Obstetrics Flashcards
1
Q
miscarriage
A
- We need to have a look at what is going on by doing a TVUS.
- Since you’re bleeding, we also need to do some blood tests for your blood count and blood type.
- We will also check at the time the levels of the pregnancy hormone which we will need to repeat in 48 hours.
- i am going to refer you to the early pregnancy clinic
- this wasn’t your fault and it doesn’t affect the odds of it happening next time
- depending on these results, they will treat it in one of 3 ways: wait, give you misoprostol, or surgery.
- they may give you some anti-D
2
Q
recurrent miscarriage
A
- we need to investigate whether there are any structural abnormalities of your womb by doing some imaging (pelvic US +/- MRI)
- we need to do parental karyotyping for chromosomal abnormalities
- check your blood for evidence of antiphospholipid syndrome, thyroid problems and clotting problems
- I will refer you to a recurrent miscarriage specialist
3
Q
ectopic pregnancy
A
- we need to double check you’re pregnant by doing a urine test
- we need to do an ultrasound to have a look at whether this is in fact an ectopic, and to see whether it has ruptured or not
- we need to do some blood tests (G&S, crossmatch, FBC, clotting, U/Es)
- [you’re very unwell, so we need to put in two large cannula into your arms and start resuscitating you now with a blood transfusion and fluid monitoring]
- if it has ruptured, you will need surgery to remove the pregnancy as well as the tube the pregnancy is in.
- if we see that it is small, hasn’t ruptured and isn’t causing many problems, we can have the discussion as to whether we simply give you methotrexate, or whether we let your body resolve this by itself. In either of these causes, you will need 48 hourly blood tests to make sure the hormone level is dropping adequately.
- we need to give you anti-D
4
Q
molar pregnancy
A
- we need to do an ultrasound because molar pregnancies have a typical snowstorm appearance
- we also need to do a hormone blood test as this can be high in molar pregnancies
- you will need surgery to remove this, and we need to send off the sample to histology because there is a very small chance it could have progressed to a type of cancer. We will give you Anti-D if required.
- i will then refer you to a specialist clinic
- you will need to use contraception for the next 12 months
5
Q
placenta praevia
A
- we need to do an ultrasound to look at the position of the placenta
- we will do some blood tests for your blood count and blood group
- we can consider doing an ultrasound (AFI) for your baby to check it is happy and healthy
- since this is a mild bleed I would be happy to monitor you carefully and do an elective caesarean at 39 weeks
- since this is a heavy bleed we may need to do an emergency caesarean
- [since you’re less than 32 weeks, we won’t do anything now apart from monitor you again at 32 weeks because these sometimes resolve themselves]
- [since you’ve had a caesarean before we need to investigate you for placenta accreta]
- [since you’re very unwell we need to resuscitate you]
6
Q
placental abruption
A
- we need to do an array of blood tests (FBC/U&E/clotting/G&S/cross-match)
- we need to catheterise you and measure your urine output
- if it is mild, we can get away with waiting and doing serial ultrasounds
- if it is severe, we may need to consider early delivery
7
Q
hyperemesis gravidarum
A
- we need to do an array of blood tests because you risk being dehydrated which can affect many organs (U&Es/LFTs/clotting/FBC)
- we also need to test your urine
- you need to go NBM until you are fully rehydrated, which we will do intravenously.
- we can give you an anti-sickness medication as well
- we must also give you vitamin B1 as this can become depleted when you vomit a lot.
8
Q
PIH
A
- we need to do a blood pressure now and also screen you for pre-eclampsia which will involve a blood test and a urine sample.
- we need to assess your risk of developing PET by doing a special blood test assay (also a blood test)
- we can also assess your baby and check they are doing ok by doing an ultrasound scan
- we need to prevent you getting PET by giving you low dose aspirin as well as high dose vitD+Ca
- we will need to monitor you by doing 2x/week blood pressure and urine dip and 1x/2week scans for the baby.
- if you are >160 –> medicate as for PET
- if you are >140 –> DAU
9
Q
pre-eclampsia
A
- we need to do a full set of blood tests screen
- we need to do a urine dip to see whether there is any protein in your urine
- we need to measure your blood pressure
- we need to give you labetalol (or nifedipine if asthmatic) to bring your blood pressure down.
- magnesium will prevent you from developing eclampsia
- we need to deliver you by 36 weeks
- if it needs to be earlier than 34 weeks, we need to give steroids
- you will need follow up blood tests until 6 days after the pregnancy to make sure it is ok
10
Q
SGA/IUGR
A
- if you’re just at risk then we need to do serial SFH measurements
- if any of these are abnormal, then we’ll need to do an ultrasound and also a doppler scan for the baby
- if the baby is just small, then we can repeat the dopplers until 37 weeks, at which point we should induce you due to the risk of stillbirth
- the the baby has an abnormal doppler, we may need to delivery even earlier
11
Q
unstable lie/breech
A
- if it is before 37wks, don’t worry and recheck at 37wks
- ECV
- consider natural delivery, if not caesarean
12
Q
PROM
A
- we need to check whether there is any infection by doing some blood tests as well as doing a speculum to look at the liquor
- we can confirm PROM by doing the Actim PROM test
- we need to confirm lie by doing an ultrasound
- if infection –> deliver now
- if <36, erythromycin and 4 hourly ops till delivery at 36 weeks
- if >36 weeks, should induce now due to risk of infection but its your choice
13
Q
preterm labour
threatened preterm labour investigation
A
- TV-USS for cervical length
- fetal fibronectin assay
- USS for growth and presentation of baby
- if <34wks, tocolysis and steroids
- if >34 wks, accept its coming and ensure antibiotics, magnesium for neuroprotection and delayed cord clamping
14
Q
multiple pregnancy
A
- inform of risks: IUGR, PET, PIH, anaemia, diabetes, TTTS, haemorrhage, perinatal mortality 4x, preterm labour, miscarriage, congenital malformations.
- pregnancy will be consultant led, and there will be 3 extra growth scans (even more, every 2 weeks, if monochorionic due to TTTS)
- you will be screened for diabetes, pre-eclampsia and PET
- delivery will be on CDS with a CTG
- you will have natural birth unless the first baby is breech
15
Q
congenital malformations
A
- combined first trimester screening
- quad testing
- 20 week anomaly scan
- diagnostic tests (amniocentesis, CVS, NIPT)
- genetic counselling before diagnostic test
- continue with pregnancy or TOP:
- <9wks = medical mifipristone/misoprostol 48hrs
- > 9wks = surgical dilation and suction
