Perinatal Flashcards
A woman should book for antenatal care when…
She has missed her 2nd period
Extra uterine pregnancy suggested by…
Lower abdo pain and vaginal bleeding
What C/S patient can have a vaginal labour?
Transverse lower segment incision with a non-recurring problem
The LMP can be used to calculate duration of preg if
Patient has regular cycle and not on contraception.
Abdo exam is useful for duration of pregnancy from
13-17 weeks
Uss accurate for dates until
24 weeks
Active syphilis
+ RPR
+ TPHA
Positive RPR if titre is more than
1:16
Syphilis treated in preg with
Benzathene penicillin
How often must a low risk preg mum visit clinic between 28 and 34 weeks
No visit is required
Visit at week 34 is NB because
The lie and presentation become NB and have to be determined
Oesophageal candidiasis = what HIV stage
4
ARV prophylaxis provided with what drugs
AZT and nevirapine
Which clinical technique is best to measure uterine growth between 18 and 36 weeks
Sf height
Which sf height = intrauterine growth restriction
Slowing of sf height til 1 is below 10th centile
Severe intrauterine growth restriction = ? Weeks difference between gest age and sf height
4 weeks or more
Growth restriction at 32 weeks
, what must be done?
Refer to level 2 hospital for Doppler umbilical artery flow
Antenatal fetal condition determined by
Number of fetal movements
Essential to determine fetal condition from ? Weeks
28 weeks
Who needs a fetal movement chart
All mums where there is a reason to be worried about fetal condition
When to worry about decrease fetal movement
Less than half previously counted movements
Patients reports few fetal movements in hour. What to do?
Ask them to lie on side and count movement for further hour
Management for reduced fetal movement when there is no ctg.
Exclude death by listening for fetal heart
Who should get antenatal fetal hr monitoring?
High risk pt where fetal movements not reliable eg. Insulin dependent diabetics, pure labour ROM, conservatively managed preeclampsia
Non reactive fetal hr pattern?
Assess beat to beat variability to determine fetal well being
Why repeat fetal hr pattern test 45 mins later if beat to beat variability is poor?
Sleeping fetus can produce non reactive fetal hr pattern and poor beat to beat variability
Abnormal stress test equals
Uterine contractions with late decelerations
Late deceleration defined as…
Biggest decrease in hr occurs 30 or more after peak of contraction.
What to do if abnormal stress test?
Rule out false positives. Eg
Postural hypotension
Spontaneous overstimulation of uterus
Correct method of intrauterine resus
Suppress uterine contractions
Decrease uterine tone
Hypertension in preg?
> 90 diastolic
>140 systolic
Significant proteinuria?
1+ or more
Defn preeclampsia
Hypertension + proteinuria after 20 weeks preg
Defn chronic hypertension
Hypertension without proteinuria in first half of preg
How common preeclampsia
5-6% preg woman
Preeclampsia associated with
Abruptioplacenta
Intrauterine growth restriction
Fetal distress
Preeclampsia results in fetal distress because
Decrease placental blood flow
Sign of imminent eclampsia
Increased tendon reflexes
early warning sign of preeclampsia
Generalized oedema esp on face
Management of preeclampsia
Hospitalisation
Method of deliver usually chosen in preeclampsia
Surgical induction at 36 weeks, if reached
NB complications of preeclampsia
Eclampsia
Intracerebral haemorrhage
Management of severe preeclampsia
Stabilize patient and send to level 2 hospital
Drug used for diastolic >110
Nifedipine (adalat)
Sign of magnesium sulphate overdose
Depressed tendon reflexes
Drug used to prevent and manage eclampsia
Magnesium sulphate
Borderline preeclampsia at 36 weeks
Weekly check ups and additional visits if needed
Defn of antepartum hemorrhage
Any vaginal bleeding between 24 weeks and DELIVERY
Antepartum hemorrhage NB because
Mother and fetus may die
NB sign of shock due to blood loss
Fast pulse rate
Why speculum exam wi antepartum hemorrhage?
Exclude local cause of bleeding from vagina/cervix
Antenatal hemorrhage + no fetal heart sounds usually
Abruptioplacenta
Massive hemorrhage most likely
Placenta previa
Factor causing highest risk of abruptioplacenta
Previous episode
What suggests abruptioplacenta
Signs of shock Severe abdo pain Uterus tonically contracted = hard and tender Uterus bigger than dates No fetal hr Hub is low Fetal parts hard to palpate
Management of abruptioplacenta plus intrauterine death
Vaginal exam + ROM + vaginal delivery
Risk factors for placenta previa
Multiple fetus
Previous c section
G5 or more
Threatened abortion in 3rd trimester
Findings on exam with placenta previa
Shocked Soft non tender abdo Fetus easily palpated Head not engaged Abnormal presentation
Management of small placenta previa bleed at 34 weeks
Hospitalize, manage conservatively til 36 weeks or until active bleeding
What can exclude placenta previa.
Vaginal exam in theatre
Management of antepartum hemorrhage of unknown cause
Admit to hospital and monitor fetal movements
Antepartum hemorrhage of unknown cause NB because
Can be abruptioplacenta
Typical feature of a ‘show’
Slight bleed of blood mixed with mucus
Management of 30 week patient with blood stained vaginal discharge caused by vaginitis
Metronidazole (flagyl)
What is a partogram
Chart for progress of labour, maternal and fetal condition
A partogram must be used on all patients in 1st stage of labour. True or dale
True
What indicates patient is fine in first stage of labour?
Relaxed between contractions and not pale. (Nothing to do with BP, urine, pulse, temp)
Young anxious primigravida with painful contractions must recieve
Comfort, analgesia and a friend/family member if possible
What is normal maternal temp during labour
37-38
Why is pyrexia an NB complication in first stage?
May cause convulsions
Normal pulse in labour
80-100
What causes rapid pulse in labour?
Pyrexia
How often mus BP be measured in low risk patient in latent phase?
2 hourly
Hypotension patient on back must be…
Turned on her side and BP measured soon after
Oliguria = urine less than
20 ml per hour
Oliguria NB sign of ..
Dehydration
UTI may cause how much proteinuria
1+
Is ketonuria abnormal
It may be seen in normal patients
Signs of maternal exhaustion
Tachycardia Pyrexia Dry mouth Oliguria Ketonuria
What causes exhaustion
Long labour with low fluid and energy intake
How to treat maternal exhaustion
2 liters ringers lactate with 5% dextrose IV and adequate analgesia
Commonest cause of reduced blood supply to fetus
Contraction
How does fetus respond to lack of oxygen
Decrease HR
What is preferred to measure fetal HR in labour
Doptone
When should fetal HR be monitored
Before during and after contraction
How often to measure fetal HR in low risk pt
2 hourly in latent phase
Half hourly in active phase
Baseline fetal HR in labour
100-160 bpm
Early decelerations usually cause bu
Compression of fetal head
Defn late decelerations
Return to baseline 30 s or more after contraction has ended
What do late decelerations always indicate
Fetal distress
What can cause a baseline tachy
Maternal pyrexia Exhaustion Salbutamol Chorioamnionitis Fetal hemorrhage
Baseline Brady indicates..
Fetal distress caused by hypoxia
Fetus is at high risk of dying
Which HR pattern indicate increased risk of fetal distress
Early decelerations
How common is MSL
10-20% of pregs
What form of meconium in the liquor most likely indicates distress
Any form of meconium .
What cause fetus to pass meconium
Hypoxia
Correct management when there is MSL
Monitor fetal HR carefully
What is latent phase of first stage of labour
Onset of labour to 3cm dilation
What is first oblique line on partogram called
Alert line
What rate should cervix dilate in active phase
1cm or more / hour
Second oblique line of partogram
Action line
If alert line crosses action line?
Very slow progress of labour. Doctor must be in charge of patient.
What defines the second stage of labour
Cervix full dilated to complete delivery of baby
What suggests patient is full dilated
Contractions increase in freq and time
Restlessness, vomiting, nausea
Uncontrollable urge to push
Perineum bulges
Fetal head engaged when..
2/5 or less of head palpable above brim
Largest transverse diameter of head passes pelvic inlet/brim
Why anxiety make pain worse
Lowers pain threshold
Defn third stage of labour
Period between delivery of baby and delivery of placenta/membranes
Do not give oxytocin (syntometrine) if
Hypertensive disorder of preg
Valve disease
What sign will confirm placenta has separated
Pushing on uterus does not shorten cord
What advantage does active method in third stage have
Less blood loss
When should umbilical cord be allowed to bleed before delivering placenta
Rhesus negative mother with single baby
Management of prolonged third state of labour
IV oxytocin and traction on cord
When should post partum hemorrhage be diagnosed
When there is any hemorrhage after delivery that is seen to be excessive
Management of retained placenta.?
Give IV oxytocin , if still retained refer to hospital for manual removal under anesthesia
Severe hemorrhage before placenta? Management
IV oxytocin in 1000ml basol/saline. Attempt to remove placenta
If hemorrhage after placenta delivered, what must be done
Rub up the uterus
What sign suggests bleeding is caused by an atomic uterus?
Intermittent vaginal bleeding and presence of dark red clots
Most likely cause of post partum hemorrhage due to atomic uterus.
Uterus full of blood clots
If a cotyledon is found to be missing what sound be done
Evacuate uterus
Clinical finding that indicates a tear
Continuous stream of bright red blood
The puerperium starts when…
The placenta is delivered
Soon after normal delivery, a mother’s pulse should be?
Below 100
Hb becomes stable by
Day 4
The cervical os should be closed by..
Day 7
Normal lochia smells like?
Non offensive
How does a normally involuting uterus feel?
Firm and nontender
How long is puerperium
42 days
How often must primipara visit clinic after birth
Day 1,3,5,7
Cystitis is treated with
Single oral dose amoxicillin or co-trimoxazole
Why NB to treat asymptomatic bacteruria?
One third develop acute pyelonephritis
How asymptomatic bacteruria diagnosed
Culture MSU sample
Defn anemia in preg
Hb less than 11
Commonest cause if anemia
Fe deficiency
Management of anemia depends on
Whether there is SOB or thachycardia
