Obstetrics Flashcards
What are the key components of a history in pregnancy?
Amenorrhoea Previous periods Contraception Whether planned pregnancy Date positive pregnancy test Smoking, alcohol, drugs, infections, blood group
What are the criteria for instrumental delivery?
Adequate analgesia
Abdo exam: head either 1/5 or 0/5 palpable
Vaginal exam: fully dilated, known fetal position
Adequate maternal effort and regular contractions for ventouse
Empty bladder
What are the complications of instrumental delivery?
Genital tract trauma Haemorrhage Infection Fetal scalp oedema Bruising Facial nerve palsy
What are the indications for emergency C-section?
Placenta praevia Breech Abnormal CTG Cord prolapse Delay in 1st stage
What are the indications for elective C-section?
2 previous LSCS Maternal disease eg pre-eclampsia Maternal request Active genital heroes HIV depending on viral load Twin pregnancy if twin 1 not cephalic
What are the complications of C-section?
Haemorrhage Gastric aspiration Bladder or bowel injury Infection VTE Future pregnancy
What should be done at a pregnant lady’s first contact with a healthcare professional?
Folic acid 400mcg daily
Food hygiene
Smoking cessation, drug and alcohol use
Screening: haemoglobinopathies, anomaly screen and screening for down’s
When is the “booking” appointment?
Ideally by 10 weeks
Who should have screening for gestational diabetes?
BMI over 30 Previous macrosomic baby >4.5 kg Previous gestational diabetes 1st degree family history Ethnicity Hypertension Pre-eclampsia
What are the risk factors for pre-eclampsia?
>40 Nulliparity / pregnancy interval >10y Family history Previous history BMI>30 Hypertension Renal disease Multiple pregnancy
What are the symptoms of pre-eclampsia?
Severe headache Problems with vision Severe pain just below ribs Vomiting Sudden swelling of face, hands or feet
What is the routine screening for Down’s syndrome?
Combined test between 11 and 14 weeks
Nuchal translucency, beta-hCG and PAPP-
Confirmatory diagnostic CVS or amnio if positive
What is the quadruple test for Down’s syndrome?
Can be used from 14+2
hCG, AFP, uE3 and inhibin-A
What is defined as high risk for Down’s?
1 in 150
This is the level at which patients are offered further testing (CVS or amnio)
When is the anomaly scan done?
Between 18 and 21 weeks
What is the purpose of the anomaly scan?
Reproductive choice (TOP)
Parents can prepare
Managed birth in a specialist centre
Intrauterine therapy
How many appointments do women have in an uncomplicated pregnancy?
10 for primips
7 for multi
What happens at every antenatal visit?
BP and urinalysis
From 24: symphysis-fundal heigh
From 36: check presentation
When is anti-D prophylaxis given?
28 weeks
What are the common symptoms of pregnancy?
Nausea and vomiting Heartburn Constipation Haemorrhoids Vaginal discharge Varicose veins Backache
What happens in pregnancy over 41 weeks?
Offer membrane sweep
Induction if beyond 41
If IOL declined after 42 weeks, increased surveillance with CTG and USS
What is the management of breech presentation at term?
Offer external cephalic version in uncomplicated singleton
What is the management of baby blues?
If not resolved after 10-14 days, assess for PND. If symptoms persist then seek urgent further action
How do you manage perineal pain postnatally?
Offer to assess
Signs of infection, wound breakdown or non-healing require urgent action
NSAIDs, topical cold therapy