Obs & Gynae bits

Question 1

Signs & symptoms of ectopic pregnancy

Answer 1

Sudden, sharp, abdo pain, usually painful on palpation; absence of period, or irregular bleeding; shoulder pain due to diaphragmatic irritation; syncope due to pain; profound bleeding will leading to high HR, and low BP.

Question 2

What is placenta previa?

Answer 2

Where the placenta lies at the mouth of the cervix, rather than at the top or the sides of the uterus.

Question 3

What are the potential consequences of placenta previa?

Answer 3

As the pregnancy progress the lower uterine segment expands and the cervix begins to thin. This can lead to partial placental abruption. In addition, it may block the cervix making vaginal birth dangerous.

Question 4

Symptoms of placenta previa

Answer 4

Painless bleeding after 24 weeks, typically around 32 weeks. If abruption occurs then abdo pain & signs of shock.

Question 5

Gestation

Answer 5

From the date of last menstrual period (which can precede ovulation & fertilisation by about two weeks). Up to ten weeks is an embryo, then after, a foetus.

Question 6

Maternal adaptations to pregnancy

Answer 6

Supporting foetal growth, inc providing oxygen, nutrients and waste removal; protection from starvation, toxins and even drugs that may have entered the mother’s body; preparation of the uterus prior to labour; protection of the mother from cardiovascular injury due to delivery.

Question 7

Blood volume changes in pregnancy

Answer 7

Progesterone release decreases vascular resistance, leading to a drop in BP. To compensate, cardiac output increases by 30-50%. Presence of angiotensin encourages sodium & water retention which increases blood volume. Elevated HR & volume can mask an internal bleed so obs alterations should be taken seriously.

Question 8

GI issues in pregnancy

Answer 8

Morning sickness occurs in c 70% of pregnancy and normally resolves after the first trimester. It can happen at any time of day. It should not affect MorB, but if it persists and prevents normal fluid and vitamin intake it may be hyperemesis gravidarum and is an emergency. Reflux is also normal, esp in final trimester.

Question 9

Obstetric abbreviations

Answer 9

EDD - estimated delivery date; Gravid/Parity (G2P1); fundus - top of uterus; ceph - head down and ready to go; br - breech (feet down/high risk); SROM - waters breaking; USS - ultra sound; LSCS - lower cesarean; VBAC - vaginal birth after previous c section; HBAC - home birth after c section; vent - ventous suction cup; NBFD - forceps; APH - antepartum bleed; PPH; EBL - estimated blood loss; ANC - antenatal clinic; NAD - nothing abnormal detected.

Question 10

History from pregnant patients

Answer 10

Date & gestation of previous pregnancies; how previous children were delivered; any multiple foetus pregnancies; any previous complications.

Question 11

What constitutes ‘labour’?

Answer 11

Regular contractions increasing in intensity

Progressive cervical dilation

Question 12

Braxton Hicks

Answer 12

‘False contractions’, irregular and don’t increase.

Question 13

Second stage of labour

Answer 13

Should not last for more than 2 hours. If it does, seek advice.

Cervix dilated fully to 10cm

Urge to push

Deliver there ideally, unless there is reason to suspect pt is high risk

Question 14

Third stage of labour

Answer 14

Delivery of placenta and foetal membranes. Should need no involvement from crew and should last no longer than 30 minutes.

Question 15

Cutting the cord

Answer 15

No longer pulsating (no blood passing through).

Clamp 3cm apart, 15cm from the umbilicus.

If it breaks, clamp baby side first as it is more at risk of blood loss.

Note the time.

Question 16

APGAR - appearance, pulse, grimace, activity, respiration.

Answer 16

Scored when born then every five minutes. Minimum score of 7, if not, consider intervening.

Question 17

Cord prolapse

Answer 17

When SROM occurs, the cord can prolapse into the vag.
Attempt to press in to prevent compression of the cord and allow blood etc to continue to pass.
Cover with a dry pad and convey.
Knee to chest. Gently walk but do not use chair.
Transport lying flat with blanket under right hip

Question 18

Shoulder dystocia

Answer 18

Head visible. Shoulders stuck.
Diagnosed if two contractions have occurred since the head was delivered but the body is still in situ.
Risk of asphyxiation.
‘Turtle’s sign’ - head appears to be being pulled back in.
Lay on back and flex knees towards chest.
Suprapubic pressure from baby’s posterior side.
All fours.

Question 19

Breech birth - feet first

Answer 19

Transport unless too late.
All fours.
Support as it emerges.
Baby's tummy should be up - if not, gently rotate, holding pelvis.
Support head as it emerges.