Obstetrics 1 Flashcards
how often are FHR monitored during labour
every 15 minutes (or continuously on CTG)
how often are contractions assessed during labour
every 30 minutes
how often is maternal pulse measured during labour
every hour
how often is maternal BP and temperature measured during labour
every 4 hours
how often is VE offered during labour
every 4 hours to check for progression
how often is maternal urine checked for ketones and protein
every 4 hours
what is the antibiotic of choice for temperature >38 during labour for GBD prophylaxis
benzylpenicillin, vancomycin if penicillin allergy
how do you treat PPROM
erythromycin for 10 days or until the induction of labour
what is the biggest risk factor for prolapse
artificial amniotomy, ARM (artificial rupture of membranes
is there screening for GBS in pregnancy
no and if found in pregnancy don’t necessarily treat as could clear the infection before birth
if patient has not had MMR vaccine do you give during pregnancy
no MMR is a live vaccine and should not be administered to women known to be pregnant or attempting to become pregnant, avoid getting pregnant for 28 days after vaccine
features of rubella infection during pregnancy for baby
sensorineural deafness, congenital cataracts, congenital heart disease, growth retardation , micropthalmia, cerebral palsy
which immunoglobulin is raised if you have recently had an infection
IgM
which IG is raised if you are immune to an infection
IgG
what happens to blood pressure during pregnancy
it usually falls in first trimester (especially diastolic) until 20-24 weeks after it usually increases to pre-pregnancy levels
what does HELLP stand for
Haemolysis, elevated liver enzymes, low platelets
can you breastfeed if HIV +
no but you can deliver virginally if viral load is undetectable, should be given antiretrovirals 4 hours pre C section or during delivery
what do you do if mum who is pregnant comes into Gp practice and says they have been in contact with someone who has chickenpox and they don’t know if they have had the infection
check IgG and if negative then give VZIG
what treatment is given for pregnant woman who comes in with chickenpox and has not had it before
VZIG IS NOT GIVEN, give oral acyclovir
what is the hyperemesis gravidarum triad
5% pre pregnancy weight loss
dehydration
electrolyte imbalance
what important test would you do for someone who you think presents with hyperemesis gravidarum
KETONES usually urinary
management of hyperemesis
antihistamines eg promethazine/cyclizine, 2nd line is ondansetron then metoclopramide,
antisickness medications are safe to take in pregnancy and CAN take more than one if needed
why are NOACs contraindicated in pregnancy
the cause placental haemorrhage
below what level is the rectus sheath only anterior
arcuate line
where is the arcuate line
one third of the distance between the pubic crest and the umbilicus
where does the illiioinguinal nerve travel
in the plane between internal oblique and transversus abdominis
what is the ilioinguinal nerve from
L1
what is the blood supply to the anterolateral abdominal wall
superior and inferior epigastric arteries
where does the superior epigastric artery branch from and where is it found
continuation of internal thoracic, emerges at superior aspect of abdominal wall, lies posterior to rectus abdominis
where does inferior epigastric artery branch from and where is it found
branch of external iliac artery, also lies posterior to rectus abdominis
what supplies the lateral abdominal wall
intercostal and subcostal arteries, continuation of posterior intercostal arteries
where does the inferior epigastric artery emerge from
lateral to the deep inguinal ring
where is the deep inguinal ring
half way between ASIS and pubic tubercle
what initiates and sustains contractions
oxytocin
what does oestrogen do in labour
makes uterus contract (promotes prostaglandin production
what does progesterone do in labour
keeps uterus settles (hinders contractability of myocytes)
what is the decidua
lining of the uterus, forms under influence of progesterone=name for endometrium in pregnancy
what is the ferguson reflex
name given to neuroendocrine reflex comprising the self-sustaining cycle of uterine contractions indicated by pressure at the cervix or vaginal walls
in the active part of the first stage of labour what is considered normal progression
1-2cms per hour
in the second stage what is considered prolonged
if nulliparous >3 hours with regional anaesthesia or >2 hours without regional anaesthesia
if multiparous prolonged if >2 hours with regional anaesthesia or 1 hour without
how soon after post partum does a woman require contraception
21 days
when can you start the POP after delivery
can start straight away but need contraception after day 21 for 2 days
can you take the COCP after giving birth
COCP is ABSOLUTELY CONTRAINDICATED if breastfeeding and less than 6 weeks post-partum
when can you start COCP
may be started from day 21 and provides immediate contraception, if started after day 21 additional contraception should be used for first 7 days
nb COCP can reduce breast milk production in lactating mothers
when can IUS/IUD be inserted
can be inserted within 48 hours of childbirth or after 4 weeks
what is lactational amenorrhoea
98% providing the woman is fully breastfeeding
criteria: no supplementary feeds, amenrrhoeic and <6 months post partum
what is the Edinburgh scale
a depression tool for postnatal depression 10-item questionnaire with a max score of 30
indicates how the mother has felt over the past week
score >13 incates a depressive illness of varying severity
