Obstetric scores and indications Flashcards
what constitutes Bishop’s score? and what is it used for?
used to indicate chance of successful induction. scored out of 10.
takes into account five things:
- cervical consistency
- cervical dilatation
- cervical position
- cervical length
- position of the presenting part
what are the most common indications for elective C-section?
co-infection with HIV and HepC
HIV with high viral load, or not on ART
abnormal breech lie, only after ECV has attempted and has failed
twin pregnancy if the first baby is breech
placenta praaevia
primary genital herpes infection at 3rd trimester (but not recurrent genital herpes)
what criteria must be fulfilled in order to go for instrumental delivery
head must not be palpable abdominally head must be at ischial spine or below ischial spine cervix must be fully dilated adequate analgesia must be provided bladder must be completely emptied position of head known
what options do we have for instrumental delivery
three main options:
Neville Barnes forceps:
those have two curvatures cephalic and sacral. only provide traction, not rotation
Kielland’s forceps:
those only have one curvature, cephalic. provide rotation and traction
Ventouse:
provide traction and rotation
what is the difference between Neville barnes forceps and Kielland’s forceps?
Neville Barnes forceps:
those have two curvatures cephalic and sacral. only provide traction, not rotation
Kielland’s forceps:
those only have one curvature, cephalic. provide rotation and traction
what is the difference between forces delivery and ventouse delivery
ventouse delivery is associated with less maternal complication, but more foetal complications including: cephalohematoma, chignon, neonatal jaundice. ventouse has a higher failure rate (i.e. requirement for proceeding with c-section)
forceps, safer for the baby (although higher chance of facial bruising, and seventh cranial nerve damage), but higher complications in mother including grade 3 perineal tears.
there is NO difference in APGAR scores
what are the indications for surgical management of an ectopic pregnancy?
- woman is not haemodynamically unstable
- significant abdominal pain
- adnexal mass >35mm
- serum BhCG levels >5000
- visible fetal heart on scan
what are the surgical options available for an ectopic pregnancy?
discuss their differences and indications for future conception
salpingostomy - this involves removal only of the ectopic in the affected tube.
salpingectomy - this involves the removal of the whole affected tube
salpingostomy means if the contralateral tube is damaged, natural conception is still possible. Although, there’s a 10% of repeat surgery for persistent ectopic and subsequent ectopic pregnancies
in salpingectomy - if contralateral tube is damaged, no chance of natural conception (IVF required)
if contralateral tube not damaged, then conception rates between both procedures is the same
when can a female have medical management of an ectopic pregnancy?
no significant abdominal pain adnexal mass <35mm fetal heart not detected serum BHCG <5000 patient can return for follow-up no co-existing intrauterine pregnancy
what levels of serum BHCG indicate resolution of an ectopic pregnancy? and when are they used?
<20
they’re used if female has had medical management OR salpingostomy
what are the chances of a future ectopic after an ectopic pregnancy?
10%
what are the chances of having a successful future pregnancy after an ectopic
70%
what is the presentation of an ectopic pregnancy
4-10wks of amenorrhea
acute: collapse, with abdominal pain and bleeding
sub-acute: abdominal pain, dark PV bleeding, lower abdominal tenderness, cervical excitation, adnexal tenderness
incidental: diagnosed at ultrasound.
what is the prevalence of an ectopic pregnancy
> 1%
