Obstetrics Flashcards
Eclampsia red flags + Emergency Mx?
Headache, epigastric pain, breathlessness, visual disturbance
Periorbital oedema, Hyperreflexia, clonus
give maternal steroids up to 36wks
O2 + mag sulfate (control fits) + labetalol
Possible sensitisation events for Rhesus
TOP, ERPC after miscarriage ECV Blunt abdo trauma Amniocentesis or CVS Intrauterine death Delivery Antepartum haemorrhage
Mx of IUGR (high risk woman)
Screen for pre-eclampsia
Minimise risks + treat maternal illness
Serial scans: Liquor volume, fetal growth, umbilical artery flow
Primary PPH causes? (4Ts)!!
Tone - atonic (most common cause)
Tissue - retained placenta w/ long 3rd stage (>30mins)
Trauma - vaginal/cervical tear
Thrombin - assoc. pre-eclampsia / DIC
> 500ml - minor
1000ml - major
1500ml - massive
Special test for Rhesus -ve ladies - esp if large ante/post-partum haemorhage?
Kleihauer test - looks for fetal blood cells in maternal circulation
Causes of polyhydramnias?
DITCH
Diabetes - causes fetal polyuria = ^AM
Idiopathic/infection (parvovirus/CMV)
Twins - (+TTTS)
Congen abnormalties (e.g. fetal duodenal atresia-swallow difficulty)
Heart failure (due to VSD/Down’s) - causes fetal polyuria (due to ^BNP)= ^AF
Risks of polyhydramnios? (6 Ps)
Placental abruption Pretty unusual lie Premature labour Prolapse cord Post partum haemorrhage Perinatal mortality
4 main indications for induction? (4 Ps)
Post dates
Pre-labour rupture of membranes
Pre-Eclampsia
Plus Diabetes
Diabetes risks in pregnancy?
SMASH Shoulder dystocia Macrosomia Amniotic fluid excess - polyhydramnios Stillbirth Hypertension + neonatal hypoglycaemia
+Miscarriages + congenital malformations = if preceding diabetes
Gestational diabetes levels?
5, 6, 7, 8
Fasting >5.6
2hours post glucose >7.8
When to give Aspirin 75mg as prophylaxis for pre-eclampsia?
ECLAMPT Existing hypertension CKD Lupus Anti-phospholipid Maternal diabetes - pre-existing Previous hypertension in pregnancy Twins
(+nulliparity + obesity + Fam Hx)
Complications of pre-eclampsia? Fetal + Maternal
FIP (fetal) SHAME (maternal)
Fetal growth restriction
Intrauterine death
Premature delivery
Stroke HELLP Abruption of placenta Multi-organ failure (+DIC +/- death) Eclampsia
Failure to progress in labour - 3 causes?
3 Ps
Power
-Inneffective uterine contraction - induction
-Hyperactive uterine contraction - terbutalline
Passenger
- big baby? bid head? (head swelling during delivery - caput)
- Presentation? -breech/brow/face/shoulder
- Position? - Normal = OT@inlet + OA@outlet
Passage
-Small pelvis?
General Obs risk factors
Nulliparous Obese Twins Fam Hx Personal Hx Old (40yrs+)
When deliver monoamniotic Monochorionic?
32 weeks!
Types of Small for gestational age - which is IUGR?
SWAN
Starved small (IUGR) - pre-eclampsia, drug/alcohol abuse
Wrong small - i.e. wrong dates
Abnormal small - congentital/chromosomal things
Normal small - genetic (growth velocity ok)
Complications of prematurity
What reduces risk of these? Drug!
Heads, hearts, lungs, and guts (lungs and guts) x2
..and Retinitis drives me nuts
Resp distress Interventricular haemorrhage necrotising enterocolitis (retinitis) congenital heart abnormalities - patent ductus!
Maternal steroids!!! - IM dexa
High risk factors for IUGR?
SHITS (common) CRAP (rare) Smoking Hypertension & pre-eclampsia IUGR previous Twins Previous stillbirth
Cocaine use
Renal disease
Antiphospholipid
PAPPA levels low
Shoulder dystocia maneouveurs?
McRoberts
Suprapubic pressure
Episiotomy (to allow for complicated)
Woodscrew (deliver posterior arm + rotate shoulder)
Break clavicle
Zavanelli
CST. What? When? What’s covered?
What if missed? What’s covered in that?
Down syndrome scan
11-14 weeks
Nuchal translucency on USS, hCG, PAPP-A
Quadruple test (14-20weeks - late bookers) hCG, AFP, Inhibin A, unconjugated oestriol
When is Anti-D prophylaxis routinely?
28 + 34 weeks
OGTT when routinely?
24-28 weeks
What’s attempted before induction?
Membrane sweep
3 stages of induction? whats given/done
Cervical ripening - Vaginal prostaglanding E2
Amniotomy - rupture of membranes
Cervical dilatation - oxytocin to generate contractions
Bishops score to indicate induction?
<5
Pre-term pre rupture of membranes what do you give?
steroids - lung dev!!
erythromycin delivery @ 34weeks
Hyperememsis gravidarum dx? Mx?
5% pre-preg weight loss, dehydration, electrolyte imbalance
1st anti-histamine - cyclizine
2nd ondansetron / metoclopramide
