Obstetric Summaries Flashcards
CLASP
Prophylactic low dose aspirin in high risk women probably reduces risk of preeclampsia, but result wasn’t statistically significant, and does reduce risk of preterm birth.
ACHOIS
Routine screening and treatment of GDM reduces serious perinatal outcomes including death
MAGPIE
MgSo4 around time of delivery in preeclampsia reduces eclampsia by around half, and reduces placental abruption.
HYPITAT
IOL >36 weeks gestation for gestational hypertension or mild pre-eclampsia reduces maternal adverse outcomes and severe HTN without adverse neonatal outcome.
ACTORDS
Short term neonatal outcomes were improved with repeat weekly doses of corticosteroid prior to 32 weeks.
ORACLE I
In PPROM <37/40, Erythromycin results in prolonged pregnancy and reduction in neonatal adverse outcomes. Augmentin increases risk of necrotising enterocolitis.
ORACLE I - 7 year follow up
At 7 years of age there was no difference in outcomes for children of those treated with Erythromycin for PPROM.
TRUFFLE
In IUGR <32/40, waiting until late ductus venosus changes to deliver did not increase hypoxia mediated deaths and neurodevelopment impairment is reduced, rather than delivery based on computerised CTG changes, although in practice a combination of both should be utilised as many of the DV group were delivered for reasons other than an abnormal DV.
ARRIVE
Induction at 39 weeks of low-risk nulliparous women does not reduce risk of perinatal death or severe complications, but does reduce risk of caesarean delivery and development of hypertensive disorders compared to expectant management.
TERMPROM
In Term PROM, IOL with oxytocin, IOL with vaginal prostaglandin, and expectant management all have similar rates of neonatal infection and cesarean section. Induction with oxytocin results in a lower risk of maternal infection than expectant management.
WOMAN
In PPH, TXA given within 3 hours of delivery reduces risk of death secondary to atony by about one third, without increasing risk of thrombotic events or other complications.
PPROMT
In PPROM close to Term, in the absence of infection or fetal compromise, expectant management with surveillance is appropriate, given immediate management does not reduce neonatal sepsis and increases risk of CS and RDS.
HAPO
Increasing glucose levels at OGTT (not overtly diabetic range) are associated with increasing risk of adverse maternal and neonatal outcomes, eg shoulder dysotica, LGA, hypoglycaemia and C-section
Doyle et al
Cochrane review, In pregnancies at high risk of preterm birth, in utero exposure to magnesium sulphate reduces the incidence of cerebral palsy and severe motor dysfunction in offspring
Fonseca 2003
Vaginal progesterone significantly reduces rate of preterm birth in high risk pregnancies, namely previous preterm birth.
Fonseca 2007
For asymptomatic singleton women with a cervix <15mm on second trimester USS, 200mg vaginal progesterone reduces risk of birth prior to 34 weeks gestation.
Gyamfi-Bannerman et al
ALPS
Antenatal betamethasone for women at risk of late preterm delivery 34-36+6 weeks significantly reduces rate of neonatal respiratory complications and need for respiratory support, but increases rate of hypoglycaemia.
Term Breech Trial
Planned caesarean section in Term Breech presentation seemed to be significantly associated with reduced adverse neonatal outcomes and no increase in maternal adverse outcomes, although this trial has later come under scrutiny.
Stutchfield et al (ASTECS)
Antenatal Steroids for Term Elective Caesarean Section reduces admission to SCBU for respiratory distress. The benefit of antenatal corticosteroids should be compared with the benefit of delaying delivery until 39 weeks.
Twin Birth Study Collaborative Group
There is no reduction in morbidity or mortality of twins with planned caesarean over planned vaginal delivery if the first twin is cephalic. The second twin has increased risk regardless of mode of delivery.
ORACLE II
Antibiotics should not be routinely prescribed for women in spontaneous PTL without evidence of clinical infection.
ORACLE II - 7 year follow up
Antibiotics in preterm labour do not improve childhood outcomes
