Obstetrics Flashcards

1
Q

Define antepartum haemorrhage

A

A vaginal bleed that occurs after 24 weeks gestation

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2
Q

What is abruptio placenta?

A
  • It is when the normally positioned placenta has separated from the uterus before delivery
  • There is continuous severe abdominal pain
  • Blood is dark with red clots
  • Absence of fetal movement following bleeding
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3
Q

What are the risk factors for Abruptio placenta?

A
  • Previous abruptio placenta (10%; 25%)
  • Pre-eclampsia / Hypertensive disorder of pregnancy
  • Smoking
  • IUGR
  • Poor socio-economic circumstances
  • History of abdominal trauma
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4
Q

What are the clinical findings in abruptio placenta?

A
  • Patient is shocked out of proportion to blood loss
  • Severe abdominal pain
  • Tonically contracted hard and tender uterus
  • Rigid abdomen
  • Fetal parts not palpable
  • Uterus big for dates
  • Low Hb
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5
Q

What is the classification of abruptio placenta?

A
  • Grade 1 - Small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother.
  • Grade 2 - Mild to moderate amount of bleeding, uterine contractions, the fetal heart rate may shows signs of distress.
  • Grade 3 - Moderate to severe bleeding or concealed (hidden) bleeding, uterine contractions that do not relax (called tetany), abdominal pain, low blood pressure, fetal death.
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6
Q

What is the management of abruptio placenta?

A
  • If in doubt DO NOT PV!
  • Certain signs and symptoms of abruptio - PV
  • If cervix >9cm - ROM and NVD or emergency C/S
  • If fetus not viable - NVD
  • While preparing for delivery - resus and intrauterine resus
  • If fetal distress + viable fetus - C/S
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7
Q

What is Placenta preavia?

A

When the placenta is implanted completely or partially in the lower segment of the uterus

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8
Q

What are the risk factors for placenta preavia?

A
  • Grande multiparity (>5)
  • Previous C/S
  • Multiple pregnancy
  • Threatened abortion
  • Abnormal presentation
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9
Q

What are the clincal finding of placenta preavia?

A
  • Patient shocked in proportion to blood loss
  • Painless bleeding and bright red in colour
  • Uterus soft and non-tender
  • Fetal parts easily palpated and FH present
  • Abnormal presentation
  • Fetal head high in cephalic presentation
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10
Q

What is the classification of placenta preavia?

A
  • Minor
    Type I - Low-lying placenta - placenta implanted in the lower uterine segment >2cm from the os
    Type II - Marginal placenta previa - placental edge at margin <2cm from the internal os
  • Major
    Type III - Partial placenta previa - internal os partly covered by placenta.
    Type IV - Complete placenta previa - internal os completely covered by placenta.
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11
Q

What is the management of placenta preavia that is not bleeding?

A
  • <38 weeks and not bleeding
  • U/S to localize placentae
  • Hospitalized, bed rest, conservative management till 38 weeks / active bleeding
  • steroids for lung maturity if >28 and <34
  • > 38 weeks
  • U/S to localize placentae
  • PV in theater if no U/S and C/S
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12
Q

What is the management of placenta preavia that is bleeding?

A
  • > =38 weeks + bleeding
  • If actively bleeding - C/S
  • Grade 1 - ROM, NVD
  • Grade 2 - C/S
  • 36 weeks + grade 4 - Emergency C/S
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13
Q

What are the types of Antepartum haemorrhage?

A
  • Abruptio placentae
  • Placenta preavia
  • Ruptured uterus
  • Decidual bleeding
  • Vasa Placentae
  • Cervical cancer
  • Local lesions
  • APHUO
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14
Q

What are the causes of Postpartum haemorrhage?

A
  • Primary
  • Uterine atony
  • Contracted uterus
  • Uterine inversion
  • Lower genital tract laceration
  • Coagulopathy
  • Haematoma
  • Secondary
  • Endometriosis
  • Haematoma
  • Gestational trophoblastic neoplasm
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15
Q

What is the management of postpartum haemorrhage?

A
  • Prevention
  • Refer to higher level of care
  • Antepartum correction of anaemia
  • Consent for possible hysterectomy
  • Counselling regarding sterilization
  • Medical
  • Uterine atony
    • Fundal massage
    • Empty bladder
    • Oxytocin infusion
  • No retained products of conception
    • Misoprostol PR
    • Prostin
  • Surgical
  • Local suturing
  • Uterine packing
  • Subtotal abdominal hysterectomy
  • B-lynch suture
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16
Q

What is the definition of preterm labour

A

The onset of labour before 37 completed gestational weeks OR if the gestation is unknown when the estimated fetal weight is less than 2500g

17
Q

What are the causes of preterm labour?

A
  • Maternal
  • Chorioamonionitis
  • Pyrexia of other causes
  • Cervical incompetence
  • Fetal
  • Multiple pregnancy
  • Congenital fetal anomaly
  • Placental
  • Placenta preavia
  • Abruptio placenta
18
Q

What are the risk factors for preterm labour?

A
  • History of PTL
  • Unbooked - No ANC
  • Smoking, EtOH
  • Coitus in second half of pregnancy
19
Q

Management of Preterm labour?

A
  • Determine GA
  • <24 weeks - Inevitable abortion
  • 24-33 weeks - Suppression
  • 34-36 weeks - If pulmonary mature – allowed to continue
  • Any fetal distress ? - Prompt delivery if viable
  • Treatable causes addressed (eg pyelonephritis)
  • Suppression of labour
  • CCB (Nifedipine)
  • Salbutamol (acute suppression, eg cord prolapse)
20
Q

Contraindications for suppression of labour?

A
  • Fetal distress
  • > 34 weeks OR <24 weeks
  • Chorioamnionitis
  • Congenital abn incompatable with life
  • Pre-eclampsia
  • APH of unknown cause
21
Q

DDx for poor SF-growth?

A
  • Constitutional (familial)
  • Fetal
  • congenital abnormalities
  • congenital infection
  • Placental insufficiency
  • Pre-placental (malnutrition, PE)
  • Abruptio placentae
  • Post-term pregnancy
22
Q

DDx for large for gestational age

A
  • Wrong dates
  • Maternal obesity
  • Multiple pregnancy
  • Polyhydramnios
  • Macrosomia (DM)
  • Uterine leiomyomas
23
Q

DDx for Polyhydramnios

A
  • Multiple pregnancy
  • Maternal Diabetes
  • Fetal anomaly
    • spina bifida
    • anencephaly
    • oesophageal atresia
24
Q

DDx for oligohydramnios

A
  • IUGR

- Urinary tract obstruction/abnormality of the fetus

25
Q

Management of Breech presentation at term

A
  1. External cephalic version
  2. Counsel about mode of delivery
    - C/S - elective at 39 weeks
    - Vaginal delivery upon request if suitable

Vaginal Birth:

  • If good progress in labour, allow for spontaneous delivery to the scapula
  • Assist delivery of the head
26
Q

Management of Cord prolapse

A

A. General

  • Cord presentation – do C/S
  • Cord prolapse – Indication for immediate delivery if viable

B. Assessment

  • Replace cord in vagina or cover with warm, wet towel
  • Avoid unnecessary handling
  • Determine the degree of dilatation of cervix
  • Determine nature and station of presenting part
  • Elevate presenting part digitally
  • Confirm that fetus is alive by lightly palpating the pulsatile cord and confirm viability

C. Delivery (only if longitudinal, full dilatation, presenting part at pelvic floor)

D. Tocolysis

  • Reassure patient
  • Administer oxygen by face mask
  • Tocolytic – Salbutamol
  • Position patient in knee-chest position or insert 300ml into bladder with catheter

E. C-section

  • Prepare for fetal resus
  • Empty bladder
  • Prophylactic antibiotics
27
Q

What is Gestational Diabetes?

A

Diabetes which develops in pregnancy and resolves spontaneously after delivery

28
Q

What are the complications of gestational diabetes?

A
  • Infection - candida and UTIs
  • Congenital abnormalities
  • Pre-eclampsia
  • Polyhydramnios
  • Large baby - Cephalopelvic disproportion / shulder dystocia
  • Increased risk of PPH
  • Neonatal hypoglcaemia
  • Hyaline membrane disease
29
Q

Management of Gestational diabetes

A
  • Admit to secondary level of care
  • Control blood sugar - Diabetic diet and ?Metformin
  • Adjust insulin levels accordingly
  • @36 weeks test placental function and determine fetal size
  • Induce labour if macrosomia at 36 weeks
  • @38-40 weeks induce labour