Prolonged pregnancy Flashcards

1
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy. Discuss management of this patient.

A
History
Examination
Investigations
Problem list
Associated risks
Management
Side effects of misoprostol
Alternate IOL methods
Poor progression management
Instrumental delivery requirements
Advice for future pregnancies
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2
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

History

A

HIV tested last
Obs hx
Fetal movements
Rest of history

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3
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Examination

A

BP 150/95
Pallor
Rest of exam

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4
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Investigations

A
Repeat HIV 
Urine dipstick
Sonar
CTG
Hb
PET bloods
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5
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Problem list

A
  1. Primigravida
  2. Post-term pregnancy
  3. Anemia
  4. Hypertension
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6
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Risks assoc with post term pregnancy

A
Maternal - psych stress
Fetal
- SB
- MSL
- MAS
- decr cord pH
- shoulder dystocia
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7
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Management of problem list

A
  1. Admit to labour ward
  2. Short acting antiHT
  3. IOL depending on Bishop score
    - 25ug every 2hrs po x 12 doses max 72hrs
    - CTG before and after each dose
    - stop once contractions established
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8
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Side effects of misoprostol

A
Uterine rupture
Nausea
Vomiting
Headache
Dizziness 
Fever
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9
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Bishop score?

A
Dilation
Length
Consistency
Position
Station
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10
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Alternate IOL methods

A

Mechanical induction
PE2
Oxytocin and AROM

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11
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Assess and manage poor progression of labour

A
Patient
- psych
- pain
- hydration
- bladder
- position
Power
- need 3-4 contractions/10min >30s -> otherwise give oxytocin infusion
Passenger
- fetal size, lie, presentation, position, HR, HAB
Passage
- cervix, membranes, application, presenting part, pelvic size and shape
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12
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Requirements for an instrumental delivery

A
Consent
Analgesia
Vertex
Full cervical dilation
No HAB
No CPD
Ruptured membranes
Experienced operator
Functional equipment
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13
Q

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Advice for future pregnancies

A

Breastfeeding
Contraception options
Family spacing

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