Obs and gynae Flashcards
what can mimic pre term labour with intermittent cramps?
placental abruption - separation of placenta from uterus
What test can exclude pre term labour?
how does it work?
fetal fibronectin
if not found pre term labour unlikely in next 1 -2 weeks
what are the two traces on a CTG
What are the normal parameters on CTG?
Baseline rate ~140bpm = normal
Normal variability ~15bpm
Accelerations present
No decelerations
Contractions present 3 every 10min
what can cause fetal tachycardia
Fetal hypoxia
Chorioamnionitis
Hyperthyroidism
Fetal or maternal anaemia
Fetal tachyarrhythmia
what can cause fetal bradycardia?
Severe bradycardia?
Bradycardia
* Post date gestation
* Occiput posterior or transverse presentations
Severe bradycardia
* Prolonged cord compression
* Cord prolapse
* Epidural and spinal anaesthesia
* Maternal seizures
* Rapid fetal descent
How do you manage pre term labour?
Tocolytic (anti contraction) - oral nifidepine 20mg 30min up to 60mg then QID
Betamethasone 11.4mg IM x2 24hrs apart
IV Antibiotics: Benzylpenicillin 1.2g stat
Neuroprotection: MgSO4 4g over 30min, then 1g/hr infusion
Disposition = Retrieval to obstetric / paediatric facility
what does no fetal pole mean?
non viable pregnancy
Missed Miscarriage / Anembryonic pregnancy / Blighted ovum
how do you manage a missed miscarriage?
Expectant Mx -see what happens
Medical Mx – misoprostol 800mg PV
Surgical Mx – suction evacuation
what are two absolute indications for surgical management of miscarriage
severe bleeding
septic miscarriage
what is the dose and route of Rh Igs
250 international units IM
- **?labour established **- presence of pelvic pressure and low back pain - ?contractions
- **?ruptured membranes **- fluid, blood, mucous PV - ?dilation of cervic
- Stage of labour - cervical length/effacement
- **fetal well being **- CTG
- **mother well being **- observations
- risk factors for preterm labour - UTI/IUGR. drug use
what medications are used in pre term labour and their indication
1.** betamethasone 11.4mg IM** - for lung maturity if under 34 weeks
2. nifidepine 20mg PO - tocolysis in preterm if fetus at risk from prematuritt
3. **MGsulphate 4g IV over 20 mins then 1g/hr - fetal neuroprotection in pre term
4. IV antibiotics **- amox, metronidazole - chorio-amnioitis
abdo pain and collapse
what does US show?
what could this mean in young person?
fluid in morrisons pouch
fluid in splenorenal angle
in young - ectopic - do BHCG to confirm
what are the management priorties in ecoptic pregnancy
- urgent O+G for surgical assessment
- resus fluids - large bore Iv
- analgesia
- psych support
- anti D if resus negative
what is the preferred technique using US for fetal wellbeing in under 14 weeks
M mode as less thermal damage from tissue heating
what could be inclusion and exclusion criteria for bedside US to assess viability in early pregnancy
list the steps you would take to manage surprise labour in the ED for someone who did not not know they were pregnant
- call for help - specialty teams if there
- resus space
- 2 teams - mum and baby
- call on anyone with O+G experience
- baby- resus equipement, resusicatire, obtain guidelines, correct sized equipment
- mother - pain relief, monitoring, IV access
how quick should a baby with shoulder dystocia be delivered to avoid fetal hypoxia
under 10
techniques for shoulder dystocia
- McRoberts - lay flat and flex and abduct hips
- episiotomy
- mother on all fours
- delivery of posterior arm to allow exit
- cleidotomy
what are the features of routine immediate management of newborn
- clamp cord and cut
- temp control - warm, rub, dry
- airway - anticipate cry and stimulate id needed
- APGAR scoring
what is the third stage of labour and how do you manage?
delivery of placenta
Steps
* check no twin
* administer 10 units oxytocin IV
* deliver placenta via controlled cord traction
* uterine massage
* obseve for PV loss
* observe perineum for tears
how do you manage incomplete placenta delivering and heavy PV loss?
- ensure O+G there
- uterine massage
- resus - IV access, blood and fluid
- IDC and empty bladder
- visual inspection ?trauma
- ergometrine/syntocin
- bimanual uterine compression
list four differentials
pre eclampsia
HELLP
HUS/TTP
acute fatty liver of pregnancy
bliary disease
management priorities?
- call O+G
- IV access and resus
- treat hypertension - IV hydralazine 5mg every 5-10 mins aiming BP under150 systolic
- IV mg 4g to prevent seizures
- consider correcting coagulopathy
what is the medical treatment for eclamptic seizure
1st line - IV Mg 4g followed by 1g/hr infusion
2nd line - IV midaz
on a CTG what indicates fetal distress?
- fetal HR above 180 or below 100
- variable or late decelerations (normal is none or early)
what are the treatment steps in eclamptic seizure?
- Urgent O+G input
- ensure airway secure and give o2
- left lateral position
- IV access
- drugs - 4g IV mg
- R/O hypoglucaemia
name labelled parts
A - baseline HR
B - late deceleration
C - uterine contraction