Obstetrics Flashcards
which day do we measure serum progesterone in a woman’s menstrual cycle ?
7 days before the end
normally day 21 in a 28 day cycle
Ectopic pregnancy management
Transvaginal USS to locate
1) methotrexate < 35mm
2) x >35 salpingectomy /salpingotomy
what epilepsy drugs can you prescribe in pregnancy
what extra thing should you remember to prescribe ?
most epileptic drugs but not valproate , remember they are safe in breastfeeding :)
+ give folic acid 5mg /day
placental abruption
- definition
-Features
- treatment
complete or partial detachment of the placenta before delivery
hard woody uterus
Dark red blood, PAIN
fetal distress
it may be revealed or the blood might be accumulating elsewhere so do USS
Anti-natal steroid @ 34 weeks
anti-D prophylaxis
emergency C section If unstable
placenta praevia
low lying placenta , graded 1-4( covering the internal OS)
painless bright red vaginal bleeding
steroids
USS
planned C section at 37 weeks
PPH
Tone - uterine atony , failure of uterine contraction
Trauma- perineal tears
Tissue - retained placenta
Thrombin - clotting disorders
Management :
ABCDE
->MAJOR haemorrhage protocol
IV OXYTOCIN - to squeeze intrauterine vessels to slow and stop PPH
Ergometrine
Misoprostol -pg analogue , increased tone
cord prolapse
mother needs to be on all 4s and then Immediate C section
tocolytics ie : oxytocin
Hyperemesis gravidarum
5% pre pregnancy weight loss
Electrolyte imbalance
Ketones have to be present
Treatment :
Oral Cyclizine
Promethazine
Oral prochloroperazine
vasa praaevia
(2)
Normally fetal blood vessels travel in the umbilical chord !
Vasa previa is defined when unprotected umbilical vessels run through the amniotic membranes, and pass over the cervix.
1) velementous
2) Multi lobed placenta
Emergency C section at 34-36 weeks
corticosteroids from week 32
and in the case of APH -> C SEC
UTI in pregnancy
nitrofurantoin is good
avoid near term
antepartum haemorrhage causes
- placenta praaevia
- vasa praaevia
- Placenta abruption
gestational diabetes
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate insulin (plus or minus metformin) should be started
Breech treatment
external cephalic version
(give analgesia , Tocolytics , anti-D immunglobulins)
hypertension in pregnancy
when BP>140/90
before 20 weeks is chronic HT–> labetalol (NO ACE/ARB)
After 20 week + no protein = gestational HT
labetalol and nifedipine if asthmatic
HELLP syndrome
Haemolysis
Elevated Liver enzymes
Low Platelets
vasa previa triad
1) membrane rupture
2) Painless bleed
3) Fetal Brady
polyhydramnios
when the fetus can’t swallow amniotic fluid
Causes:
+esophageal and duodenal atresia
+anenecephaly
+ Increased urine production ( multiple gestationm diabetes )
Oligiohydramnios
Too little amniotic fluid
- inadequate urine excretion : bilateral renal agenesis and posterior urethral valves
-Placenta insufficiency - reduced blood flow to the kidney of the fetus , Hence reduced urine output
CAN LEAD TO POTTERS SYNDROME :
- lack of fluid , less space for fetus
-flattened face , low set ears, widely separated eyes , clubbed feet
Pre eclampsia
proteinuria + bp >140/90 and oedema
Severe:
if above 160/110 = ADMIT and observe
labetalol / nifedipine
if seizures develop -> mg sulphate
to prevent give aspirin 75mg from 12 weeks gestation until birth
Eclampsia
what should you be careful of in treatment ?
Once seizures develop and decision to deliver has been made !
Mg Sulphate IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour
Mg sulphate can cause respiratory depression , so give Calcium gluconate here !
uterine stimulants/inducers
examples and uses
- Oxytocin for labour induction / to treat PPH
->for Labour induction / to treat PPH
causes muscle contraction so that the uterine vessels are compressed - Ergometrine , causes uterine contraction and is used in PPH
-Prostagladins –> used to ripen cervix , shorter and softer in preparation for labour = misoprostol
Uterine relaxants
- B2 agonists - Terbutaline , inhibits uterine contraction
-Ca2+ channel blocker
-Cox inhibitors - indomethacin
Used to delay birth bc lungs wouldn’t have matured
Termination of pregnancy
Woman less than 9 weeks
-Oral Mifepristone ( blocks progesterone required for continuation of pregnancy )
- Misoprostol - prostaglandin analogue , smooth muscle contraction resulting in expulsion of the uterine contents
intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
+ itchy palms and feet
+ jaundice
+ increased BRB
