obstetrics Flashcards
physiological changes in pregnancy
BP reduced in 1st and 2nd trimester
blood volume up by 30%
platelet count falls
pulmonary ventilation up by 40%
Ca requirement increased
pre conception care
folic acid - 400mg until 12 weeks
if diabetic 5mg from 12 weeks
abdominal discomfort
prelabour rupture of membranes
cord prolapse
tense shiny abdomen
inability to feel fetal parts
polyhydramnios
= excess amniotic fluid
investigation for polyhydramnios
ultrasound
oral glucose tolerance test
antibody screen
management of polyhydramnios
IOL at 40 weeks
amnioreduction can be considered
1st line medication for hypertension caused by pre-eclampsia
labetolol
abdominal pain that is unilatelal and lower
amenorrhoea
vaginal bleeding
mass
shoulder tip pain
ectopic pregnancy
= ovum implants outside of uterus usually in fallopian tube
investigation for ectopic pregnancy
ultrasound
serum hCG
management of ectopic pregnancy
methotrexate - single dose
surgery - salpingectomy or salpingotomy
what is a miscarriage
loss of a pregnancy at less than 24 weeks
risk factors for miscarriage
age > 35
previous miscarriage
smoking
alcohol
illicit drugs
antiphospholipid syndrome
infections
investigation for miscarriage
transvaginal ultrasound
speculum
bHCG
management of miscarriage
misoprostol
mifepristone
surgical suction
pregnant women with weight loss, dehydration, ketotic breathe, hypotension
cannot keep any foods or liquids down
hyperemesis gravidarum
management of hyperemesis gravidarum
antiemetic - promethazine
IV fluids
thiamine
women is bleeding PV after 24 weeks differentials
placental abruption
placenta praevia
ectropion
polyp
pregnant women has
vaginal bleeding
abdominal pain
uterine contraction
lower back pain
woody abdomen on palpation
placental abruption
investigation for placental abruption
clinical
CTG
management of placental abruption
resus
c-section
antepartum bleeding in a mother who has had multiple c-sections
placental accreta
= placenta implants deeper through the endometrium making it difficult to separate the placenta after the delivery of the baby
painless antepartum haemorrhage, fetal movement present, uterus soft and non tender
placenta praevia
= placenta edge is lying directly over cervical os
investigation for placenta praevia
midtrimester ultrasound
management of placenta praevia
corticosteroids
magnesium suplhate
c section
pregnant mother with severe abdominal pain with shoulder tip pain
sudden collapse
vaginal bleeding
acute abdomen
uterine rupture
pregnant women after rupture of membranes has a small amount of dark vaginal bleeding
fetal bradycardia
vasa praevia
= fetal vessels and transverse membranes below presenting part over cervical os
management of vasa praevia
corticosteroid
elective c section
pregnant women with:
headache
hypertension
visual disturbance
nausea
RUQ pain
oedema
pre eclampsia
investigation in pre eclampsia
BP - elevated
proteinuria
ultrasound
management of pre eclampsia
aspirin - before 16 weeks in high risk women (obese, diabetics, CKD)
hypertension - labetalol
nifedipine
IV magnesium sulphate - if severe
what to give if pregnant mother seizing
IV magnesium sulphate
post partum haemorrhage management
ABCDE
cross match 6 units of packed red cells
warm crystalliod fluid
uterine massage
oxytocin
carboprost
misoprostol
tranexamic acid
surgery
post partum mother has vaginal bleeding
abnormal vaginal discharge
lower abdominal pain
fever
retained products of conception
investigations for retained product of conception
ultrasound
what is a complication of post partum haemorrhage
sheehan syndrome
= drop in circulatory blood volume leads to avascular necrosis of pituitary gland
symptoms of sheehan syndrome
reduced lactation
amenorrhoea
adrenal insufficiency
hypothyroidism
