Obstetric Assessment Flashcards
Obstetric History To Gain
> Age: risk of complications/congenital disease.
> Parity & Gravida.
> Menstrual Hx: LMP, gestation, EDD.
> Presenting symptoms: PC/HPC.
> Past obstetric hx.
> PMHx & Surgery: DM ^ preg risk, IBD can be worse postnatal.
> Drug Hx: prescribed, OTC, natural, alcohol, smoking, illicit. Check if taking daily folic acid until 12/40 to red. risk of neural defects.
> Family Hx: inherited conditions? Down’s 20y/o 1:1500, 45y/o 1:30 (Macleod, 2018).
> Social Hx: partner? Stable? Housing?
Define the term Gravida.
Total no. of pregnancies including miscarriages and stillbirths.
Define the term Parity.
Total no. of children given birth to alive.
How do the mother’s observations change throughout the pregnancy?
> HR: ^ by around 10%.
> RR: ^ due to ^ respiratory drive & diaphragmatic compression.
> BP: can initially fall slightly in early pregnancy, rising later on. If 140+ sys -> consider pre-eclampsia.
(British Medical Journal).
Miscarriage.
> M/C: upto 23w 6d. Convey to ED. Most common at 6-14/40 (JRCALC, 2022).
> Stillbirth 24/40+. Convey to mat unit.
> S/S: PV bleed, central/suprapubic/back pain, vaginal d/c of fluid or tissue.
> Hx: pain (SOCRATES), alternative diagnosis, bleeding (character, vol, other cause?).
Ectopic Pregnancy.
> 1:80, some fatal for mother (Miscarriage Association).
> 13% of preg related deaths (JRCALC, 2022).
> Ovum implanted outside of uterus, usually fallopian tubes. Never viable. (American College of Obs & Gyane).
> S/S: missed period, suprapubic abdo pain (pain will usually be on the side of the Fallopian tube affected), shoulder tip pain (referred pain), vom, dizzy, rebound tenderness, rigid abdo, tacky, hypotensive, abdo wall bruising.
> Risk Factors: prev ectopic, infection GU, surgery on Fallopian tubes, abdo surgery, endometriosis, fertility issues.
Pre-eclampsia.
> Early signs: HTN & proteinuria.
> Later Signs: severe headaches, visual disturb, pain just below right rib, vom, sudden peripheral oedema.
> Risk Factors: DM, HTN, kidney disease, FHx, geriatric mother, 10+ yrs since last preg, expecting multiple babies, BMI 35+.
Eclampsia.
> Seizures associated w/ pre-eclampsia. Hypoxia -> foetal compromise -> death.
> Other S/S: headaches, N/V, RUP pain, fatigue, pallor.
> HELLP Syndrome: Haemolysis (RBC rupture into surrounding fluid). Elevated Liver Enzymes. Low platelet count.
> Administer diazepam, early request for CCP/HEMs for magnesium sulphate. Works to reduce risk of maternal death & further seizures (Duley et al., 2010).
Ante-Partum Haemorrhage.
> After 22/40.
> Placenta Previa: cervix covered by placenta, 1:200 births (NHS). Bright red PVB, w/out pain, C-section often needed.
> Placenta Abruption: placenta torn away from uterine wall. Dark blood, bleeding can be concealed, suprapubic abdo pain, foetal death likely.
> Bleeding: how much? Pads? ^ blood vol so can tolerate more haem before signs show (major haem 1L). Foetal circulation shunted away -> compromise. (Pillory & Lethbridge, 2019).
Post-Partum Haemorrhage.
> Up to 24hrs post birth. How much? Pads? 500ml significant.
> 4 T’s:
Tone: atonic uterus, placenta previa.
Tissue: retained, invasive placenta.
Trauma: lacerations, uterine rupture, C-section, pelvic haematoma).
Thrombin: coagulopathies, clotting disorders.
> Mother’s Weight: >50% deaths in mothers <60kg (red. blood vol = less able to tolerate haem). Obese ^ risk of atonic uterus. (PROMPT Course Manual, 2017).
Pulmonary Embolism in Obstetrics.
> 5x more likely in preg, leading cause of death (Royal College of Gynae).
> ^risk throughout preg -> 3mths post birth.
> ^ risk due to ^ clotting, red. peripheral circulation (^risk DVT), ^ immobility, C-section.
> RCOG recommend ^risk women start on low-molecular-weight-heparin (LMWH) throughout antenatal - 6/52 post birth.
Post-Natal Depression & Maternal Mental Health.
> 1:5 experience post natal mental health issues, inc PND, anxiety, OCD, PTSD, PP psychosis. 70% hide or underplay (Maternal MH Alliance).
> PND: low mood, tearful, irritable, sleepless, anxious.
> Maternal suicide is a leading COD w/in of having a baby.
> ‘Saving Mothers Lives Report’ 2015 - 25% of all deaths up to 1 year postpartum were psychiatric causes. Advises ask about previous psychiatric hx.
> Consider child protection, safeguarding, NAI.
Maternal Sepsis.
> “Life-threatening condition resulting in organ dysfunction caused by infection during pregnancy, post-natal or after abortion”. (Escobar, 2020).
> 25% of maternal deaths in UK (Sepsis UK).
> Risk Factors: C-section, prolonged labour, prep membrane rupture, placenta abruption, DM, bacterial infection (UTI), emergency surgery, MC.
> RCOG: Modified Early Obstetric Warning Score (MEOWS).
> RCOG Red Flags: T>38.0, HR>100, RR>20, abdo/chest pain, D/V, vaginal d/c, dizzy, SOB.
What position should pregnant women be transported in and why?
> Left lateral tilt position.
> Avoids aortocaval compression syndrome (compression of aorta & IVC by gravid uterus when supine) - causing hypotension, LOC and foetal demise.
