Obstetrics

Question 1

How would you manage PROM at 26 weeks?

Answer 1

Cx swabs to exclude infection and prophylactic Abx commenced until the swab results are available.
If only normal flora identified - cease abx
Glucocorticoid therapy for 48hrs to improve fetal lung maturity and reduce risk of intracranial bleeding
transfer to tertiary centre
assess white cell count and CRP every 2-3 days looking for evidence of possible uterine infection
CTG assessment every 2-3 days - abnormality often first sign of subclinical uterine infection
Give contraction-inhibiting drugs (IV salbutamol or nifedipine) if uterine contractions start before steroid therapy given.
Prolong gestation in the absence of infection is aim.

Question 2

What are the salient features of an obstructed labour?

Answer 2

Moulding of the fetal head with caput formation; cervical oedema, fetal tachycardia, station of the fetal head at or above the IS, and >2 finger breadths of head palpable above the pelvic brim when the lowest point of the head is at the IS.

Question 3

What are some common side effects of syntocinon?

Answer 3

Syntocinon is oxytocin which stimulates smooth mm contraction.
S/Es = uterine hypertonus and tetany with inevitable fetal distress. Uterine rupture is a risk, esp if multip. Water intoxication is a risk where the infusion of fluid does not contain electrolytes
HypOtension

Question 4

When is Ergometrine CI?

Answer 4

Don’t use in pre-eclampsia, severe fibroids, CVD, htn or IHD
Possible side effects include nausea, vomiting, abdominal pain, diarrhea, headache, dizziness, tinnitus, chest pain, palpitation, bradycardia, transient hypERtension

Question 5

What is syntometrine?

Answer 5

Combo of oxytocin and ergometrine

Question 6

medical management of Ectopic is ok under what 7 conditions?

Question 7

How is medical management of Ectopic achieved?

Answer 7

IM Methotrexate.
F/U BHcg at 4 days time then weekly till zero.
*Avoid preg for 3/12 post due to methotrexate.