Passmedicine Knowledge Flashcards
Presentation of placental abruption
Severe abdominal pain in third trimester
Cold mother
Bleeding in 80% cases (not always)
Tx of PPROM?
10 days erythromycin
Contraindications of VBAC?
Classical Caesarean scar
other contraindications = praevia
MCC of PPH?
Atony
Other causes of PPH?
Tone
Tissue
Trauma
Thrombin
Risk factors for primary PPH?
Previous PPH prolonged labour pre-eclampsia increased maternal age polyhydramnios emergency C-section placenta praevia, placenta accreta macrosomia ritodrine
Mx of Primary pph?
ABC
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
surgical:
b-lynch suture, ligation of uterine arteries or internal iliac arteries
hysterectomy
Tx for babies born to mother with acute hepatitis B during pregnancy
complete course of vaccination and hepatitis B immunoglobulin
Causes of bleeding in 1st trimester
spontaneous abortion
ectopic pregnancy
hydatidiform mole
Causes of bleeding in 2nd trimester
Spontaneous abortion
hydatidiform mole
placental abruption
Causes of bleeding in 3rd trimester
Bloody show
Placental abruption
Placenta praevia
Vasa praevia
Presentation of ectopic pregnancy
6-8 weeks amenorrhoea
lower abdominal pain
may be shoulder tip pain and cervical excitation
Presentation of hydatidiform mole
Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy: hyperemesis
LFD uterus
serum hcg may be very high
presentation of placental abruption?
constant lower abdominal pain
women may be more shocked than is expected by visible blood loss
tender, tense uterus with normal lie and presentation
fetal heart distressed
presentation of placental praevia?
vaginal bleeding, no pain
non tender uterus but presentation may be abnormal
presentation of vasa praevia?
rupture of membranes followed immediately by vaginal bleeding
fetal bradycardia is classically seen
Cord prolapse position
all fours
risk factors for cord prolapse
prematurity multiparity polyhydramnios twin pregnancy cephalopelvic distortion abnormal presentations placenta praevia long umbilical cord high fetal station
Classification of tears:
1st: superficial damage with no muscle involvement t
2nd: injury to perineal muscle but not involving the anal sphincter
3rd: injury to perineum, involving anal sphincter complex
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
4th: injury to perineum involving anal sphincter complex
McRobert’s manœuvre position
This manoeuvre entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen
Tx of varicella exposure in pregnancy?
Varicella zoster immunoglobulin
Presentation of chorioamnionitis?
uterine tenderness and foul-smelling discharge
Preterm PPROMM + pyrexia, maternal/foetal tachycardia
Placenta accreta
attachment of the placenta to the myometrium due to a defective decidua basalts
Risk factors for placenta accreta?
previous Caesarean section
placenta praevia
Elements of the combined test
Nuchal translucency
beta-hCG and PAPPA + CRL
Combined test results for Downs syndrome
low PAPPA and high beta hCG
quadruple test components
AFP
unconjugated oestriol
beta-hCG
inhibin A
Placenta praevia associated factors?
Multiparity
multiple pregnancy
Mx of shoulder dystocia in labour
Help
Do not use fundal pressure
McRobert’s manœuvre = first line intervention
Tx of suspected PE in pregnancy?
ECG and chest X ray
compression duplex USS
Antenatal care:
8-12 weeks
booking visit: general info
BP, using dipstick, check BMI
Booking bloods/urine: FBC, blood group, rhesus, red cell alloantibodies, haemoglobinopathies hepatitis, syphilis, rubella HIV urine culture - asymptomatic bacteriuria
antenatal care 10-13+6 weeks
early scan to confirm dates, exclude multiple pregnancy
antenatal care 11-13+6 weeks
Down’s syndrome screening including nuchal scan
antenatal care: 16 weeks
information on anomaly and blood results. If Hb <11g/dl consider iron
Routine care: BP and urine dipstick
antenatal care: 18-20+6 weeks
anomaly scan
antenatal care 28 weeks:
Urine dip, BP, SFH
Second screen for anaemia and atypical red blood cells
anti-D prophylaxis if needed
antenatal care 34 weeks
routine care
second dose of anti-D
antenatal care 36 weeks
routine care
check presentation - offer external cephalic version if indicated
information on breast feeding, vitamin K, baby blues
40-41
routine care
labour plans, prolonged pregnancy plans
What does low/high AFP indicate?
Increased: NTD, fetal abdominal wall defects, multiple pregnancy
Decreased: Down’s syndrome, trisomy 18, maternal diabetes mellitus
Abnormal features on CTG
Single prolonged deceleration lasting 3 minutes or more
Variable decelerations occurring with over 50% of contractions
In labour: variability <5bpm
Intrahepatic obstetric cholestasis presentation
pruritus
no rash
raised bilirubin
High ALP and GGT, lesser rise in ALT
Features of acute fatty liver of pregnancy
abdominal pain nausea and vomiting headache jaundice hypoglycaemia
Pre-eclampsia high risk factors
hypertensive disease in a previous pregnancy chronic kidney disease autoimmune disease t1/t2DM chronic hypertension
Pre-eclampsia moderate risk factors
first pregnancy 40 years or older pregnancy interval of more than 10 years 35+ BMI FH of pre-eclampsia multiple pregnancy
Causes of oligohydramnios
premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia
management of cord prolapse
- tocolytics to reduce cord compression
- presenting part of foetus may be pushed back into uterus
- patient advised to go on all fours
- emergency c section
- If delivering - hand into vagina to elevate presenting part
GBS management in labour
IV Abx for mum
HELLP syndrome presentation
haemolysis, elevated liver enzymes, low platelets
Drugs contraindicated in breastfeeding
abx: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
Psychiatric: lithium, BDZ
Aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
What is the name of the depression scale for Post natal depression?
Edinburgh scale
Placenta praevia investigations
transvaginal USS
Drug to reverse respiratory depression caused by magnesium sulphate?
Calcium gluconate
Obstetric cholestasis treatment?
Induction of labour at 37 weeks
Ursodeoxycholic acid
Vitamin K supplementation
Secondary prevention of women with pre-eclampsia?
Low dose aspirin to reduce risk of babies being born SGA
When can gestational hypertension be recognised?
after 20 weeks
Which markers indicate downs syndrome?
low AFP low oestriol High HCG Low PAPPA thickened nuchal translucency
What is a molar pregnancy?
significantly high levels of beta hCG for gestational age - marker of gestational trophoblastic disease. beta hCG has a similar structure to LH, FSH and TSH, so can produce higher levels of thyroxine (symptoms of thyrotoxicosis)
What is the treatment for women with high VTE risk?
4 risk factors: LMWH until 6 weeks postpartum (DOAC and warfarin avoided)
3 risk factors: heparin from 28 weeks until 6 weeks postnatal
What are the causes of puerperal pyrexia?
Endometritis - needs treating with IV clindamycin and gentamicin)
UTI
wound infections (perineal tears and Caesarean section)
mastitis
venous thromboembolism
What are the features of HELLP syndrome?
haemolysis
elevated liver enzymes
low platelets
Which layers of the abdominal wall are cut through in C-section?
Skin Superficial fascia Deep fascia Anterior rectus sheath Rectus abdominis muscle Transversalis fascia exztraperitoneal connective tissue Peritoneum Uterus
What are the indications of C-section?
absolute cephalopelvic disproportion placenta praevia grades 3/4 pre-eclampsia post-maturity IUGR fetal distress in labour/prolapsed cord failure of labour to progress malpresentations: brow placental abruption: only if fetal distress vaginal infection e.g. active herpes cervical cancer (disseminates cancer cells)
What is the wood screw manoeuvre?
Action of putting a hand in the vagina and rotating the foetus 180 degrees
What is McRobert’s position?
hyperflex the mother’s legs onto her abdomen and apply suprapubic pressure
What is the Rubin manoeuvre?
press on the posterior shoulder to allow the anterior shoulder extra room
What is the management of puerperal mastitis?
- Continue breast feeding - improves milk removal
- Antibiotics if lady has infected nipple fissure, symptoms do not improve / are worsening after 12-24 hours despite effective milk removal or bacterial culture positive.
flucloxacillin 500 mg qds for 14 days
What test is used to monitor DVT treatment with LMWH in obese women?
anti Xa activity
Steps of PPH treatment
- bimanual uterine compression
- IV oxytocin/ergometrin
- IM carboprost
- Intramyometrial carboprost
- rectal misoprostol
- surgical intervention
What is vasa praevia?
What is the presentation?
Vasa praevia describes a complication in which fetal blood vessels cross or run near the internal orifice of the uterus. The vessels can be easily compromised when supporting membranes rupture, leading to frank bleeding.
The classic triad of vasa praevia is rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.
What is the presentation of placenta accreta?
Delayed third stage of labour
underlying RF: previous section + previous PID
Definitive treatment = hysterectomy
What is placenta accreta?
Attachment of the placenta to the myometrium due to a defective decidua basalis
Under what circumstances can you perform ECV in a transverse lie?
At 36 weeks if the amniotic membrane has not ruptured
What is Sheehan’s syndrome?
Complication of PPH in which the pituitary gland undergoes necrosis which can manifest as hypopituitarism
Lack of postpartum milk production and amenorrhoea following delivery
What is the indication of positive fetal fibronectin?
Having a high level has been shown to be related with early labour
Give 2 doses steroids and monitor BMs
What is the most common cause of umbilical cord prolapse?
ARM
