signs of early labour. This happens to 8 in 100 babies.
- We will check to see if your waters have broken and if there may be an infection. We will also record any contractions and the baby’s heartbeat.
- If your waters have broken, there is an increased risk of infection and you’ll be given antibiotics. It doesn’t mean you’ll definitely go into labour, but you should stay in hospital for a few days. You might be given steroids to help the baby’s lung develop in case he comes early and allowed to go home.
- If your waters haven’t broken, we will check your contractions and do a vaginal exam to check the baby’s head and position. We might try and stop labour in some cases and give steroids. Sometimes it might be safer for the baby to be born- e.g., if you have an infection or you’re bleeding. Your baby might need to stay in hospital for a few days/weeks after birth.
- Safety net: call your maternity unit if you have regular contractions, fluid from your vagina or unusual backache before 37w. Also call if you have a fever, notice green/smelly fluid from the vagina or notice a chance in your baby’s movements.
9
Q
VBAC
A
- • It’s a common myth that you can’t give birth vaginally after having a caesarean. As long as your baby is face down and you have had 1 prior LSCS, it is clinically safe.
- The current success rate for VBAC is about 75%- this is higher if you have had a previous vaginal delivery and even higher if you’ve had a successful previous VBAC.
- VBAC can be complicated by factors such as multiple pregnancy, large baby or advanced maternal age.
- Now it’s not very nice to talk about, but I have to inform you of the possible complications of VBAC and ERCS to help you make an informed choice about delivery.
- The advantages of VBAC are that if it is successful, you will have a shorter hospital stay and recovery. It also means that you have a good chance of successful future VBACs. However, there is a small risk of HIE to the baby during delivery and there is a 1 in 200 risk of uterine rupture. The absolute risk of birth-related death with VBAC is comparable to first time mums delivering vaginally.
- The advantages of ERCS are the smaller risk of HIE and the no risk of anal sphincter injury as you will not be pushing. There is no risk of uterine rupture but there is increased risk of placental problems and adhesion formation. ERCS also means that you are likely to require caesareans in future. The risk of maternal death is also higher with ELCS than VBAC.
- If you choose to have a VBAC and don’t go into labour by 39w, your obstetrician will probably recommend a ERCS to minimise the risk of complications.
- I know it’s a lot of information, but I will write this down for you to take away with you. You don’t have to make a decision now and can think about it before your next appointment. Are there any questions you have for me at the minute?
10
Q
TOP
A
- A termination can be carried out before 24 weeks. I will refer you to a termination service which will carry out the procedure. The decision to have a termination is yours alone and impartial information and support is available from the counselling service and Reproductive Choices UK. You may also want to speak to family, but you do not have to. If you don’t want to tell anyone, your details will be kept confidential.
- The service will perform an ultrasound to work out how many weeks pregnant you are. They will talk to you about your decision and what happens next.
- Where possible, you will be given a choice between medical and surgical termination. With medical, you take 2 medications 24-48 hours apart. With surgical, you have a procedure to remove the pregnancy and go home afterwards. Afterwards, you should take things easy for a few days and expect vaginal bleeding and minor cramping for up to 2 weeks.
- Termination is safe and most women don’t experience any problems but there is a small risk of complications such as infection of the womb, excessive bleeding, damage of the womb or cervix or some of the pregnancy remaining in the womb. You might need surgery if these occur.
- A termination doesn’t affect your chance of getting pregnant in future. You should use contraception if you do not wish to get pregnant. Have you given it much thought?
- Safety net: you should take a pregnancy test 3 weeks after the termination which should be negative. If it’s not, wait another week and repeat the test. If it’s still positive, come back and see us. Go to A&E if you develop a fever or severe tummy pain or if you continue bleeding after 2 weeks or if you don’t start bleeding after 24hr
