Obs Flashcards
anaemia cut off in pregnancy?
Hb <110
if Hb <110 in pregnancy, next step?
check ferritin
if <30 start iron and repeat FBC + ferritin in 6 weeks
if >30 check folate and B12
check FBC within 48 hours in postnatal women, if >____ then no treatment required
100
can you have a planned vaginal delivery with HIV?
yes depending on viral load
only offered if <40
recommended course of action in HIV +ve women if viral load >400 at 36 weeks?
pre-labour c-section
(between 39 and 40 weeks)
T/F: all HIV +ve women are given IV zidovudine during labour
false
depends on viral load and the ART given during pregnancy
if <20 (undetectable) at 36 weeks and adherent to ART, not required
when is IV zidovudine given to HIV+ women in labour?
viral load > 1000 (consider if between 40-1000)
untreated women with unknown viral load
T/F: babies born to HIV +ve mothers required PEP
true- duration and dose depends on risk
T/F: HIV +ve mothers can breastfeed regardless of viral load
false - safest way to feed infants in formula milk as there is ongoing risk
diagnostic criteria for hyperemesis gravidarum?
protracted N+V in pregnancy with the triad of >5% pre-pregnancy weight loss, dehydration and electrolyte imbalance
criteria for admission in HG?
Na <120
haematemesis
>10% pre-pregnancy weight loss
persistent vomiting/ ketosis after rehydration in day care
3 previous day case for rehydration admissions
haematemesis
severe abdo pain
avoid giving what type of fluids in HG?
dextrose containing fluids - high carb contents may precipitate Wernicke’s encephalopathy
T/F: IV pabrinex should be given to all women admitted to hospital with severe prolonged vomiting
True (once weekly, over 60 mins)
oculogyric crisis can occur with which antiemetics? treatment?
prochlorperazine or metoclopramide
Procyclidine 5mg IM or IV
pre-eclampsia defintion?
new hypertension after 20 weeks associated with significant proteinuria
all pts with PET should be admitted to hospital
true
also severe hypertension (SBP >160)
systolic blood pressure of what level requires treatment
> 150
T/F: early delivery should be considered in women with PET
true
if non-severe, consider from 37 weeks
if mod-severe, consider from 34-37 weeks
offer delivery within 48 hours if PET develops >37weeks
1st and 2nd line hypertensive therapy?
1) oral labetolol
2) oral nifedipine
why is vit K given to all babies after birth
vit K is needed for production of clotting factors
babies are relatively deficient in this and require vit K to reduce risk of serious bleeding including ICH
(1mg IM then 2mg oral within 6 hrs of birth, 2nd and 3rd doses at day 7 and 28 respectively)
who should be tested for gestational diabetes?
BMI >35
previous macrosomic baby
FH of diabetes in first degree relative
testing for gestational diabetes?
fasting BG and a OGTT of 75g between 24-28weeks
diagnosis of gestational diabetes
1) fasting glucose >___
2) 2 hours after OGTT >___
diagnosis of gestational diabetes
1) fasting glucose >5.1
2) 2 hours after OGTT >8.5
if a woman with gestational diabetes has a fasting BG <___ then they should first be offered a trial of lifestyle and diet modifications
7
treatment of mild hypoglycaemia in pregnancy (BG <4, mild symptoms)
15g of quick acting CHO e.g. 4 glucotabs, 60mls of glucojuice, 150ml fizzy juice
recheck in 15 mins
if >4 give 20g starchy carbohydrate snack e.g. sandwich/ banana
treatment of moderate hypoglycaemia in pregnancy (BG <4, drowsy)
squirt glucoboost into sides of mouth
follow by 20g complex carb snack once swallowing ok e.g. 2 biscuits, slice of toast
treatment of severe hypoglycaemia in pregnancy (BG <4, unconscious)
1mg IM glucagon
or
100ml IV 20% dextrose
reduce all insulin doses by 10%
management of women with gestational diabetes requiring elective c-section
give use insulin dose the evening before
fast from midnight
put first on the list
rarely require sliding scale
if BM >8, delay
monitoring and management of patients with gestational diabetes who have gone into spontaneous labour?
monitor BG hourly
if >8 commence sliding scale (specific maternal one)
when is 3rd stage of labour considered prolonged
no placental delivery after 30 minutes of active management after birth or 60 mins is physiological management
T/F: physiological management of 3rd stage of labour is first line
false active management first line, but can have physiological at the mothers request if low PPH risk
what does active management of the 3rd stage of labour involve?
oxytocin if low risk (syntometrine if moderate/ high risk and BP normal)
in pregnant women who also have signs of a DVT, what is the first line test
bilateral lower limb doppler
imaging in ?PE
bilateral lower limb doppler if have signs of DVT too
if not do CXR to r/o other causes
if normal CXR do CTPA
T/F: the radiation dose to the foetus from a CXR during pregnancy is negligible
true
women should be fully counselled before undergoing a CTPA in pregnancy - why?
higher radiation dose to maternal breasts therefore higher risk maternal breast cancer (lifetime risk increased by up to 13.6%)- especially important if there is a family history of breast cancer
T/F: d dimer testing should not be done in pregnancy
true
take which bloods prior to commencing anticoagulant treatment for VTE in pregnancy
FBC, coag, UEs, LFTs
T/F: warfarin is contraindicated in breastfeeding
false (but should be avoided until at least 3 days postpartum)
treatment of choice for pregnant patients presenting with massive PE
unfractioned IV heparin
(thrombolysis with alteplase if arrested/ massive PE confirmed on imaging)
in PROM >37/40, when would induction of labour be considered
after 24 hours (60% of women will go into labour before this point)
IMMEDIATE induction of labour offered in certain risk factors: significant meconium/ blood stained liquor, known GBS +, diabetes, evidence of infection, reduced foetal movements)
T/F: induction of labour reduces risk of neonatal infection
false - only maternal
T/F: digital examination in the absence of contraction should be avoided in PROM
true - increases risk of infection
women who have GBS in a previous pregnancy have a ___% chance of having it again in subsequent pregnancy
50%
they should be offered intrapartum antibiotic prophylaxis or testing in late pregnancy and antbiotics if still positive
who should receive Intrapartum Antibiotic Prophylaxis (IAP)?
- in pre-term labour or
- have group B strep colonisation, bacteriuria or infection during the current pregnancy or a previous pregnancy (without a subsequent negative swab in this pregnancy)
- previous baby with invasive group B strep infection or
- clinical diagnosis of chorioamnionitis
when should IAP be given in relation to the birth?
where possible, at least 2 hours prior to delivery
how long post SRM shoulder IAP be commenced?
48hrs
do NOT administer syntocinin within __ hours following a vaginal prostaglandin
6
how long is a syntocinin infusion continued for after delivery
at least an hour - decrease the rate by half every 15 minutes as long as the fundus is firm and the lochia normal
anti-D should be given following sensitising events in RhD- NEGATIVE/ POSITIVE women
negative
(there’s no issues with blood incompatibility if a women is resus positive)
examples of sensitising events requiring anti-D in RhD-negative women?
invasive prenatal diagnosis after 12 weeks
APH after 12 weeks
ECV
Any abdominal trauma after 12 weeks
Foetal death
Surgical/ medical TOP
Miscarriage after 12 weeks
Inadvertent administration of RhD-positive blood products
Surgical management of ectopic or molar pregnancy
when is post-partum anti-D Ig given?
to all rhesus D negative women within 72hrs of delivery of a rhesus D positive baby
what’s a kleihauer test used for? when to do it?
to determine if there is fetal blood in maternal circulation
within 2 hours of delivery and also following a sensitising event after 20 weeks
in PPROM, ensure steroids are given if <___ weeks
34
also 10 days oral erythromycin
T/F: expectant management in PPROM <37 weeks has better outcomes
true
perform twice weekly follow up inc CTG and FH
weekly CRP, FBC, LVS
contact triage if symptoms e.g. liquor changes colour, abdo pain, bleeding, fever
T/F: blood should be taken for an antibody screen at 28 weeks regardless of rhesus status
true
when is prophylactic anti D given?
to all Rh D-negative women by 30 weeks (even if they’ve previously received a dose following a sensitising event)
management of a pregnant women exposed to chicken pox?
test for VCIG if unvaccinated/ no history of chickenpox
otherwise safety net and contact GP if rash develops
management of cord prolapse
push presenting part off the cord by VE, do not remove fingers from vagina
call for help
prep for emergency c-section (or can delivery immediately if fully dilated)
tocolysis with 250mcg s/c terbutaline if any delay in delivery
T/F: VE should be done in all women presenting with antepartum haemorrhage
false - do speculum exam but never VE until placental site established
