Obstetrics Case Based Learning Flashcards
You are a registrar working in the maternity hospital.
Gabrielle is a very distressed primiparous 26-year-old who has presented with heavy vaginal bleeding at 31 weeks gestation.
Gabrielle is not in pain.
what is the most likely cause?
placenta praevia
how is placenta praevia diagnosed?
Ultrasound scan - transvaginal may be required to provide accurate measurement of how placenta is related to cervix
- vaginal exam contraindicated
how does low lying placenta differ from placenta praevia?
- placenta praevia is when the placenta lies directly over the internas os
- For pregnancies greater than 16 weeks of gestation, the placenta should be reported as ‘low lying’ when the placental edge is less than 20 mm from the internal os.
how is placenta praevia managed?
Management:
- ABCDE approach
- IV access, cross match and transfusion if shocked
- Foetal monitoring CTG
- Ultrasound if diagnosis in doubt and patient stable
- Maternal monitoring HR, BP, temp.
- Steroids if preterm delivery likely - IM betamethasone/dexamethasone
- Magnesium sulphate if preterm delivery imminent
- Anti-D if rhesus negative
what are some complications of placenta praevia?
- premature delivery
- post-partum haemorrhage
- hysterectomy
- blood loss, and in severe cases, death
38-year-old G2P1 has rupture of membranes at 33 weeks gestation
what is meant by the term G2P1?
- Gravida 2, para 1
- Gravida = total number of confirmed pregnancies that a woman has had (including current pregnancies), regardless of the outcome
- parity = no. deliveries alive or dead after 24 weeks gestation, + no. deliveris alive or dead before 24 weeks gestation (e.g. ectopic, miscarriage)
- this lady has one child and is expecting another
You are a registrar working in O&G.
Tracy, a 38-year-old with gestational diabetes, presents with a clear gush of liquid from the vagina.
Tracy reports no contractions.
Onset of labour before how many weeks is defined as ‘preterm’?
Onset of labour before 37 completed weeks gestation
32-36 weeks mildly preterm
28-32 weeks very preterm
24-28 weeks extremely preterm
Tracy has ruptured membranes but has had no contractions yet.
Has labour started?
What is the name of this condition?
No; labour is defined as the onset of contractions with progressive cervical change
Prelabour premature rupture of membranes (PPROM)
what are some complications of Prelabour premature rupture of membranes (PPROM)?
- Pre-term delivery – resulting in neonatal morbidity (e.g. low birth weight, respiratory hypoplasia, sepsis)
- Chorioamnionitis (inflammation foetal membranes due bacterial infection)leading to sepsis in baby and/or mother
- Abruption
Tracy, a 38-year-old with gestational diabetes, presents with a clear gush of liquid from the vagina.
Tracy reports no contractions.
You perform a sterile speculum examination. The cervix is closed, and a foetal fibrinonectin (fFN) test is negative. A high vaginal swab is taken to check for infection.
What does a negative fFN test tell us?
Negative - labour unlikely in the next 2 weeks
If positive, likely in next 2 weeks => therefore steroids, tocolysis, analgesia and hospital observation may be indicated
Tracy, a 38-year-old with gestational diabetes, presents with a clear gush of liquid from the vagina.
Tracy reports no contractions.
She has PPROM.
Tracy receives prophylactic antibiotics to reduce risk of chorioamnionitis, and corticosteroids (IM betamethasone). The recommendation is to observe then discharge, with the aim to induce birth after 36 weeks gestation.
why were corticosteroids administered?
Induce foetal lung maturation. 2 IM injections (dexamethasone or betamethasone) 24 hrs apart (effect is maximal 24hrs after the second dose) are given.
Tracy, a 38-year-old with gestational diabetes, presents with a clear gush of liquid from the vagina.
Tracy reports no contractions.
She has PPROM.
Tracy receives prophylactic antibiotics to reduce risk of chorioamnionitis, and corticosteroids (IM betamethasone). The recommendation is to observe then discharge, with the aim to induce birth after 36 weeks gestation.
Sometimes tocolytics are administered too, why not here?
Tocolytics aim to stop contractions to allow time for steroids to work before birth or to allow transfer to an appropriate facility for birth. As Tracy has no contractions here, tocolytics are not indicated.
what are some signsd of respiratory distress syndrome in a baby?
- STERNAL and SUBCOSTAL RECESSION
- Increased RESP RATE
- Expiratory Grunting
- Diminished Breath Sounds
- Cyanosis
- Nasal Flaring
how is respiratory distress syndrome managed in a baby?
Oxygen. Early treatment with surfactant if required. Continuous positive airway pressure (CPAP) and minimal intervention.
