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Specialties Mx 2021 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Which patients are vaginal progesterone offered to?

A

Hx of spontaneous prterm birth (< 34 weeks)

Hx of midtrimester loss (>16 weeks)

Cervical length on USS (between 16-24 weeks) shows cervical length < 25mm

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2
Q

When is vaginal progesterone offered for prevention of preterm birth?

A

16-24 weeks until at least 34 weeks

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3
Q

When is prophylactic cervical cerclage offered?

A

Hx of spontaneous preterm birth (<34),
mid trimester loss (>16) and cervical length < 25mm

Hx of Cervical trauma AND cervical length < 25mm

cervical length scan between 16-24 weeks

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4
Q

When is rescue cervical cerclage provided?

A

Cervical dilation in the absence of uterine contractions between 16-27+6 weeks

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5
Q

What is offered in Preterm labour but NOT PPROM?

A

Tocolytics, increased risk of infection in PPROM

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6
Q

How is preterm labour managed?

A

IM Betamethasone 24mg, 2 doses 12 hours apart

Tovolytics given simultaneously, either:
- nifedipine (CCB)
2nd line: atosiban (Oxy receptor antagonist)

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7
Q

When are tocolytics contraindicated?

A

PPROM, active bleeding, signs of infection

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8
Q

When is magnesium sulphate given pre-term?

A

if birth is likely / planned within 24h

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9
Q

What is the dosing of mag sul for neuroprotection?

A

4g loading dose over 5-15 mins

then IV 1g / hour

until birth or for 24h

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10
Q

What can mag sul overdose lead to?

A

toxicity - RR depression and arrhythmia

monitor HR RR BP reflexes every 4h

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11
Q

What is the antidote for mag sul overdose?

A

10% 10mL calcium gluconate over 10 mins (stop mag sul)

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12
Q

What Ix are performed for diagnosing PPROM?

A

Sterile Speculum

Check for pooling in posterior vaginal fornix

if -ve: check for IGF protein 1 OR placental alphamicroglobulin 1

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13
Q

If PPROM is diagnosed, what is the Mx?

A
  1. Admit to antenatal ward
  2. Prophylactic ABx: 250mg Erythromycin QDS 10 days
    OR oral penicillin 10 days
  3. Offer Steroids, IM Betamethasone 24mg, 2 doses 12hours apart
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14
Q

What are the risk factors for PPROM?

A

smoking, STI, previous PPROM, multiple pregnancy

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15
Q

PACES: what do you need to explain for PPROM?

A 
RF
need to admit
want to keep baby in as long as possible 
ABx as infection can be dangerous 
Will be closely monitored with CTG
Explain why steroids are given

Discuss whether delivery is likely

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16
Q

What is the Mx for PROM?

A
  1. Admit to antenatal if evidence of chorioaminionitis or foetal distress, if no issues after check up they can go home to await onset of labour
  2. ABx prophylaxis after 24h if no labour still : erythromycin 250mg QDS
  3. intense clinical surveillance:
    - CTG
    - signs of infection
  4. Expectant management for 24h after ROM, as 60% go into labour
    - if past 24h, offer IOL
  5. Monitor neonate for 12 hours after
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17
Q

How is shoulder dystocia identified?

A

Turtling of foetus

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18
Q

How is shoulder dystocia managed?

A
  1. STOP PUSHING
  2. Call for senior help
  3. McRoberts
  4. Suprapubic Pressure
  5. Evaluate for Episiotomy
  6. Wood’s Screw Maneouvre - pressure on anterior aspect of posterior shoulder
    Rubin II - force anterior shoulder toward chest, turning foetus diagonal
  7. All fours
  8. Consider symphisiotomy, cleidotomy or Zavanelli
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19
Q

What are the types of breech position?

A

Frank - extended (most common)

Complete - flexed

Footling

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20
Q

How is breech position managed?

A
  1. ECV at 36 weeks
  2. Vaginal breech
  3. C - Section
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21
Q

When is ECV performed?

A

36 weeks if nulliparous

37 if multip

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22
Q

What is the success rate of ECV?

A

50%

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23
Q

When is ECV contraindicated?

A 
C section inevitable
Recent APH wihtin 7 days
abnormal CTG
ROM
Multiple pregnancy
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24
Q

What are the advantages of c-section over vaginal breech?

A

small reduction in foetal and maternal mortality

small increase in risk of complications for mother

affects future pregnancy e.g. praevia

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25
Q

What are the advantages of vaginal breech vs c-section?

A

40% reqiure c section anyway

ABSOLUTELY CONTRAINDICATED IF FOOOTLING

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26
Q

PACES: What needs to be explained for breech presentations?

A

RF: fibroids, poly/oligohydramnios, placenta praevia, uterine malformations, prematurity, fetal abnormalities

Explain what breech means

Offer ECV and explain risks (50% success, placental abruption, distress –> c section)

benefits of vaginal breech vs c section

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27
Q

What medication must be given following an ECV?

A

Anti-D within 72 hours

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28
Q

Describe the vaginal breech delivery

A

Induction NOT recommended

maternal position on all fours

  1. Hand’s off - only place thumbs on sacrum on ASIS
  2. Delivery of legs and lower body - flexed will deliver spontaneous, extended: perform Pinnard’s
  3. Shoulders: Winging of scapulae indicates baby is stuck, Loveset’s manoeuvre - rotate to transverse and pull arm down
  4. Head: Mariceau-Smelly-Veit manoeuvreL place baby on your forearm and flex head downward
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29
Q

What are the other malpresentations and how are they delivered?

A

Face:

  • chin anterior: vaginal delivery possible
  • chin posterior: delivery by c section only

Brow: Deliver by c section

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30
Q

What are the components of the BISHOP score?

A

Dilation of cervix

Consistency of cervix

Length of cervical canal

Position of cervix

Station of presenting part

all graded 0-3

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31
Q

What is the order of Induction of labour?

A

Vaginal Prostglandin E2:

  • tablet and gel: 1 dose, 2nd after 6 hours
  • pessary: 1 dose over 24 h

ARM: only if cervix is dilating and effacing, avoid if high / mobile presenting part -

IV Syntocinon:

  • offer if 2 hours after ARM labour not started
  • max 3-4 contractions over 10 mins
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32
Q

What are the risks of ARM?

A

inc risk of cord prolapse

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33
Q

What are the risks of iv syntocinon?

A

uterine hyperstimulation and uterine rupture (not good for VBAC)

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34
Q

What happens if induction fails?

A

rest period, attempt again, c-section

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35
Q

When is membrane sweeping offered?

A

40 weeks for nulliparous

41 weeks for multiparous

  • only if cervix beginning to dilate and efface*
  • exclude placenta praevia*
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36
Q

What can be used to induce labour following intrauterine death?

A

Mifepristone (anti-progesterone) and misoprostol (prostaglandin)

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37
Q

Which types of miscarriage is mifepristone contraindicated for?

A

missed or incomplete

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38
Q

How is unstable lie managed?

A

if mechanical - LSCS

37 week onward admission

ECV, ARM or LSCS considered

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39
Q

What is the success rate of VBAC?

A

72-75%

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40
Q

What factors improve success of VBAC?

A

spontaneous onset,
previous successful VBAC,
normal size baby and
vertex presentation

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41
Q

What are the risks of VBAC?

A

Uterine rupture

Scar rupture

Cord prolapse if augmented labour

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42
Q

What are the risks of Elective repeat C section?

A

Risk of accreta / praevia

likely needs C Section in future

avoids scar rupture and uterine rupture

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43
Q

What are some relative contraindications for VBAC?

A

> 2 previous c sections

need for IOL

Previous suggestions of cephalopelvic disproportion

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44
Q

What are some ABSOLUTE contraindications?

A

previous classical scar

previous uterine rupture

placenta praevia

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45
Q

PACES: what needs to be explained about VBAC?

A

Discuss options of VBAC and ERCS

Explain risks of uterine rupture

Explain risks of ERCS

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46
Q

How is umbilical cord prolapse managed?

A
  1. CALL FOR HELP
  2. Prepare for emergency delivery in theatre
  3. if cord outside of introitus, avoid handling but maintain warmth and moisture
  4. Elevate presenting part (manually or fill bladder)
  5. Reposition mother, knee to chest or left lateral and head down
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47
Q

How is uterine rupture managed?

A
  1. CALL FOR HELP
  2. ABCDE
    - 2x large bore cannulae
    - bloods, G&S, clotting, FBC
    Transfuse blood
  3. expedite delivery and urder laparotomy
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48
Q

What is the doseage of prophylactic uterotonic drugs?

A

IM oxytocin 10iv if vaginal

IM oxytocin 5iu if c section

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49
Q

How is a minor PPH managed?

A

ABCDE
HELP

1x IV Access
Bloods for G and S, FBC
Warm, crystalloid infusion
HR RR and BP every 15 mins

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50
Q

How is major PPH managed?

A

HELP
2222 and major obstetric haemorrhage protocol

  1. lie patient flat
  2. 2x large bore cannulae
  3. urgent bloods, FBC, clotting, group and save
    transfuse
  4. HR, RR and BP constantly
  5. Massage uterus
  6. IV/IM sytocinon / IM ergometrine (unless hypertensive or heart disease) or IV syntometrine
  7. IM carboprost (unless asthmatic)
  8. balloon tamponade
  9. surgical measures, iliac artery ligation, UAE, hysterectomy
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51
Q

What advice is given pre-conception to mothers with chronic HTN?

A

stop ACEi, ARBs, thiazide-like diuretics and thiazides within 2 days of positive pregnancy test

contact GP for alternatives:

  1. labetalol unless asthmatic
  2. nifedipine
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52
Q

What advice is given antenatally for women with chronic HTN?

A

c: stop smoking, reduce salt and exercise

monitoring: BP, weekly if poorly-controlled and every 2-4 if well controlled
serial growth scans every 4 weeks from 28-36 weeks

Medical :75mg aspirin from 12 weeks to delivery

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53
Q

What is the cut off for offering induction for women with chronic HTN < 37 weeks?

A

if <160 / 110 do not offer induction < 37 weeks

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54
Q

how are women with chronic HTN managed postnatally?

A

monitoring: BP daily for the first two days after birth

once on day 3 and 5

follow up with GP at 2 weeks

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55
Q

What advice is given to mothers with diabetes mellitus pre-conception?

A

stop all meds except insulin and metformin

5mg folic acid - needs to be prescribed

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56
Q

Which conditions require high dose folic acid?

A

DOSEI

diabetes, obese, sickle cell, epilepsy, (auto)immune

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57
Q

What antenatal advice is given for women with diabetes?

A

seen in joint obstetric and diabetic clinic every 1-2 weeks

ensure she is up-to-date with retinal / renal screening (within the last three months, otherwise offer)

HIGH DOSE FOLIC ACID AND 75MG ASPIRIN FROM 12WEEKS TO PREVENT PRE ECLAMPSIA

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58
Q

How are women with diabetes monitored?

A

cap BM 7x a day

pre prandial < 5.3
1 hr post prandial < 7. 8

specialist foetal cardiac scan 19-20 weeks
SERIAL GROWTH SCAN EVERY 4 WEEKS 28-36

REPEAT RETINAL AND RENAL (IF ABNORMAL AT BOOKING - 16-20 WEEKS, IF NORMAL: 28 WEEKS)

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59
Q

What medications do diabetic women need to take when pregnant?

A

high dose folic acid - pre conception to 12 weeks

low dose aspirin (75mg) - 12 weeks to delivery

advise metformin increase in 2nd half of pregnancy

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60
Q

When are women with diabetes advised to give birth?

A

37-38+6 elective

IOL or c section

be careful of adminstering corticosteroids

NO LATER THAN 40+6

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61
Q

What is the ideal BM during labour and how is this controlled?

A

4-7, sliding scale of insulin

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62
Q

What postnatal checks are done for diabetic women?

A

check BM within 4 hours of birth

return to pre-pregnancy metformin and insulin dose immediately after delivery

63
Q

How are hypothyroid women monitored antenatally?

A

every 2-4 weeks, TSH < 4

FOR HYPOTHYROID, INCREASE THYROID DOSE BY 25MG

64
Q

When are TFTs checked postnatally?

A

at 6-8 week postnatal check

65
Q

How are hyperthyroid women monitored antenatally?

A

every 2-4 weeks, TSH < 4

continue carbimazole / propylthiouracil at lowest possible dose

  • safety net about agranulocytosis
  • lower dose if nec. throughout pregnancy
66
Q

How are asthmatic women managed?

A

ALL medication safe

advise about technique, smoking cessation

intrapartum: no ergometrine or carboprost, regional anaesthesia >general for c section

NO LABETALOL

67
Q

How are women with heart disease advised pre-conception?

A

avoid all ACEi, ARBs, thiazide diuretics and statins and warfarin

68
Q

How are women with heart disease managed antenatally?

A

jOINT CARDIAC AND OBSTETRIC CLINIC EVERY 2-4 WEEKS UNTIL 20 WEEKS, EVERY 2 WEEKS UNTIL 24 AND WEEKLY AFTER

maternal echo at booking scan and at 28 weeks
specialist foetal cardiac scan at 22 weeks

VTE prophylaxis with LMWH SC

69
Q

How are women with heart disease managed intrapartum?

A 
avoid IOL 
Epidural where possible 
Prophylactic ABx for structural defect 
NO ERGOMETRINE only syntocinon
minimise 2nd stage (e.g. intrumental)
70
Q

How are women with heart disease managed postnatally?

A

transfer to HDU for 12-48h

arrange obstetric and cardiac F/U

71
Q

Which conditions needLMWH from 12 weeks?

A 
Previous hypertension in pregnancy 
Small baby 
Chronic HTN 
CKD 
autoImmune 
Diabetes
Sickle Cell Disease

HACCSSD

72
Q

What advice are epileptics given pre-conception?

A

reduce to monotherapy, ideally lamotrigine
NEVER VALPROATE

5MG FOLIC ACID PRE CONCEPTION UNTIL 12 WEEKS

73
Q

How are epileptics managed antenatally?

A

joint epilepsy and obstetric clinic

serial growth scans from 28-36 weeks eery 4 weeks

advise to joining the UK EPILEPSY IN PREGNANY REGISTER

74
Q

How are epileptics managed postnatally?

A

advise on safe handling

recommend breast feeding

start on contraception

baby needs 1mg of Vitamin K especially if on phenytoin

consider long acting benzo / clobazam if high risk of intrapartum seizure

75
Q

What conservative measures are taken to manage UTIs

A

plentiful fluid intake

simple analgesia

76
Q

Which analgesiac is absolutely ocntraindicatedi n breastfeeding?

A

aspirin

77
Q

What is the medical management for UTI?

A

nitrofurantoin 50mg QDS 7 days
- avoid if full term

2nd line: amoxicillin or cefalexin (if no improvement in 48h)

trimethoprim is a folate synthesis inhibitor

78
Q

How is syphillis managed?

A

benzylPenicillin IM + GUM for contact tracing

79
Q

Describe primary manifestation of syphillis

A

painless genital ulcer 3-6 weeks after infection (condyloma lata)

80
Q

Describe the secondary manifestation of syphillis

A

6 weeks to 6 months after

widespread maculopapular rash

81
Q

When is toxoplasmosis most dangerous to baby?

A

first trimester but low infectivity

82
Q

When is toxoplasmosis most infective?

A

3 rd triemster

83
Q

What is the management of toxoplasmosis in pregnancy?

A

spiramycin 2-3g OD 3/52

consider TOP or more aggressive Tx e.g. sulfadiazine

84
Q

How can toxoplasmosis be avoided?

A

avoid raw meat and cat litter

85
Q

How is CMV treated?

A

no tx availale

refer to tx foetal medicine specialist for regular surveillance

foetal US examination every 2-4 weeks from Dx and MRI at 28-32

if evidence of foetal infection: continue with expectant management or TOP

postnatal Anti viral therapy (valganciclovir, ganciclovir)

86
Q

How is chickenpox managed during pregnancy?

A

Antenatal:
VZIG up to 10 days after exposure
800mg Aciclovir 5x/day for 7 days

refer to a specialist at 16-20 weeks for detailed US assessment

87
Q

What happens if chicken pox develops <7 after delivery, prior to delivery?

A

delay elective until 7 days after rash

arrange neonatal ophthalmic exam

give neonate VZIG and monitor for 28 days

88
Q

How is maternal parvovirus infection managed?

A

Bed rest, fluids

REFER TO FOETAL MEDICINE SPECIALIST WITHIN 4 WEEKS FOR REGULAR SURVEILLENCE

89
Q

What are the management options if foetal anaemia or foetal hydrops are suspected due to parvovirus?

A

expectant: spontaneous resolution occurs in 50% of cases

In utero transfusion: always offer if infection occurs in the first 20 weeks

sample blood from middle cerebral artery

90
Q

How is Listeria managed?

A

IV amoxicillin 2g every 6 hours for 14 days

91
Q

What sign may raise suspicion of listeria infection?

A

meconium staining of amniotic fluid

92
Q

When HSV infection the most dangerous?

A

primary infection within 6 weeks of delivery

93
Q

How is primary in first/second trimester Herpes managed?

A

Refer to GUM
PCR

400mg oral aciclovir TDS for 5 days

daily suppressive aciclovir from 36 weeks to delivery

OFFER VAGINAL

94
Q

How is primary herpes in the third trimester managed?

A

continue oral aciclovir until delivery (400mg TDS)

recommend elective C SECTION

if she chooses vaginal: intrapartum iv aciclovir

avoid ARM

95
Q

What are the risks of GBS for the neonate?

A

early onset sepsis

96
Q

How is GBS managed antenatally?

A

if detected incidentally, treatment NOT recommended as no reduction in GBS colonisation for delivery

97
Q

How is GBS managed intrapartum?

A

IV benzylpencillin 3g ASAP after onbset of labour

then 1.5g every 4 hours until delivery

mild allergy to pen = cephalospori n

severe = vancomycin

98
Q

When are antibiotics not needed for GBS?

A

elective c section

no sign of labour

intact membranes

99
Q

What are some risk factors requiring GBS prophylaxis intrapartum?

A

previous GBS

intrapartum fever
prolonged ROM > 18 h
GBS bacteriuria
incidental GBS finidng in current pregnancy

100
Q

How is GBS sepsis managed in the neonate?

A

IV penicillin and gentamicin

101
Q

How is chlamydia managed in pregnancy?

A

erythromycin or azithromycin

AVOID TETRACYCLINES

102
Q

How is HIV managed antenatally?

A

contact with joint HIV physicians and obstetrician clinic every 1-2 weeks

monitor viral load every 2-4 weeks at 36 weeks and delivery

if on ART, continue

if not: advise start of ART by 24th week

103
Q

How is HIV managed intrapartum?

A

DEPENDS ON VIRAL LOAD AT 36 WEEKS

< 50 copies - reassure that vaginal is possible

> 50 / co-existent HCV - elective c-section (at 38 weeks to reduce chance of spontaneous labour), intrapartum IV zidovudine

CLAMP CORD ASAP

104
Q

How is HIV managed postnatally?

A

advise not to breastfeed (in resource limited settings this may not be possible)

all newborns should receive ART within 4 hours of birth

  • low risk: zidovudine monotherapy 2-4 weeks
  • high risk: triple ART (zidovudine, lamivudine and nevirapine) for 4 weeks

direct viral amplification by PCR at birth, discharge, 6 weeks and 6 months)

105
Q

PACES: HIV counselling

A
  • explain need for joint obs and HIV clinic
  • explain need to monitor viral load every 2-4 weeks at 36 weeks and delivery
  • stress importance of compliance of ART
  • discuss delivery is dictated by viral load
  • advice against breastfeeding
  • explain neonatal treatment with ART for 4 weeks
106
Q

How is Hep B managed antenatally?

A

Refer to hepatologist

tenofovir with high HBV viral load (HBV DNA > 10^7)

start in third trimester and stop 4-12 weeks after delivery unless she qualifies for long term treatment

monitor HBV viral load every 2 months

LFTs monthly

107
Q

How is Hep B managed postnatally?

A

Hep B Ig and immunisation for neonata

HBV Ig - given within 24h delivery
HBV immunisation - 4 dose, birth, 1 month, 2 months and 12 months

blood test of neonate to confirm or deny diagnosis

ENCOURAGE BREASTFEEDING - NO RISK OF TRANSMISSION

108
Q

How is Hep C managed antenatally?

A

refer to hepatologist

Tx usually contrainidcated e.g. ribavirin

no special delivery needed

109
Q

define mild HTN

A

s: 140-149
d: 90-99

110
Q

define moderate HTN

A

s: 150-159
d: 100-109

111
Q

define severe HTN

A

> 160

> 110

112
Q

Which forms of gestational HTN are admitted?

A

severe

113
Q

is proteinuria tested for in gestational HTN?

A

mild and moderate: at every visit

severe: daily

114
Q

How often is BP measured in gestational HTN?

A

mild: once a week
mod: twice a week
severe: 4 times a day

115
Q

which forms of pre-eclampsia are treated?

A

all

116
Q

is proteinuria measured after the admission in pre-eclampsia?

A

no

117
Q

Which forms of pre-eclampsia are admitted?

A

mild, moderate and severe

118
Q

How is gestational HTN managed antenatally?

A

admit if severe

monitoring: BP and urinalysis 1-2x/week until BP controlled
Bloods (FBC, UEs and LFTs) weekly
US foetal surveillence every 2-4 weeks

119
Q

Which anti-hypertensives are used in gestational HTN?

A

1st - labetalol unless asthma

2nd nifedipine

3 = methyldopa

aim for BP <135/85

120
Q

How is gestational HTN managed postnatally?

A

monitor BP daily for first 2 days

once on days on 3 and 5

if on methyldopa stop within 2 days post birth

reduce antihypertensive if BP <130/80

F/U with GP at 2 weeks from discharge

F/U at 6-8 weeks, should be fully resolved by then

121
Q

When are pre-eclamptic women delivered?

A

34 weeks if severe

37 if mild / mod

give steroids if 34 weeks

122
Q

What are the high risk factors for pre-eclampsia?

A

HACCD

HTN in previous pregnancy

Chronic HTN
CKD
Autoimmune
Diabetes

123
Q

What medication is contraindicated in pre-eclampsia

A

ergometrine

124
Q

How often is BP measured in pre-eclampsia?

A

every 2 days and more freq if admitted

FBC, LFTs and UEs 2x/week

US foetal surveillence every 2 weeks

125
Q

When is mag sul given to pre-eclamptic women?

A

if delivery is imminent within 24h, prevent eclampsia

126
Q

What intrapartum advice is givne to pre-eclamptic women?

A

labour ward and continuous CTG

127
Q

How are pre-eclamptic women managed post-natally?

A

observe for at least 24h

monitor BP: at least 4x/day

128
Q

PACES: pre-eclampsia

A

RF: explain RF
Explain admission likely
explain risks of PRE-eclampsia to baby and mum
explain treatment
explain BP will be monitored closely
explain delivery may be earlier than normal

129
Q

How is eclampsia managed?

A

call for help
222

IV mag sul, 4g loading over 15 mins and then 1g every hour for 24h / until delivery

130
Q

What are the BM targets in GDM?

A

pre-meal < 5.3

1 hour post meal < 7.8

131
Q

How is GDM managed?

A

1st - lifestyle (as long as fasting BM <7)

2nd - after 1-2 weeks of lifestyle, metformin

3rd = add insulin / glibenclamide if insulin declined

132
Q

How is GDM managed intrapartum?

A

delivery no later than 40+6

133
Q

How is GDM managed post natally?

A

discontinue meds immediately

Fasting BM at 6-13 weeks:
- < 6 moderate risk of T2DM –> annual HbA1c
-6-6.9: high risk, annual HbA1c
>7 - likely has T2DM now

134
Q

How are women with GDM managed in future pregnancies?

A

OGTT asap after booking and at 24-28 weeks

135
Q

PACES: GDM

A

RF: age, FH, PMH, previous, ethnicity

  • Explain Dx
  • Explain risks - macrosomia, operative, stillbirth, traumatic
  • explain Tx: lifestyle, metformin and insulin
  • explain how to monitor BM
  • need to be seen within 1 week by joint diabetes and ANC, then every 2 weeks
  • ultrasound every 4 weeks between 28-36
  • medication stopped after delivery and follow up
136
Q

How is anaemia managed antenatally?

A

100-200mg ferrous sulphate and recheck Hb in 2-3 weeks

137
Q

how is anaemia managed intrapartum?

A 
advise delivery in labour ward
IV access plus group and screen
active management of third stage 
active PPH mx
consider prophylactic syntocinon
138
Q

How is obstetric cholestasis managed antenatally?

A

monitoring LFTs and bile acid weekly, doppler and CTG twice weekly unitl delivery

wear loose clothes, emollients, cool baths
ice packs and topical emollients

139
Q

What medical options are available for obstetric cholestasis?

A

Antihistamines
ursodeoxycholic acid
vit K

140
Q

How is obstetric cholestasis managed intrapartum?

A

induction at 37 weeks

labour ward and continuous CTG

141
Q

How is obstetric cholestasis managed postnatally?

A

LFTs 6 weeks postnatal (to ensure resolution)

142
Q

PACES: obstetric cholestasis

A
  • RF: personal / FH, liver disease and multiple pregnancy
  • explain Dx and risks
  • Explain early delivery by 37 weeks
  • explai nneed for regular monitoring and bloods and doppler
  • pay close attention to foetal movements
  • symptomatic Tx with ursodeoxycholic acid and emollients
143
Q

How is acute fatty liver of pregnancy managed?

A

supportive: ITU, continuous maternal and foetal monitoring, correct coagulopathy, electrolytes and hypoglycaemia

expedite delivery

144
Q

How is IUGR managed antenatally?

A

serial growth scans every 2 weeks
doppler 2x/week
advise mothers to monitor foetal movements

145
Q

What are the indications for delivery in IUGR?

A

abnormal CTG / doppler waveform

delivery by 37 weeks usually needed
consultant led decision

146
Q

How is an asymptomatic low-lying placenta managed?

A

identified at 20 week
avoid sex

rescan at 32, if low rescan at 36
if low - recommend elective c-section at 38 weeks

147
Q

How is a symptomatic placenta praevia managed?

A

ABCDE
IV access, bloods and continuous CTG

ANTI-D IF RHESUS NEGATIVE

expedite delivery if mum is unstable or foetal distress

stable and no evidence of distress - rescan at 36 weeks

148
Q

PACES: Placenta Praevia:

A

RF: previous PP, multiple, previous c section, smoking, drugs

  • asymp: 90% resolve, rescan at 32, avoid sex,
  • symp: admit until bleeding has stopped +48h more, deliver if unstable i
149
Q

How is placental abruption managed?

A

ABCDE:

  • 2x IV access
  • bloods (FBC, Rhesus, cross match and clotting)
  • continuous CTG
  • fluid, afibrinolytics, blood replacement

anti-D if rh negative

expedite if unstable or distress

if stable, >37 deliver, <37 steroids and admit to antenatal ward

150
Q

Where will the abnormalities on an ECG be seen in a woman who has a PE?

A

S1Q3T3

151
Q

If a woman is investigated for a PE and CXR is abnormal, what should be done next?

A

Straight to CTPA

152
Q

In any woman presenting with suspicious signs of DVT or PE, how should they be managed?

A

Treatment dose of LMWH until diagnosis is excluded

153
Q

What is the reversal for Unfractionated heparin?

A

Protamine Sulphate

154
Q

What are some risk factors for a VTE in pregnancy?

A

Maternal: smoking, SLE, obesity, previous VTE, thrombophilia

Gestational: Pre-Eclampsia, multiple pregnancy, GDM, stasis

Specialties Mx 2021 (4 decks)

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