Obs pass med Flashcards
what is puerperal pyrexia?
A temperature of > 38ºC in the first 14 days following delivery
What is the most common cause of puerperal pyrexia?
Endometritis
other causes include: UTI, wound infections, mastitis, venous thromboembolism
What is the management of puerperal pyrexia?
If endometritis is suspected the patient should be referred to hospital for IV (clindamycin and gentamicin until afebrile for greater than 24 hours)
what medications are suitable for breastfeeding women (antidepressant)?
sertraline and paroxetine are the SSRIs of choice
What are the two main risk factors for placenta acretta?
-Previous C section
-Placenta previa
What is oligohydraminous?
-Reduced amniotic fluid
-Less than 500ml between 32-36 weeks and an amniotic fluid index <5th percentile
What are the causes of oligohydraminous?
-Premature rupture of membranes
-Potter sequence (bilateral renal agenesis + pulmonary hypoplasia)
-IUGR
-Post-term gestation
-Pre-eclampsia
Why folic acid important to take in pregnancy?
protects against neural tube defects - which are caused by folic acid deficiency
How should “high risk” women take folic acid?
5mg of folic acid before conception until 12th week pregnancy
What is recommended with folic acid to all women in pregnancy?
400 mg of folic acid until 12 weeks
When are women considered “high risk” for having a baby with neural tube deftect?
-Fhx NTD
-Taking antiepileptic drugs
-Coeliac disease
-Diabetes
-Thalassemia triat
-Obese BMI>30kg
Why does shoulder dystocia occur?
Due to impaction of anterior fetal shoulder on maternal pubic symphysis - occurs after the head has been delivered
What are the risk factors of shoulder dystocia?
-Fetal macrosomia (hence association with MDM)
-High BMI
-Prolonged labour
-DM
How should shoulder dystocia be managed once idenifted?
-Senior help
-Episiotomy (allows better access for internal manoeuvres)
-McRoberts’ manoeuvre
What is McRoberts’ manoeuvre?
Flexion and abduction of maternal hips - it increases the relative anterior-posterior angle of the pelvis
What are the complications of shoulder dystocia?
-Maternal: PPH and perineal tears
-Fetal: Brachial plexus injury and neonatal death
What are symptoms of placental abruption?
Vaginal bleeding with pain and discomfort
What are risk factors for placental abruption?
-Chronic hypertension
-Smoking
-Cocaine use
-Abdominal trauma
What investigation should be done if placental abbruption?
NOTE: these are performed to investigate the extent and consequence of the arupbtion
-Blood test - FBC (Hb), group and save, Kleihauer in RhD - women, this is to gauge the dose of anti D
-Ultrasound can be used to diagnose placenta praevia but does not exclude abruption
-CTG to see if the there is fetal distress
What weeks are corticosteriods useful ?
24- 34+6 - if at risk of preterm birth
What are antenatal corticosteroids associated with?
Significant reduction in rates of neonatal death, RDS, intraventricular haemorrhage
What is the management of placental abruption if fetus alive and <36 weeks?
Fetal distress: immediate C section
No fetal distress: Admit observe closely, administer corticosteroids, no tocolysis, threshold to deliver depneds on gestation
What is the management of placental abruption if fetus alive and >36 weeks?
Fetal distress: Immediate C section
No fetal distress: deliver vaginally
How to manage placental abruption if fetus dead?
Induce vaginal delivery