Obs&gynae Flashcards
The four Ts of partum haemorrhage
Tone- uterine atony
Tissue- retained tissue or clots
Trauma- uterine, vaginal or cervical lacerations
Thrombin- preexisting or acquired coagulation disorders
Risk factors for PPH
APH, placenta previa, placental abruption, multipregnancy, multiparity (4+), preeclampsia, previous PPH, obesity, maternal age, caesarean, induction of labour
Management of uterine atony in PPH
ABCDE bimanual uterine massage Catheterise Oxytocin Ergometrin Carboprost Misoprostol Surgery: Balloon tamponade Hysterectomy
what blood pressure levels are deemed serious pre eclampsia?
diastolic 110+
systolic 160+
risk factors for pre eclampsia
first pregnancy maternal age 40+ BMI 35+ Family history multipregnancy DM1&2 Hypertension CKD
symptoms of pre eclampsia
headache
ankle swelling
visual disturbances
epigastric pain/vomiting
signs of pre eclampsia
high blood pressure proteinuria papilloedema reduced foetal movements foetus small for gestational age
investigations for pre eclampsia
FBC- platelets hellp? LFTs- hellp? urine- protein, MC&S renal function ultrasound- Foetal size, amniotic fluid volume doppler scan- umbilical arteries
management for pre eclampsia
usually conservative delivery of placenta is the only 'cure' labetalol if 150/100 + magnesium sulphate for seizure risk if severe fluid restrictions
what does HELLP stand for?
Haemolysis, elevated liver enzymes, low platelets
risk factors for HELLP
age 35+ nulliparous multipregnancy PMH HELLP or hypertension APS- antiphospholipid syndrome caucasian
symptoms of HELLP
*nonspecific headache vomiting/nausea/epigastric pain fatigue symptoms worse at night
signs of HELLP
Oedema
proteinuria
hypertension
hepatomegaly
investigations for HELLP
Blood film- haemolysis, fragmented red cells
liver enzymes- AST/ALT raised
FBC- low platelets
treatment for HELLP
delivery (If 34w+)
magnesium sulphate
transfusions
what is eclampsia?
severe complication of pre eclampsia, in which high blood pressure leads to one or more seizures
management of eclampsia
resus magnesium sulfate intubation if required labetalol fluid monitoring delivery of baby once control of blood pressure, seizures and hypoxia is ascertained (caesarean likely)
What is gestational diabetes?
Glucose intolerance with onset during pregnancy
what level of fasting glucose would indicate gestational diabetes?
5.6mmol/L
risk factors for gestational diabetes (GD)
age ethnicity high BMI pre pregnancy smoking previous macrosomia FH of DM2 or GDM
what are the criteria for screening for gestational diabetes
BMI>30 prev macrosomic baby prev GDM 1st relative diabetic family origin with increased risk associated
risks of Gestational diabetes to foetus
macrosomia obesity risk increased diabetes risk increased intellectual impairment shoulder dystocia
causes of antepartum haemorrhage
*placenta previa
*placental abruption
local trauma, domestic violence, vasa previa, uterine rupture
presentation of antepartum haemorrhage
bleed +/- pain
contractions, foetal distress, malpresentation, hypovolaemic shock
management of antepartum haemorrhage
estimate blood loss bloods- FBC, group and save, crossmatch, clotting studies, U&Es, LFTs foetal monitoring and ultrasound scan antiD for resus negative corticosteroids if preterm risk avoid vaginal exam
why should a vaginal examination be avoided in antepartum haemorrhage?
if previa then risk of torrential bleed
what is placenta previa?
partial or full covering of the cervical os by the placenta
risk factors for placenta previa
previous placenta previa previous caesarean older maternal age increased parity smoking cocaine use in pregnancy previous spontaneous or induced abortion endometritis assisted conception
presentation of placenta previa
routine scan painless bleed 28w+ post coital bleed spontaneous preterm abnormal lie- transverse/oblique
diagnosis for placenta previa
ultrasound for leading edge of placenta
management of minor placenta previa
vaginal delivery possible
if <2cm from os then caesarean
management of major placenta previa
caesarean
no penetrative intercourse
hospitalisation from 34 weeks if bleed
what are the risks of a placenta previa?
major haemorrhage- hypovolaemic shock
VTE- associated with hospitalisation
Foetal prematurity
asphyxia during birth
what is the normal presentation of the head during vaginal delivery?
occipito-anterior position
what are the different types of malpresentations?
breech (frank, complete, footling), transverse, oblique
what are the different types of breech presentation?
frank (legs extended upwards), complete (legs fully bent), footling (one flexed one extended)
what are the risk factors for breech presentation?
high parity (lax uterus) placenta previa uterine abnormalities multipregnancy polyhydraminous IUGR preterm previous breech presentation smoking, diabetes
what treatments are available for breech presentation?
ECV- external cephalic version after 37w
moxibustion- Chinese medicine
caesarean
what are the risk factors for a malpresentation?
prematurity multipregnancy uterine abnormalities foetal abnormalities placenta previa
what are the complications associated with breech delivery?
preterm cord prolapse foetal head entrapment intracranial haemorrhage due to rapid head descent hyperextension causing spinal injury
