Obstetrics Flashcards
What is the management for Hyperemesis Gravidarum?
- IV fluid replacement
- Metclopromide or cyclizine
- Thromboprophylaxis with enoxaparin + stocking
- Avoid dextrose but correct electrolytes
What type of laxatives should you avoid in pregnancy?
- Stimulant
How do you define small for gestational age?
< 10th centil for age
What is the commonest cause of stillbirth?
Brain sparing effect of placental insufficiency
If there is evident IUGR, when should you deliver?
After 34 weeks ideally after 37
If a baby is larger for dates, at what weights should you consider an elective C-section?
- Diabetic - >4500g
- Non-Diabetic >5000g
What are the risks of Large for gestational age for baby?
- Neonatal death
- Birth trauma
- Hypoglycaemia
- Jaundice
What are the ranges for normal amniotic fluid in utero?
2cm - 8cm (outside of these boundaries = poly/Oligohydramnios)
What is Foetal Hydrops?
Abnormal accumulation of fluid in two or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin oedema
When are the first foetal movements felt?
18-20weeks
If a woman cannot feel movements what advice do you give?
- Lie of left side
- Focus for 2 hours
- If they do not feel 10 movements in 2 hours, contact midwife/MAU
- If first time, reassure that 70% pregnancies with 1 episode are uncomplicated
At which point should escalation be considered if no foetal movements are felt by?
24 weeks
What is the difference between PROM and PPROM?
- PROM = labour not started within 1hr of rupture, >37weeks
- PPROM = Membranes break before 37 weeks
Give 4 signs of Chorioamnionitis
- Maternal pyrexia/tachycardia
- Uterine tenderness
- Foetal tachycardia
- Offensive, yellow vaginal discharge
What is the management for PPROM <34 weeks?
- Betamethasone IM BD for one day
- Erythromycin for 10 days
- Admit 24hrs for close monitoring
- MAC twice a week with regular CTG and infection monitoring
What is the management for PROM (>37 weeks)
- Go home and come back in 24hours for induction
What advice is important when sending a mother home for PROM?
- Call MAC in infection risk/red flag
- Change pad every 4 hours
- No tampons, no sex, no soap
What risk to the foetus of CMV infection is there?
- Deafness
What is offered to women who get Rubella infection <16 weeks
- Termination
How do you define hypertension in pregnancy?
> 140/90 on more than one occasion
What is your target blood pressure treatment in pre-eclampsia/gestational hypertension?
<150/80-100 as over treatment can cause IUGR
What is the first and second line treatment for gestational hypertension if diagnosed before 20weeks
Labetolol
Nifedipine
Hydralazine
What is should be given if the woman has HTN from 12 weeks?
aspirin
What are red flag signs of Pre-eclampsia?
- Headache
- Visual disturbance
- Epigastric or RUQ pain
- Breathlessness