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National Diploma > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

What bp is considered preeclampsia in pregnant women?

A

greater than 140/90. They usually have vision problems too

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2
Q

What is seizures in pregnancy called?

A

Eclampsia (if they result from high blod pressure) I.e. Gestatational proetinuric hypertension (GPH).

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3
Q

What is the most common cause of seizures in pregnant women?

A

Epilepsy

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4
Q

What is placenta Previa?

A

Where the placenta is lying across the cervix (the opening to the uterus)

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5
Q

What are the signs of placenta previa?

A

Uncontrolled frank blood PV bleed
Usually painless
May present with shock (will need to be transported)

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6
Q

What are the changes to a womans body during pregnancy?

A 
Increased oxygen consumption
Raised diaphragm/ribs (so harder to compensate with breathing)
Increased cardiac output
increased blood volume
Increased coagulation
Uterus grows
Uterus may compress inferior vena cava
Skeletal ligaments and muscles relax
increased skin pigmentation
Kidneys work harder
Gut slows down
Gestational diabetes
Increase in oestrogen and progestrone
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7
Q

What are causes of bleeding in non pregnant women?

A

Abnormally heavy menstrual bleeding (menorrhagia)
Traumatic injuries
Infection/sexually transmitted diseases

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8
Q

What are causes of PV bleeding up to 20 weeks?

A

Threatened spontaneous abortion
Inevitable spontaneous abortion
Complete spontaneous abortion
Ectopic pregnancy

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9
Q

What is an ectopic pregnancy?

A

An embryos implants itself at a site outside of the uterus

Embryo implants in Fallopian tube
Leads to death of fetus and is life threatening to the mother
Growing fetus may cause the Fallopian tube to rupture at around 5-7 weeks
Pain, massive blood loss

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10
Q

What is spontaneous abortion?

A

Miscarriage

Generally prior to 24 weeks gestation

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11
Q

When does spontaneous abortion require transport?

A

When:
Pain is significant
Pain is different to that of menstrual pain
Bleeding is clinically significant

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12
Q

What is antepartum haemorrhage?

A

PV bleeding from 20-40 weeks pregnancy

All patients should be transported to hospital

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13
Q

What is placental abruption?

A

Bleeding due to premature separation of the placenta from the uterine wall.
Although bleeding can be significant, it can be concealed in the uterus in 20% of cases.
May be present with pain an PV bleeding

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14
Q

How may placental abruption present?

A 
Over 20 weeks pregnant
May be PV bleeding
Pain
Shock
Sepsis
Fetal compromise
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15
Q

How do we recognise shock in pregnant women?

A

Pregnant women have an increased blood volume and can lose more than one litre of blood without showing signs of shock.
If they are showing signs of shock then by definition it is already severe.

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16
Q

What is hypertension in pregnancy?

A

Blood pressure greater than 140/90mmHg (or a 20mmHg rise in bp)

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17
Q

What is GPH?

A

Gestational Proteinuric Hypertension

18
Q

What is placental abruption?

A

Bleeding due to premature separation of the placenta
Massive bleeding
Can be partial or complete
Pain/PV bleeding (bright red blood)
Massive maternal haemorrhage, shock, sepsis, fetal compromise
Bleeding can be internal so important to look for signs of shock

19
Q

What is preeclampsia (GPH)?

A

Hypertension with protein in the urine, with or without generalised oedema.
Associated with liver and renal failure, cerebral ischemia and fetal growth restrictions.

20
Q

How are seizures associated with GPH?

A

Preeclampsia may progress to where seizures occur.

Seizures with GPH can lead to fetal or maternal death or permanent CNS damage.

21
Q

How do we manage GPH?

A

Manage airway, breathing and circulation and call for back up.
Keep noise and stimuli to a minimum.

22
Q

How do we manage premature labour?

A

Transport immediately to hospital.

Prepare for neonatal resuscitation.

23
Q

What is premature labour?

A

Onset of labour prior to 37 weeks gestation.

24
Q

What is supine hypotension?

A

Low blood pressure while lying supine. Commonly occurs in pregnant women as the weight of the baby impedes venous return through the vena cava.

25
Q

How do we manage supine hypotension in pregnant women?

A

Tilt the patient to their left, or if this cannot be achieved, manually displace the uterus to the left.

26
Q

What are the three stages of labour?

A

Onset of labour with cervix fully dilated.
Fully dilated until delivery of baby
Delivery of placenta

27
Q

What are some questions relevant to obstetric patients?

A

Is this your first baby?
When are you due?
Have your waters broken?
What are the contractions like?
How frequent are the contractions?
Do you feels and urge to open your bowels or push?
Have you had any antenatal care?
Have there been any problems with the pregnancy?
Have there been any problems with previous pregnancies?

28
Q

How do we manage a woman in labour?

A 
Palpate the abdo during a contraction
Inspect the perineum
Obtain vital signs
Reassurance
Transport or deliver at home
29
Q

How do we deliver a baby?

A

Allow patient to adopt position that she wants to
Consider pain relief during contractions
Create a warm and private environment
Set up maternity pack
Clean working space with towels etc available.
Support babys head and shoulders as they appear without applying any traction.

30
Q

What do we do post delivery?

A

Note time of birth
Baby will appear cyanosed - this is normal and will resolve after a few minutes.
Place on mothers abdo
Dry and stimulate
clear nose and mouth of secretions if required
Encourage breast feeding
Place towels around baby for warmth, turn on vehicle heaters

31
Q

How do we cut the cord?

A 
Wait for cord to stop pulsing
place a clamp on cord 5cm from baby
Places second clamp 10cm from baby
cut between clamps
Offer cutting to parents
32
Q

What do we do if baby gets stuck?

A

Get mother to grab her knees and pull them back to her chest and push as hard as she can with the next two contractions.
If this fails place your hand directly above the pubic bone pushing firmly straight towards the patients back
If this fails transport urgently

33
Q

What is a prolapsed umbilical cord?

A

When umbilical cord appears in the vagina ahead of the baby.
This is an emergency. The umbilical cord can get compressed between the fetus and the bony pelvis which carries a high risk of fetal death due to lack of blood flow to/from the baby.

34
Q

How do we manage a prolapsed umbilical cord/breech delivery?

A

Transport urgently
Tell patient not to push unless birth is imminent
Position patient so that her hips are higher than her shoulders

35
Q

What is post partum haemorrhage?

A

Abnormal PV bleeding >500ml
Usually with severe shock
Bleeding may be in to uterus so may not be visible

36
Q

How do we treat post partum haemorrhage?

A

Trasnport urgently - request back up
Treat as for hypovolemic shock
Encourage breastfeeding - stimulate nipples for 15 min (pt or partner)
Feel for uterus and massage firmly with two hands
if bleeding is severe and patient is deteriorating severely apply bimanual compression

37
Q

Newborns: What do we do if breathing is inadequate and HR is less than 100bpm?

A

Ventilate with manual ventilation bag at a rate of 1breath per second, using PEEP set to 5 without added oxygen. Monitor HR.

If HR fails to improve consider an LMA and oxygen.

38
Q

Newborns: What if during resus HR drops to less than 60bpm?

A 
Start CPR at a ratio of 3:1
Continue to focus on ventilation
Consider placing an LMA
Gain IV or IO access but good CPR takes priority
Give 20ml/kg bolus of saline
39
Q

Newborns: What if during resus HR raises to greater than 100bpm?

A

Dry the baby. Keep them warm.
Do not give oxygen.
Continually monitor breathing and heart rate.

40
Q

What is normal neonatal perfusion?

A

Neonates tend to have cyanosed peripheries for a few hours after birth.

41
Q

What are normal neonatal saturations?

A

60% at 2 minutes

90% at 10 minutes

42
Q

How do we initially inflate lungs on neonates?

A

If rise and fall is not sufficient during ventilation we can increase pressure by closing the relief valve on the BVM for a few breaths.

National Diploma (15 decks)

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