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Obstetrics and Gynaecology > Obstetric Presentations > Flashcards

Obstetric Presentations Flashcards

1
Q

What is an antepartum haemorrhage?

A

Bleeding from birth canal >24 weeks

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2
Q

How common is an antepartum haemorrhage?

A

3-5% of all pregnancies

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3
Q

What would you ask about in the history of an antepartum haemorrhage?

A 
How much blood
What colour
Provoked? - post coital
Have waters broken?
Any pain
Foetal movements
Risk factors - smoking, drugs, domestic abuse
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4
Q

What would you look for on examination in a patient with an antepartum haemorrhage?

A 
General appearance - pallor, cap refill
Tender abdomen?
Uterus feel tense and woody? (placental abruption)
Palpable contractions
Lie of foetus
CTG - >26 weeks
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5
Q

What are some causes of an antepartum haemorrhage?

A 
Infections - candida, vaginosis, chlamydia
Vasa praevia
Uterine rupture
Placenta praevia
Placental abruption
Benign or malignant lesions
Domestic violence
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6
Q

What triad does vasa praevia present with?

A

Vaginal bleeding
Membrane rupture
Foetal compromise

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7
Q

What is uterine rupture usually associated with?

A

Hx of previous C Section or uterine surgery

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8
Q

Why should vaginal examination for suspected antepartum haemorrhage not be carried out in primary care?

A

Women with placenta praevia may haemorrhage

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9
Q

What is the immediate management in suspected antepartum haemorrhage?

A

Admit to hospital for assessment and management
Resus
Mothers life take priority!
Urgent delivery of baby if foetal distress
If Rhesus -ve - Kleihauer test and prophylactic anti-D

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10
Q

What is Kleihauer-Betke’s test?

A

Blood test to calculate amount of fetal Hb that has crossed to maternal blood stream

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11
Q

What investigations should be ordered for a patient with a suspected antepartum haemorrhage?

A

Depend on presentation

Can include - FBC, platelet, G&S, clotting, USS, foetal monitoring

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12
Q

What should you do once you rule out placenta praevia?

A

Cusco speculum examination
Digital vaginal exam
Swabs - exclude infection

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13
Q

What complications are associated with an antepartum haemorrhage?

A 
Premature labour
DIC
AKI
Placenta accreta
Foetal hypoxia and death
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14
Q

What features, if accompanying abdominal pain, require urgent midwife assessment?

A 
Bleeding or spotting
Regular cramping or tightening
Vaginal discharge that is unusual
Lower back pain
Pain or burning on urination
Pain is severe or doesn't go away after 30-60 mins of rest
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15
Q

What are the common causes of abdominal pain in pregnancy?

A

Constipation
Trapped wind
Growing pain of ligaments

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16
Q

How is abdominal pain in pregnancy complicated?

A

Visceral displacement and absence of peritoneal signs - lifting of abdominal wall

17
Q

What history would make you worry about an ectopic pregnancy?

A

History of 6-8 weeks amenorrhoea
Lower abdominal pain +- shoulder tip pain
Later - vaginal bleeding

18
Q

What is the vaginal bleeding seen in an ectopic pregnancy like?

A

Less than normal period

Can be dark brown

19
Q

What history may indicate a threatened miscarriage?

A

Painless vaginal bleeding <24 weeks

Typically at 6-9 weeks

20
Q

What history may indicate a missed miscarriage?

A

Light vaginal bleeding/discharge

Symptoms of pregnancy which disappear

21
Q

What history would indicate a patient is going into labour?

A

Regular tightening of the abdomen

22
Q

What history would make you worry about placental abruption?

A 
Shock out of keeping with visible loss
Constant pain
Tense, tender uterus
Fetal heart - absent/distressed
Coagulation problems
23
Q

What history would make you think a patient has symphysis pubis dysfunction?

A

Pain over pubic symphysis
Radiate to groin and medial aspects of thighs
Waddling gait

24
Q

What symptoms are indicative of pre-eclampsia?

A

Epigastric pain
Severe headache - often frontal
Swelling of hands, feet and face

25
Q

What symptom is indicative of HELLP syndrome?

A

RUQ pain

26
Q

What history may suggest uterine rupture?

A

Abdominal pain and shock in labour or the third trimester

27
Q

How would appendicitis present in pregnancy?

A

RLQ in 1st trimester
Umbilical pain in 2nd trimester
RUQ pain - 3rd trimester

28
Q

When should women feel fetal movements by?

A

24 weeks

29
Q

When do women normally feel fetal movements by?

A

18-20 weeks

Some women feel as early as 16 weeks

30
Q

How often do women normally feel fetal movements and how do they progress?

A

16-45 movements per hour
<75 mins between movements
Diurnal changes - peak movement afternoon/evening

Movements increase upto 32 weeks then plateau

31
Q

What should happen if no movements are felt by 24 weeks?

A

Refer to fetal medicine for investigation of possible neuromuscular disorder

32
Q

What are the possible causes of reduced fetal movements?

A

Stillbirth and fetal compromise
Anterior placenta - decrease women’s perception of movement prior to 28 weeks
Sedating drugs that cross placenta - alcohol and opiates
Cigarette smoking
Corticosteroids - fetal lung development
Major fetal malformations

33
Q

What is the general management of reduced fetal movements?

A

Assess risk factors for still birth
Auscultate fetal HR
CTG
Can do: USS, obstetrician review

SEE NOTES FOR FULL GUIDANCE

34
Q

What should women be advised to do if they suspect reduced fetal movements?

A

Lie on left side and focus on movements for 2 hours

If <10 in 2 hours then contact midwife or maternity unit immediately

35
Q

What risk factors are associated with stillbirth?

A 
Multiple consultations for reduced fetal movements
Hypertension
Growth restriction
Diabetes
Extremes of maternal age
Primiparity
Smoking
Placental insufficiency
Congenital malformation
Obesity
Ethnicity - higher if black or asian
Poor past obstetric Hx
Genetic factors
Can't access care

Obstetrics and Gynaecology (21 decks)

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