Obs

Question 1

Observation during established 1st stage

Answer 1

-1hrly pulse
- 4hrly temp, BP, P/V
- urine frequency
- fetal heart auscultation every 15 mins

Question 2

First stage

Answer 2

• history
• P/A
• P/V
• partogram
• watch progress
• care and support
• CTG
• NPO
• pain relief
• council for epidural analgesia

Question 3

2nd stage observation

Answer 3

• Partogram
• urine freq
• 4hrly temp
• 1hrly p/v
• peads call
• lithotomy clean drape
• optional episiotomy

Question 4

3rd stage active management

Answer 4

• 10IU oxytocin IM after delivery on ant shoulder or birth
• CCT
• cord clamp and cut after 1 and before 5 mins
• make sure uterus is empty

Question 5

Post delivery stuff

Answer 5

• P/v and P/A
• urine massage for 2hrs by mother
• count swabs and sharps
• despose sharps
• anti D if RH negative
• initiate breastfeeding
• skin on skin contact
• advise contraception

Question 6

Hx of preeclampsia

Answer 6

Headache,
visual disturbance,
epigastric pain, vomiting, oliguria, abdominal pain,
may have previous history / family history of pre-eclampsia (mother or sister).
SEVERE PAIN JUST BELOW THE RIBS, SUDDEN SWELLING OF THE FACE, HANDS AND FEETS

Question 7

Anaphylactic shock mx

Answer 7

1. Stop administration of allergen.
   II. Secure airway
   III. Inform consultant anesthetist, intensive care specialists.
   VI. I/V fluid 500ml R/L..

VII. Adrenaline 1-2ml of 1:10000 solution I/V(1ml of 1:1000 solution diluted with 9ml of normal saline 1:1000iv

IX. Hydrocortisone 100mg I/V.

X. Aminophylline 6mg/kg loading dose followed by IV 0.5-1.0 mg/kg/hour infusion.

XI. Cimetidine 300mg I/V

Question 8

Investigations for preeclampsia

Answer 8

• Blood group and save
• Complete blood count ( Alert if Platelet count <100000 per cubic millimeter)
• Renal function test
RET
• Serum Uric Acid.
• LFTS (ALT or AST rising to above 70 iu/l)
• Coagulation Screen ( if Platelet count <100000 per cubic millimeter)
• Urine: urine for albumin / protein.

Question 9

Mild preeclampsia Rx

Answer 9

Less than 37 weeks- expectant mx

• Tab: Labetalol 100 mg x B.D or Methyldopa ( 250 / 500 mg ) can be considered
• Bi weekly fetal surveillance.
• Blood pressure at least twice per week.
• Baseline coagulation, renal, and liver function tests - to be repeated on clinical indication
• Daily Urine protein checks with dipstick. Do 24-hour collection if 1+ or more.

• Anti platelet agent:
Advise women at high risk for preeclampsia to take 75 mg-150mg of aspirin daily from 12 weeks until the birth of the baby.

Women at high risk are those with any of the following:

• Hypertensive disease during a previous pregnancy
• Chronic kidney disease
• systemic lupus erythematosis or anti phospholipid syndrome
• Type 1 or Type 2 diabetes
• Chronic hypertension

Question 10

Severe preeclampsia classification

Answer 10

Preeclampsia is classified as severe if any one of the following signs or symptoms is present:

I. Blood pressure of 160 or more systolic or 110 or more diastolic
II. Proteinuria of 5 gm or more/24hours 70 : 3
III. Oliguria (400 ml or less/24 hours) less wine
IV. Cerebral or visual disturbances
V. Pulmonary edema or cyanosis
VI. HELLP syndrome

Question 11

HEELP

Answer 11

• Haemolysis, defined by abnormal peripheral smear, increased bilirubin, > 1.2 mg per decilitre,
and increased lactic dehydrogenase, > 900 units per litre.

• Elevated liver enzymes, defined as increased SGPT >70 units per litre.

• Low platelets, defined as platelet count < 150 × 103per mm3

Question 12

Severe preeclampsia mx

Answer 12

1- admit
2- council for mode of dil, nicu, ventilator, icu for pt.
3- Inform and Alert Consultant Obstetric, Consultant Pediatrician, Consultant Anesthetist .
4- Monitor BP 1/2 hourly fill patient fabilizes and then 4 hourly
5- Reflexes +/- clonus
6- Test urine for albumin
7- Urinary output/O charting urine output should be >30m/hr 1/0 charting.
8- IV fluids not exceeding 100 ml/hr.. / V
9- Fetal cardiotocograph & ultrasound scan on admission
10- Doppler Ultrasound studies to rule out placental insufficiency.

Question 13

Severe preeclampsia Rx

Answer 13

1- hydralazine preferred
5 mg iv bolus, then 5 - 10 mg. every 20 to 30 minutes to a maximum of 25 mg. repeat as necessary
** iv for Acute management aswell**

2- labetalol
20 mg iv bolus, then 40 mg 10 minutes later, 80 mg every 10 minutes for additional doses to a maximum of 220 mg
For chronic HTN also.

3- nifedipine
• 10 mg p.o repeat every 20 minutes to a maximum of 30 mg ORAL

Question 14

MgSo4 for eclampsia

Answer 14

1- Loading Dose: Give 4 g of magnesium sulphate (20 ml of 20% MgSo4 Solution) IV SLOWLY over 5 to 10 min (patient may feel warmth during injection)

2- Maintenance Dose: infusion of 1 g/hour maintained for 24 hours after the last seizure.

3- Recurrent seizures should be treated with either a further bolus of 2 g magnesium sulphate or an increase in the infusion rate to 1.5 g or 2.0 g/hour.

Toxicity:
Urine output <30 ml/hr
Loss of deep tendon reflexes (prolonged relaxation phase)
Respiratory rate < 16 breaths per minute.

Antidote Calcium gluconate 1 gm. / (10 ml) I/V over 10 mints should be given.