Obs Flashcards
PPH initial assessment
DRSABC (as relevant to circumstances)
Assessment
· Rate/volume of bleeding
· Lie flat, oxygen 15 L/minute, keep warm
· Continuous heart rate and SpO2, 15 minutely BP and temperature
· Ensure routine third stage oxytocic given
· 4Ts (tissue, tone, trauma, thrombin)
PPH immediate investigations
· FBC
·Full chemistry profile (Chem20)
·coagulation profile
·blood gas
· X-match if none current with laboratory
· ROTEM® /TEG® if available
· POC pathology (iSTAT, Hemocue) if no onsite laboratory
Things to ask your self in each of these 4
- Tissue
- Tone
- Trauma
- Thrombin
Tissue Apply CCT and attempt delivery • Transfer to OT if: o Placenta adherent/trapped o Cotelydon and membranes missing
Tone
• Massage fundus/expel uterine clots
• Empty bladder (IDC may be required)
Oxytocin–> Ergometrine->Oxytocin Infusion
Trauma • Inspect cervix, vagina, perineum • Clamp obvious arterial bleeders • Repair—secure apex • Transfer to OT if unable to access site
Thrombin • Do not wait for blood results to treat • Use ROTEM® /TEG® if available • Monitor 30–60 minutely FBC, ABG, coagulation profile, ionised calcium • Review MHP activation criteria • Avoid hypothermia and acidosis
Can infection increase the risk of PPH
Chorioamnionitis can increase the risk of PPH
Syntometrine
For low-risk birth, routinely use oxytocin in preference to syntometrine50
Tone in PPH
The uterine cavity must be empty of tissue for effective uterine contraction. Initial clinical and
mechanical measures include:
· Massage uterine fundus to stimulate contractions
· Assess need for bimanual compression
· Check placenta and membranes are complete
· Expel uterine clots
· Insert indwelling catheter to maintain empty bladder
What are some maternal and fetal(2) signs of uterine rupture
Signs of uterine rupture may include:
o Maternal: tachycardia and signs of shock, sudden shortness of breath, constant abdominal pain, possible shoulder tip pain, uterine/suprapubic tenderness, change in uterine shape, pathological Bandl’s ring, incoordinate or cessation of contractions, frank haematuria, abnormal
vaginal bleeding, abdominal palpation of fetal parts, absent presenting part
o Fetal: abnormal CTG tracing, loss of fetal station
If 4 T are OK, what are the other things you consider now -3 things
oUterine rupture o Uterine inversion o Puerperal haematoma o Non-genital cause (e.g. subcapsular liver rupture, AFE) · Repeat 4T assessment
What advice do we need to give for thromboprophylaxis for ALL pregnant and postnatal women
All pregnant and postnatal women should be educated about the benefits of mobilisation and avoiding dehydration as a thromboprophylactic measure. This is in addition to any other specific mechanical and/or pharmacological thromboprophylaxis that may be required.
If recommended during pregnancy, venous thromboprophylaxis (VTE) may include:
Low molecular weight heparin (LMWH) and graduated compression stockings
If indicated, postnatal thromboprophylaxis should commence:
Postnatal thromboprophylaxis should commence as soon as practical after birth.
State other names for early pregnancy loss
Early pregnancy loss, miscarriage, or spontaneous abortion.
Define Spontaneous abortion/miscarriage
loss of pregnancy before 20 weeks’ gestation
Define Stillbirth
Stillbirth: loss of pregnancy after 20 weeks’ gestation (also called intrauterine fetal demise)
Define recurrent pregnancy loss
Recurrent pregnancy loss: two or more miscarriages occurring before 20 weeks’ gestation
What are some causes of miscarriage
tip- divide into maternal, maternoplacental and systemic
Maternal
1) Abnormalities of the reproductive organs Septate uterus Uterine leiomyomas Uterine adhesions Cervical incompetence
2) Systemic diseases
Including diabetes mellitus, hyperthyroidism, hypothyroidism, genetic disorders, infections, hypercoagulability (e.g., antiphospholipid syndrome, which is associated with recurrent miscarriages)
Fetoplacental
Chromosomal abnormalities account for up to half of all spontaneous abortions
Congenital anomalies
Miscellaneous
Trauma
Iatrogenic (e.g., amniocentesis or chorionic villus sampling)
Environmental (exposure to toxins such as drugs or maternal smoking during pregnancy)
Unknown
State causes of some causes of stillbirth
1) maternal
2) maternoplacental
3) Miscellaneous
Maternal
- Fetal-maternal hemorrhage
- Diabetes mellitus
- Hypertensive pregnancy disorders (especially if complicated by placental insufficiency or placental abruption)
- Uterine rupture
- Advanced age
- Heavy smoking
Fetoplacental
- Intrauterine growth restriction (which is most commonly due to placental insufficiency)
- Placental abnormalities (e.g., placental abruption, vasa previa)
- Infection (especially following premature rupture of membranes)
- Chromosomal abnormalities
- Congenital malformations
- Umbilical cord complications (nuchal cord or knot leading to fetal vascular compromise)
- Fetal hydrops
Miscellaneous
- Unknown (in some studies, more than half of all stillbirths were of unknown etiology)
- Environmental (exposure to toxins such as drugs or maternal smoking during pregnancy)
What are the types of abortions
Threatened Inevitable Missed Incomplete Complete Stillbirth
Findings and cervical change in a threatened abortion
Vaginal bleeding
Fetal activity
Reversible–> pregnancy can go through normally but high risk
Cervical os is closed
All other abortions the prognosis is irreversible
Findings and cervical change in an inevitable abortion
Vaginal bleeding, and visible/palpable products of conception
Fetal activity may be present.
Cervical os is dilated
Findings and cervical change in a missed abortion
No bleeding
No expulsion of the products of conception
No fetal activity
Cervical os is closed
Findings and cervical change in an incomplete abortion
Vaginal bleeding; products of conception within the cervical canal or uterus
Usually occurs > 12 weeks’ gestation
Cervical os is dilated
Findings and cervical change in a complete abortion
Vaginal bleeding; products of conception completely outside of the uterus
Usually occurs < 12 weeks’ gestation
Cervical os is closed
Stillbirth- main findings
Absence of fetal movements and cardiac activity
Stillbirth (> 20 weeks’ gestation)
Ultrasound examination is the best diagnostic modality to confirm the loss of fetal heart activity and fetal demise.
A fetal autopsy is recommended to ascertain the cause of death.
Spontaneous abortion (< 20 weeks’ gestation)
Transvaginal ultrasound is the best imaging test once there is an absence of fetal cardiac activity or confirmed uterine bleeding. Findings consistent with a spontaneous abortion include:
Absence of fetal cardiac motion
Abnormalities of the yolk sac or gestational sac
A downtrending β -hCG is consistent with a failed pregnancy.
What is the management of threatened abortion
Expectant management (symptoms will resolve or will progress to inevitable, incomplete, or complete abortion)
Avoid strenuous physical activity
Weekly pelvic ultrasound
Rule out treatable causes of vaginal bleeding during pregnancy
Rh(D)-negative women should receive Rh(D)-immune globulin in cases of vaginal bleeding during pregnancy.
What is the management of inevitable, incomplete, or missed abortions
The management of uncomplicated spontaneous abortions depends mostly on patient preference.
Expectant management (option for women < 14 weeks gestation): Surgical evacuation is usually recommended if evacuation does not occur after 4 weeks.
Medical evacuation
Misoprostol is used to induce cervical ripening and expulsion of the products of conception.
When available, pretreatment with mifepristone 24 hours prior is recommended.
Surgical evacuation (dilation and curettage) The preferred method in septic abortion or if there is heavy bleeding or significant maternal disease Complications include uterine perforation, hemorrhage, endometritis, and/or intrauterine adhesions
Rh(D)-negative women should receive Rh(D)-immune globulin in all cases of vaginal bleeding during pregnancy.
What is the management of complete abortions
No treatment required
Confirm that the cervical os is closed and that uterus is equal or smaller in size than expected for gestational age.
What are the complication of abortions-3
1) Septic abortion
2) Retained products of conception → release of thromboplastin into systemic circulation → disseminated intravascular coagulation
3) Endometritis
What is the most common cause of miscarriage
Chromosomal abnormalities
What is the biggest suspicious of miscarriage on USS
Doppler ultrasound is always used to detect fetal heartbeats during prenatal visits. Absence of fetal cardiac activity should raise suspicion of spontaneous abortion.
Can threatened miscarriage become a viable pregnancy
Yes, they will have a normal pregnancy due the cervix is also closed.
Which type of urinary incontinence is most common in males and then in females
Male- urge
Female- stress and mixed
What are the causes of urinary incontinence
DIAPPERS: Delirium/confusion Infection Atrophic urethritis/vaginitis Pharmaceutical, Psychiatric causes (especially depression), Excessive urinary output (hyperglycemia, hypercalcemia, CHF) Restricted mobility Stool impaction.
State the mechanisms of micturition
Neural control of micturition: parasympathetic nervous system → S2–S4 ventral root → inferior hypogastric plexus → contraction of the detrusor muscle → voluntary relaxation of the external urethral sphincter muscle via the pudendal nerve → micturition!
Hydatidiform moles are normally treated via
D&C
under GA–> because of thyroid storm apparently high bet-HCG mimics TSH, LH and FSH
Why should a vaginal and rectal examination be done in stress incontinence
Vaginal and rectal examination should be performed to exclude a cystocele or rectocele.
Treatment options for stress incontience
Conservative–> Kegel exercises
Lifestyle changes (e.g., weight loss, avoiding alcohol and caffeine, smoking cessation)
Vaginal pessary
Pharmacological–> Duloxetine: to enhance sphincter contraction
Anticholinergic drugs can be used, but they tend to only be effective in mild cases of stress incontinence.
Surgical
Indicated if conservative treatment does not provide sufficient improvement of symptoms
Procedure of choice: mid-urethral sling to elevate the urethra
Urge incontinence aka
Overactive bladder incontinence
How does anticholinergics help with urge incontinence
First-line are anticholinergics, including oxybutynin
Effect: competitive blockade of acetylcholine at the muscarinic acetylcholine receptors → parasympathetic effect is impaired → decreased overactivity of the detrusor muscle → reduced voiding
Adverse effects: dry mouth, tachycardia, glaucoma
How will sitz baths help with Bartholin gland cyst
Sitz baths to facilitate rupture of the cyst
Definition of labour
Regular painful contraction
associated with cervical dilation
What are the 3 treatment options for Bartholin gland abscess
1) Incision and drainage followed by irrigation and packing
2) Fistulization with a Word catheter
3) Marsupialization–> Indicated for recurring abscesses
What is the ddx for Bartholin’s gland abscess
Bartholin gland carcinoma Folliculitis Inclusion cysts Leiomyomas Fibroma
On a VE of PID patient, what signs would you be able to explicit
Cervical motion tenderness (CMT)
Uterine and/or adnexal tenderness
Purulent, bloody cervical and/or vaginal discharge
Complete hydatidiform moles are associated with several additional clinical features such as
1) enlarged uterus
2) hyperemesis gravidarum
3) preeclampsia–> REMEMBER any HTN in 1st 20 weeks of pregnancy think GTD
What is the major worry about VBAC
Risk of uterine rupture- 0.5%- 1:500
We can use a VBAC calculator, however, prediction of uterine rupture is not possible.
Hydatidiform moles are normally treated via
D&C
Why is it is called a complete mole
Cause it is an EMPTY egg that is fertilized
Partial moles have how many sets of chromosomes and how many does complete moles have
Complete mole is the result of paternal disomy!(46XX)
Partial mole is the result of triploidy!(69XXX)
Which mole has embryonic or fetal parts
Partial
Which benign moles are more common
Complete(90%) and incomplete(10%)
What are some short-term complications of PID-2
- Pelvic peritonitis
2. Fitz-Hugh-Curtis syndrome (perihepatitis)
On a VE of PID patient what signs would you be able to explicit
Cervical motion tenderness (CMT)
Uterine and/or adnexal tenderness
Purulent, bloody cervical and/or vaginal discharge
How will sometimes PID present similar to
PID may present with symptoms of appendicitis due to periappendicitis or perihepatitis. Symptoms may also resemble those of an ectopic pregnancy!
Hence do a Beta-HCG in any woman with abdominal pain
Anterior wall uterine prolapse in POP
Cystocele
most common cranial nerve injury during birth
Facial nerve
Injury occurs during forceps-assisted delivery (most common)
Lower bilateral abdominal pain Fever Menorrhagia and metrorrhagia Dyspareunia Cervical discharge Cervical motion tenderness (CMT)
PID
Treatment- Abx
Initially diffuse epigastric pain
Later localized right lower quadrant pain
Nausea and vomiting
Fever
McBurney’s point tenderness
Ultrasound shows appendiceal diameter of > 6 mm.
What is it?
Appendicitis
Unilateral colicky flank pain
Pain may radiate to the lower abdomen and genital area
Not febrile
What is it and what will you see on your physical examination with this condition
Hematuria
Ultrasound shows urinary tract obstruction and radiolucent stones.
Kidney stone
Unilateral abdominal pain
Sudden onset during physical activity (exercise, sexual intercourse)
Ultrasound: adnexal mass and fluid in the pelvis
Negative pregnancy test
What is it
Ovarian cyst rupture
What are some short-term complications of PID
- Pelvic peritonitis
2. Fitz-Hugh-Curtis syndrome (perihepatitis)
What are the fetal complications of shoulder dystocia
- Brachial plexus injury (upper brachial plexus palsy, lower brachial plexus palsy)
- Clavicle or humerus fracture
- Hypoxia over an extended period of time as a result of umbilical cord compression
Why is pelvic organ prolapse more common in old post-menopausal women
As there is high incidence of atrophic vaginitis and atrophitis then
What does the urogenital diaphragm have
Consists mainly of deep transverse perineal muscles( and its fascia)
Posterior wall uterine prolapse n POP
Rectocele
What are some risk factors for ectopic pregnancies
- what is the main cause(category)
- Non-anatomical risk factors
Anatomic alteration of the fallopian tubes is the main cause of ectopic pregnancy. It may be due to:
1) A history of PID
2) Previous ectopic pregnancy
3) Past surgeries involving the fallopian tubes
4) Endometriosis
Non‑anatomical risk factors
1) Intrauterine device (IUD)
2) History of infertility
What is the most important pelvic floor muscle
Levator ani
USS findings of ectopic pregnancy
1) The empty uterine cavity in combination with a thickened endometrial lining
2) Tubal ring sign: an echogenic ring that surrounds an unruptured ectopic pregnancy.
3) Possibly free fluid within the pouch of Douglas
DDX for painful vaginal bleeding
Ectopic pregnancy Trauma Ovarian cyst rupture Endometriosis Adenomyosis Uterine leiomyoma PID
What are 4 minor gynaecological surgical procedures
1) D and C
2) LLETZ- Large loop excision of the transformational zone/ cone biopsy
3) Hysteroscopy +/- D&C
4) Excision/drainage of Bartholin, marsupialization, vulva abscess and VIN
What are some major gynaecological surgical procedures
1) Laparoscopy –> Diagnostic and therapeutic
2) Pelvic floor repair–> native repair and mesh repair
3) Hysterectomy–> - abdominal
- vaginal
- laproscopic
Indications for D and C
1) Miscarriage
2) TOP
3) RPOC
4) Molar pregnancy
Monozygotic
Identical twins(shared placenta)
Dizygotic
Fraternal twins(separate placenta)
What should you excluded in VBAC
Placenta previa and accreta
What is the major worry about VBAC
Risk of uterine rupture- 0.5%- 1:500
How many layers of the pelvic floor are present
1) Superficial perineal layer
2) The urogenital diaphragm- the middle layer
3) Pelvic diaphragm
Rotterdam criteria
Hyperandrogenism (clinical or laboratory)
Oligo- and/or anovulation
Polycystic ovaries on ultrasound
Diagnosis of PCOS is possible without the presence of ovarian cysts!
Rule out any other causes of hyperandrogenism and anovulation
A clinical picture of hyperandrogenism overrules any normal hormone levels and can fulfill a diagnostic criterium of PCOS!
What are the two groups of muscles that are present in the pelvic diaphragm
1) Levator ani
2) Coccygeus muscles
What are the muscles of the levator ani
pubococcygeus
iliococcygeus
puborectalis
Which muscles painful contracts during vaginismus
Levator ani
Anterior vaginal wall prolapse leads to - 3
Cystocele (bladder into vagina)
Urethrocele (urethra into vagina)
Cystourethrocele (both bladder and urethra)
Symptomatic fibroids- treatment
Medical
1) Hormonal–> GnRH antagonists
2) NSAIDs- to control pain
3) Antifibrinolytics (e.g., tranexamic acid): reduce bleeding
4) Androgenic agonists (e.g., danazol): suppress growth of fibroids but has many side effects (e.g., acne, edema, hair loss, etc.)
Surgical
Recurrent growths
Myomectomy: excision of subserosal or intramural fibroids
Hysterectomy: definitive treatment
Apical vaginal prolapse-2
1) Uterine prolapse (uterus into vagina)
2) Vaginal vault prolapse (roof of vagina) - after hysterectomy
What is procidentia
Total uterine prolapse
What supports the uterus-4
1) Pelvic floor muscles
2) Round ligaments
3) Cardinal ligaments
4) Uterosacral ligaments
What is the main suspensory ligament of the uterus
Cardinal ligament
Does the broad ligament support the uterus
Nope, just a drape over it
What is the most frequent sign of uterine rupture
Abnormal CTG or fetal bradycardia
Abdominal pain despite analgesia especially between contractions
What three structures support the pelvic organs
- Levator ani muscles
- Connect tissue and ligaments
- Vaginal wall
DeLancey level of support- Level 1 includes
Cardinal/Uterosacral ligaments
DeLancey level of support- Level 2 includes
1) Pubocervical fascia anteriorly
2) Rectovaginal fascia posteriorly
3) Levator ani
DeLancey level of support- Level 3 includes
1) Perineal membranes
2) Urogenital diaphragm
What is the diagnostic system we use to quantify uterine prolapse
Pelvic Organ Prolapse Quantitation system (POP-Q)
What are the conservative management options with POP
Insertion of a vaginal pessary (to support the pelvic organs)
Reduction of modifiable risk factors (e.g., avoid smoking to prevent a chronic cough, weight loss, prevent constipation)
Kegel exercises: pelvic floor muscle training (also as a preventive measure)
What are the 3 neonatal head soft tissues injuries
- Caput succedaneum: benign edema of the scalp tissue that extends across the cranial suture lines
- Cephalohematoma: subperiosteal hematoma that is limited to cranial suture lines
- Subgaleal hemorrhage: bleeding between the periosteum of the skull and the aponeurosis that may extend across the suture lines ; associated with a high risk of significant hemorrhage and hemorrhagic shock
What id caput succedaneum associated with
Caput succedaneum: benign edema of the scalp tissue that extends across the cranial suture lines
most common cranial nerve injury during birth
Facial nerve
Definition of shoulder dystocia
an obstetric emergency in which the anterior shoulder of the fetus becoming impacted behind the maternal pubic symphysis during vaginal deliver
ANTERIOR SHOULDER
What are the last resort options with shoulder dystocia
Fracture of fetal clavicle
Zavanelli maneuver
Symphysiotomy
HELPERR
Call for help
Evaluate for epistitomy
Legs- McRobert Manoeuver
P- external Pressure- suprapubic(Rubin I)
E-Enter rotational manoeuvres- Rubin I and Wood corkscrew method
R-Remove posterior arm
Zavanelli maneuver
Administer a uterine relaxant (e.g., terbutaline).
The fetal head is pushed back into the pelvis.
Once successful, perform a cesarean delivery.
What happens if you pull the head in Shoulder dystocia
Do not pull the fetal head! Doing so may cause brachial plexus injury (Erb’s palsy).
What are the maternal complications of shoulder dystocia
- PPH
2. Pernineal lacerations
What is your immediate management for uterine rupture
Imminent rupture:
Immediate IV tocolysis
Emergency C-section
Uterine rupture:
Immediate laparotomy with emergency C‑section
Hysterectomy necessary if the bleeding does not cease
What are some contraindications for tocolysis
Tocolysis is contraindicated in advanced labor (cervical dilation > 4cm), chorioamnionitis, nonreassuring fetal signs, abruptio placentae, or risk of cord prolapse!
What are some risk factors for ectopic pregnancies
- what is the main cause(category)
- Non-anatomical risk factors
Anatomic alteration of the fallopian tubes is the main cause of ectopic pregnancy. It may be due to:
1) A history of PID
2) Previous ectopic pregnancy
3) Past surgeries involving the fallopian tubes
4) Endometriosis
tachycardia, hypotension, syncope + Ectopic think
Ruptured ectopic–> EMERGENCY
USS findings of ectopic pregnancy
1) Empty uterine cavity in combination with a thickened endometrial lining
2) Tubal ring sign: echogenic ring that surrounds an unruptured ectopic pregnancy .
3) Possibly free fluid within the pouch of Douglas
DDX for painless vaginal bleeding
PCOS Endometrial hyperplasia Endometrial polyp Cancer Iatrogenic (e.g., anticoagulants, oral contraceptives, intrauterine devices)
menorrhagia, dysmenorrhea, irregularly enlarged uterus, infertility
Uterine leiomyoma
dysmenorrhea, menorrhagia, uniformly enlarged uterus
Adenomyosis
If you had to say 4 points for endometriosis
Chronic pelvic pain that worsens before the onset of menses
Dysmenorrhea, premenstrual or postmenstrual bleeding
Dyspareunia
Infertility
What is the tube saving operation in ectopics
Salpingostomy (tube‑conserving operation)
What is the not functioning fertility operation in ectopics
Salpingectomy (not function-preserving)
How does endometriosis increase risk of ectopics
Endometriosis in the uterotubal junction inhibits implantation of the egg: ↑ risk of ectopic pregnancy
If PCOS is diagnosed, what should you exclude
congenital adrenal hyperplasia
Rotterdam criteria
Hyperandrogenism (clinical or laboratory)
Oligo- and/or anovulation
Polycystic ovaries on ultrasound
Diagnosis of PCOS is possible without the presence of ovarian cysts!
Rule out any other causes of hyperandrogenism and anovulation
Causes of hyperandrogenism
Causes include PCOS, congenital adrenal hyperplasia, tumors (e.g., adrenocortical tumors), menopause, and certain drugs (e.g., some anticonvulsants).
What does the treatment approach to PCOS determined by
The therapeutic approach in PCOS is broadly based on whether or not the patient is seeking treatment for infertility.
THE NEED FOR A FERTILITY(need to have a child)
4 complications of PCOS
Cardiovascular events
Type 2 diabetes mellitus
Endometrial cancer
Increased miscarriage rate
Asymptomatic fibroids- treatment
1) Do not require treatment
2 )Frequent follow-ups (approx. every 6–12 months) are necessary to monitor any potential growth.
Symptomatic fibroids- treatment
Medical
1) Hormonal–> GnRH antagonists
2) NSAIDs- to control pain
3) Antifibrinolytics (e.g., tranexamic acid): reduce bleeding
4) Androgenic agonists (e.g., danazol): suppress growth of fibroids but has many side effects (e.g., acne, edema, hair loss, etc.)
Post-coital bleeding
Cervical cancer
What is the best initial test for candidiasis
and the best confirmatory test
KOH test (potassium hydroxide smear) on a wet mount preparation of scrapings or smears (best initial test): budding yeasts, hyphae, and pseudohyphae
Blood or tissue culture (best confirmatory test)
Treatment for candidiasis
Topical antifungal agents: e.g., clotrimazole, miconazole, ketoconazole, nystatin for 7–14 days
Vaginal yeast infection: either topical antifungal agents (e.g., clotrimazole cream) 3–14 days or a single dose of oral fluconazole
Esophageal candidiasis
First-line: oral or IV fluconazole for 14–21 days
T2DM, immunosuppressed patients(HIV) most at risk for candidiasis
Ultrasound findings in normal pregnancy(what will you see?)
At 5–6 weeks of pregnancy
At 10–12 weeks of pregnancy
t 18–20 weeks of pregnancy
At 5–6 weeks of pregnancy: detection of the embryo
At 10–12 weeks of pregnancy: detection of fetal heartbeat with Doppler ultrasound
At 18–20 weeks of pregnancy: fetal movements
Naegele’s rule
First day of the last menstrual period + 7 days + 1 year - 3 months
Mumur heard in a pregnant lady
Could be an innocent murmur
Due to a hyperdynamic state.
Cervical insufficiency- what is it? what is the treatment
Definition: painless cervical dilation, in the absence of uterine contractions and/or labor, in the second trimester of pregnancy
Cervical cerclage
Peripheral edema in pregnancy, what should we rule out-2
DVT and preclampsia
Define oligohydramnios
- complications
- what does the AFI need to be
- treatment
Definition: the amount of amniotic fluid < 500 mL in the third trimester
- Intrauterine growth restriction (diminished mobility of the fetus)
- Intrauterine compression and decreased amniotic fluid ingestion → Potter sequence: pulmonary hypoplasia (cause of death due to severe neonatal respiratory insufficiency), craniofacial abnormalities, limb anomalies
Oligohydramnios: ≤ 5 cm
Treatment
Amnioinfusion: infusion of fluid into the amniotic cavity through amniocentesis
Treat underlying cause (see preeclampsia, premature rupture of membranes, placental insufficiency for details)
Delivery is advised if the fetus is close to term.
State common causes of oligohydramnios
Urethral obstruction (e.g., posterior urethral valves) Bilateral renal agenesis
Amniotic rupture can happen
Uteroplacental insufficiency
Polyhydramnios
- define
- AFI
- treatment
Definition: excessive amniotic fluid volume (> 2000 mL in the third trimester) that results in uterine distention and is associated with an increased risk of fetal complications
AFI should be greater than 24
Treatment
Amnioreduction: drainage of excess amniotic fluid
Treat the underlying cause
Glycemic control in diabetic mothers
Intrauterine exchange transfusion for newborns with hemolytic disease
Mongolian spot, another name is
Congenital dermal melanocytosis
What are some contraindications for ECV
1) Multiple pregnancies
2) Ruptured membranes
3) Fetal anatomical abnormalities
4) Hyperextension of the fetal neck
5) Non-reassuring fetal status
6) Oligohydramnios
7) Antepartum hemorrhage
8) Placental abnormalities
9) Patient in active labour
Which types of monozygotic twins is the most common
Monochorionic diamniotic- 60-70%
T- sign
shared placenta but different amniotic sacs
Twin-to-twin transfusion syndrome- tell me about it
-tell me what each twin will get
In monochorionic twin pregnancies, the twins share a placenta. Blood flowing in a fixed direction from one twin to the other results in the transfer of blood from the donor twin to the recipient twin. This poses a risk to both fetuses.
Recipient twin: polycythemia; polyhydramnios in diamniotic pregnancies
Donor twin: anemia, dehydration, growth retardation; oligohydramnios in diamniotic pregnancies
Which prenatal diagnostic test has a greater risk of miscarriage- CVS or amino?
which one would you do?
CVS had greater risk than amniocentesis
CVS can only be done 10-13 weeks
However, CVS can give you an early diagnosis
What are high-risk factors for PTL
1) History of preterm birth
2) Cervical insufficiency–> shortened cervical length throughout the pregnancy(so have to do cervical cerclage)
3) Multiple gestations
When can MgSO4 be administered
In the event of drug interactions or contraindications; magnesium sulphate is the first-line drug if a birth < 32 weeks is anticipated.
State some of the neonatal conditions that can affect a premature baby
1) Neonatal respiratory distress syndrome (RDS)
2) Bronchopulmonary dysplasia (BPD)
3) Patent ductus arteriosus (PDA)
4) Retinopathy of prematurity (ROP)
5) Necrotizing enterocolitis (NEC)
6) Periventricular leukomalacia (PVL)
7) Neurological disorders (e.g., cerebral palsy, learning disabilities, developmental delays, ADHD)
