paassmed Flashcards
T1DM is a risk factor fo pre eclampsia what shuld haev happen at 12 weeks if this is the case
presccribed aspirin
indication for high dose folic acid in preg
women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy
obesity
DM
anitepiletic meds
reduced fetal movements
If a pregnant woman reports reduced fetal movements then handheld Doppler should be used to confirm fetal heartbeat as a first step
Initially, handheld Doppler should be used to confirm fetal heartbeat.
If no fetal heartbeat detectable, immediate ultrasound should be offered.
If fetal heartbeat present, CTG should be used for at least 20 minutes to monitor fetal heart rate which can assist in excluding fetal compromise.
If concern remains, despite normal CTG, urgent (within 24 hours) ultrasound can be used. Ultrasound assessment should include abdominal circumference or estimated fetal weight (to exclude SGA), and amniotic fluid volume measurement
If between 24 and 28 weeks gestation, a handheld Doppler should be used to confirm presence of fetal heartbeat.
If below 24 weeks gestation, and fetal movements have previously been felt, a handheld Doppler should be used.
If fetal movements have not yet been felt by 24 weeks, onward referral should be made to a maternal fetal medicine unit.
most appropriate anti-depressant to commence in breastfeeding women
sertraline or paroxetine
does induction of labour reduce shoulder dystocia
Induction of labour at term can actually reduce the incidence of shoulder dystocia in women with gestational diabetes.
PPH approach to management pre medical and srugical
ABC approach
two peripheral cannulae, 14 gauge
lie the woman flat
bloods including group and save
commence warmed crystalloid infusion
mechanical
palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
catheterisation to prevent bladder distension and monitor urine output
first line to 5th line pph medicla approach
IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH
PPH sugical mangemen
surgical: if medical options fail to control the bleeding then surgical options will need to be urgently considered
the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
women need to take what in preg for how long
Vitamin D 400IU daily throughout the pregnancy, and folic acid 5mg daily for the first 12 weeks of pregnancy
8-12 week booking appoitment for preg what occurs
Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
when do women have Early scan to confirm dates, exclude multiple pregnancy
10-13+6 weeks
Your next patient in an antenatal clinic is a woman who is 30 weeks pregnant. Which of the following findings during your examination would you be concerned with?
Fundal height growth of 2cm per week
The correct answer here is a fundal height growth of 2cm per week. After 24 weeks you would only expect the fundal height to increase by 1cm a week. You would, therefore, be concerned that either there is an unknown multiple pregnancy or the baby is big for dates and further investigations should be carried out.
You would expect the fundus to be palpable at the umbilicus from 20 weeks and at the xiphoid sternum from 36 weeks.
In gestational diabetes, if blood glucose targets are not met with diet/metformin then insulin should be added
2weeks
when do miscarriages needed to be managed medically surgerically
increased risk of haemorrhage
she is in the late first trimester
if she has coagulopathies or is unable to have a blood transfusion
previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage)
evidence of infection
side effect of ovulation induction
Ovarian hyperstimulation syndrome
