Obstetrics & Gyny Counselling key facts Flashcards
Gestational diabetes key facts to communicate (risk factors, risks, management, follow-up)
RISK FACTORS: FH of T2 diabetes, FH mediterranean, BMI of >30, Previous GDM, Previous macrocosmic baby
SCREENING: at booking if RF, at 24-28 weeks for others
RISKS:
- FETUS: Macrosomia, Still birth, shoulder dystocia, hypoglycaemia
- MOTHER: C-section, pre-eclampsia, polyhydramnios
MANAGEMENT: <7.0 lifestyle -> 2 weeks not at target (<5.3 fasting) metformin -> Insulin
FOLLOW-UP: Will be assessed for diabetes 6 weeks after birth. Upper limit of birth 40+6 weeks.
Pre-eclampsia presenting features
Hypertension (140/90) Headache Epigastric pain also: Swelling Visual disturbance Clonus
Pre-eclampsia definition
Hypertension plus proteinuria >0.3 in 24 hours
Pre-eclampsia risk factors
1) Nulliparity
2) >10 year gap between pregnancies
3) Previous pre-eclampsia
4) BMI >35
5) Age >40
6) Pre-existing hypertension/renal disease
Pre-eclampsia risks
MOTHER
- Eclampsia
- HELLP syndrome
- DIC
FETUS
- IUGR
- Prematurity
Pre-eclampsia counselling: Investigations, management
Investigations: Urinalysis, FBC, LFT, Coag, 24 hour urine
4x daily blood pressure, twice weekly blood tests
(more if >150/160)
USS examination of fetus & CTG
Management:
- 75mg aspirin from 12 weeks
- Calcium supplements
- If >160/110 start labetalol/nifedipine, prophylactic magnesium sulphate
Drugs to avoid in pre-eclampsia
Ergometrine (raises blood pressure)
Management of eclampsia
1) Airway, on L side & with high flow oxygen
2) IV magnesium sulphate, 4g initial and 1g/hour after
3) Labetalol for hypertension
4) Deliver once: Oxygen, seizure and hypertension stable
What if eclampsia but <34 weeks?
Consider corticosteroids for 24 hours to increase surfactant production in fetal lungs
Consent for c-section
Procedure
- bikini line incision, spinal or epidural, awake with screen, partner next to you, can hold baby
Risks
Immediate: Bleeding, bladder/urethral injury
Late: VTE (1/1000), infection (5/100)
Future preg: Uterine rupture, VBAC in 50-60% but more risks, placenta praaevia and accrete, small increased risk still brith
Baby: Cut to skin (1/100), breathing problems (paediatrician on hand)
Indications for C-section
1) Breech delivery
2) Pre-eclampsia
3) Repeat c-section
4) Placenta praevia
5) Multipel pregnancy
6) APH
VBAC stats
- 50-60% of women who attempt VBAC are successful
- planned VBAC is associated with an approximately 1 in 200 (0.5%) risk of uterine rupture.
- Greatest risk is having to convert to an emergency c-section
- successful VBAC has fewer complications that Elective c-section
APH Counselling
1) Presenting complaint
- Ask about baby!
- Previous c-section/myectomy?
2) History of pregnancy
- complications & rhesus status
3) Past obstetric history
- PMG/Drugs/SH (DV?)
Investigations - Resucitare - IV access - FBC, U&E, coagulation, G&S - CTG, USS, Kleirhauer & anti-D, steroids, speculum, spec if no Placenta praevia OR emergency management
PROM Counselling
Presentation
- pop and gush
Risk factors
- Smoking, bleeding in pregnancy, previous premature preg
Inv: Spec (trickling into pool), high vag swab, temp every 4 hours, NO PV EXAM
Management
- Admit for 48 hours
- if no delivery then home w/ 4-8 hourly temperature monitoring and rapid access
- Erythromycin abx prophylaxis (unless GBS then penicillin), antenatal steroids
- 34 weeks consider delivery
Complications
Maternal: Chorioamnionitis, Cord prolapse, abruption
Fetal: Prematurity, sepsis, hypoplasia
Large for dates/Small for dates investigations
1) USS
2) If polyhydramnios: Blood glucose, infection screen, FBC
3) If oligo: spec to check for drainage of amniotic fluid
