Obs Flashcards
What is an amniotic fluid embolism?
It is an obstetric emergency in which amniotic fluid and foetal cells enter the maternal circulation = cardiorespiratory distress
What is the aetiology of amniotic fluid embolism?
- Embolism provokes an anaphylactic reaction or complement cascade –> pulmonary artery spasm –> increases pulmonary artery pressure and RVP –> hypoxic myocardial and pulmonary capillary damage –> LVF and death
What does post-mortem reveal in amniotic fluid embolism?
Foetal squames and debris in the maternal pulmonary circulation
What are the rick factors of amniotic fluid embolism?
- Increasing maternal age
- Placenta praevia/abruption
- Induction of labour (use of uterotonics)
- C-section
Signs and symptoms of amniotic fluid embolism?
- Sudden onset of SoB +/- cyanosis
- Seizures
- Bleeding (activation of coagulation cascade)/DIC
- Hypotension
What do you see on examination for amniotic fluid embolism?
- Tachypnoea
- Tachycardia
- Pulmonary Oedema
- Uterine atony (uterus failing to contract)
Investigations for amniotic fluid embolism?
ABG - hypoxaemia, raised PaCo2
FBC - low Hb
Clotting - low platelets, high PT/APPT, low fibrinogens, UE, X-match
CXR - cardiomegaly, pulmonary oedema
ECG - right heart strain, rhythm abnormalities
Management of amniotic fluid embolism?
Immediate –> ABC
- Airway - maintain potency
- Breathing - high flow O2 +/- intubation
- Circulation - 2 large bore cannulae, fluid resus
Pharmacological : - Ionotropics - Correct coagulopathy: FFP Platelets Cryopercipitate Transfuse if needed - Uterine atony --> PPH management
Consider delivery +/- hysterectomy
Complications of amniotic fluid embolism?
- Cardiac arrest
- Death
- DIC
- Seizures
- Uterine atony
- Haemorrhage
- Pulmonary oedema
- ARDS
- renal failure
What is the definition of anaemia in pregnancy?
Pregnant women with a mean value of Hb < 110 g/L (1st trimester)
- <110 g/L in 1st trimester
- < 105 g/L in 2nd/3rd trimester
- <100 g/L postpartum
- <70 g/L - URGENT REFERRAL
What are the different types of anaemia?
Iron deficiency:
- Blood loss, Inc use of decreased absorption, decreased intake, haemolysis
- Hypochromic microcytic anaemia and pencil cells
Folate deficiency:
- Green leafy vegetables –> lack increases neural tube defects - diet, demand, malabsorption, drugs
- Megaloblastic anaemia (hypersegmented neutrophils, macrocytosis, thrombocytopenia, leucopenia)
B12 deficiency:
- Vegan, poultry, dairy, eggs –> lack increases neural tube defects - diet, malabsorption
- Megaloblastic anaemia (hypersegmented neutrophils, macrocytosis, thrombocytopenia, leucopenia)
Risk factors of anaemia in pregnancy?
- Multiple pregnancy
- Loss of vomit due to morning sickness
- Anaemia before becoming pregnant
- 2 pregnancies close together
- Pregnancy teenager
- DIET (esp iron deficiency)
Signs and symptoms of anaemia in pregnancy?
- Tired of weak
- Trouble concentrating
- Dizziness
- Tachycardia/tachypnoea
- SOB
- Pale skin, lips, nails, conjunctiva
What is the B12 specific signs and symptoms of anaemia in pregnancy?
- Glossitis
- Depression
- Psychosis/dementia
- Paraesthesia
- Peripheral neuropathy
- Subacute combines degeneration = metabolic disorder of the spinal cord –> loss of proprioception/vibration –> full paralysis
Investigations of anaemia in pregnancy?
Screened of anaemia at booking and at 28 weeks
- FBC
- Blood film
- Haematinics/Iron studies
- Haematocrit
Management of anaemia in pregnancy?
Supplements –> Iron, B12 and folate (100-200mg OD iron)
- Oral ferrous sulfate (SE: black stool, constipation, abdo pain)
- Oral folic acid (if cause unknown, do not give as it can exacerbate B12 symptoms)
- IM hydroxycobalamin for B12 deficiency
Increase animal food in diet and advice:
Iron - green leafy vegetables, nuts, beans, seeds
B12 - meat and dairy
Folate - green leafy vegetable, nuts, yeast, liver
Intrapartum:
- Deliver in consultant-led unit
- IV access and group and screen on admission
- Active management in 3rd stage
- Active management of PPH
- Consider prophylactic syntocinon infusion
Complications of anaemia in pregnancy?
- Preterm or LBW baby
- Post-partum depression
- Child with developmental delays
- Spina bifida
What is asthma in pregnancy?
Chronic inflammatory airway disease characterised by variable reversible airway obstruction, a hyper-sensitive airway and bronchial inflammation (existing in pregnancy)
When does asthma in pregnancy most commonly occur?
24-36 weeks
What is the aetiology of asthma in pregnancy?
Must exist before pregnancy (allergic predisposition)
Signs and symptoms of asthma in pregnancy?
- Wheeze, breathlessness, cough - worse in the morning and at night
- Precipitating factors
- Atopic history
- Tachypnoea, use of accessory muscles, prolonged expiratory phase, polyphonic wheeze, hyperinflated chest
Severe attack:
- PEFR 33-50%, pulse <110, RR >25, inability to complete sentences
Life-threatening:
- PEFR <33%, silent chest, cyanosis, bradycardia, hypotension, confusion, coma
Investigations for asthma in pregnancy?
- Peak flow
- Pulse ox
- ABG
- FBC
- CRP
- U&Es
- Blood/sputum cultures
- PEFR monitoring (diary)
Management of asthma in pregnancy?
- Regular monitoring continued throughout labour –> bronchoconstrictors should be avoided
- Encourage smoking cessation and manage exacerbations aggressively
- Flu vaccine and monitor foetal movements daily after 28 weeks
What is the acute management of asthma in pregnancy?
- High flow oxygen, neb salbutamol 5mg, ipratropium 0.5mg QDS
- Steroid therapy (IV hydrocortisone 100mg, PO prednisolone 40-50mg 5-7 days)
- IV magnesium sulphate and summon senior help (Pco2 up)
- IV aninophylline
- ITU + intubation
Discharge when:
- PEFR >75% of pts best
- Diurnal variation <25%
- Stable on discharge meds for 24 hours