obs2 Flashcards
what is an ectopic pregnancy?
implantation outside uterine cavity
what are the most common sites of ectopic?
ampulla and isthmus of fallopian tube
what are the risk factors for ectopic?
previous ectopic pelvic inflammatory disease (adhesions) endometriosis (adhesions) IVF progesterone contraceptive implant IUD pelvic surgery
how does ectopic present?
pain +/- bleeding
why is there PV bleeding in ectopic?
decidua breakdown following reducing HCG levels
where does blood from a ruptured ectopic go
intra-abdominal
may irritate diaphragm and cause shoulder pain
what are signs on exam of ectopic?
- abdo pain
- cervical excitation
- adnexal tenderness
- patient may be haemodynamically unstable - shock, pallour
how is ectopic investigated?
- pregnancy test
- pelvic USS
what is the cut off point for hcg for ectopic?
1500
what is medical mgmt of ectopic?
im methotrexate
what is surgical mgmt of ectopic?
laparoscopic salpingectomy
what must be given to rh neg women who undergo surgical treatment of ectopic?
anti d
why is there ruq pain in pre-eclampsia?
stretching of liver capsule due to oedema and haemorrhage
what are the symptoms of obstetric cholestasis?
itching, mainly palms and soles jaundice NO RASH dark urine (itching may be worse in evening)
how is obstetric cholestasis treated?
urso
how is obstetric cholestasis managed?
monitor lfts weekly
induce at 37 as induced risk of stillbirth
how do you treat profuse bleeding in miscarriage?
ergometrine
how do you medically manage miscarriage?
misoprostol, if no bleeding after 24hrs, come again
analgesia and antiemetic
how do you treat a miscarriage with bleeding?
medically with misoprostol, as there is increased risk of haemorrhage
when would you medically treat a miscarriage?
bleeding
previous adverse/traumatic event
signs of infection
what is a tender/tense uterus + bleeding a sign of?
placental abruption (+ back ache if posterior!)
why is it important to check for domestic abuse in placental abruption?
trauma can cause placental abruption
list some risk factors for placental abruption
PROM IUGR previous trauma cocaine smoking
how do you manage fetal distress in abruption?
deliver vaginally
what are the complications of abruption for mum?
PPH
DIC
renal failure
shock
what are the complications of abruption for fetus?
IUGR
hypoxia
death
why is placenta praevia bad?
can obstruct birth canal, bleeding
what is the threshold for pcr for pre-eclampsia
> 30
why is aspirin given for pre-eclampsia?
prevent stroke
until when should mgso4 be continued?
24 hrs after delivery/last seizure
causes of APH
placenta praevia
placental abruption
how does placenta praevia present?
painless pv bleeding
how does abruption present?
painful bleeding and woody hard uterus
what does fetal lie refer to?
relationship between long axis of fetus and mum
what are the different types of fetal lie?
longitudinal
transverse
oblique
what does fetal presentation refer to?
fetal part which first enters pelvis
what are the different types of fetal presentation?
cephalic breech shoulder face brow
what does fetal position refer to?
position of head as it exits canal
what are different types of fetal positions?
occiput-anterior (IDEAL)
occiput-posterior
occiput-transverse
90% of babies rotate during birth.
what are the risk factors for abnormal fetal lie/position/presentation?
- prematurity
- multiple pregnancy
- uterine abnormalities
- fetal abnormalities
- placenta praevia
- primiparity
how is fetal position assessed?
vaginal exam (fontanelles)
how is lie and presentation assessed?
abdo exam
how is fetal lie managed?
if >36, ECV
when is ECV contraindicated?
- previous c section
- recent APH
- ruptured membranes
- uterine abnormalities
in which presentations are c-sections necessary?
shoulder
brow
mento-posterior
what is cord prolapse?
umbilical cord descends through cervix with/before presenting part of fetus. can cause hypoxia
why is there hypoxia in cord prolapse?
- compression by fetus
- arterial vasospasm bc cold
what are the risk factors for cord prolapse?
breech (footling) unstable lie artificial rupture of membranes polyhydramnios prematurity
what are the signs of cord prolapse?
fetal distress - non-reassuring trace PV bleeding (due to abruption)
how is cord prolapse managed?
- avoid handling to prevent vasospasm
- elevate presenting part
- consider tocolysis with terbutaline to relieve pressure off the cord
- encourage into left lateral position
- deliver by quickest mode: c-section
what does non-reassuring trace and fetal membranes suggest?
cord prolapse
