Random Flashcards
JW patients
Explore reasons for declining blood products.
Explore understanding of risk to herself - ie high risk for PPH
Explore advanced directive - each specific RBC, Cryo, FFP, FV8, platelets, TXA, Cell saver.
Explain gravity of situation
Common medications in pregnancy and Breast feeding medicines
Antidepressants
- Discuss very minor increases congenital anomalies
- Discuss neonatal abstinence SND/neonatal withdrawal
- Discussed
High risk NT counselling
Get further history and exam (check age, fhx, partner history etc)
Investigations: AN screen, HbA1c, MSS1/2 results, NIPT result, rhesus
Mg
- Explain high risk result not diagnostic, increased chance of chromosomal abnormalities or congenital abnormalities
- Referral to MFM team to investigate further and give more information on what exactly this high risk result means
- One option is for you to do nothing and continue the pregnancy aware of the possibility of a baby with an abnormality
- Consider NIPT testing
- Another option is to do a diagnostic test for confirmation of the condition via CVS or amniocentesis - CVS can be done earlier, higher chance of detecting placental mosaicism, same chance of bleeding, infection, discomfort, miscarriage, anti D needed
- Results take 1-2 weeks
Discordant NT results in twins can mean aneuploidy, early TTTS, cardiac anomaly
TTTS counselling
Unfortunately poor prognosis often ending in perinatal morbidity and mortality.
Options for expectant management
Amnioreduction
Laser treatment (risks of PROM, miscarriage, infection, abruption)
Selective or termination
Vasaprevia
What: Type 1 or 2 (V vs S)
Risk factors: twins, velamentous cord insertion, succinturiate lobe
Identification: Anatomy scan, TV scan, FHB, within 2 cm from cervix
Get routine anatomy care, GS to re-evaluate in third trimester, return advice. Offer delivery between 34-36 weeks
Antibodies
Risks: hydrops and anaemia, difficulties with RBC tranfusion
Mg
- Check partners, consider NIPT or amnio
- Monthly titres until 28 weeks then 2 weekly
- Referral if over 1;16 or 1;32 or anti kell at any
- Two weekly MCA PSV
- COnsider IUI
Examination of infant
History
- Family genetic illness
- Pregnancy history, birth, GBS status
- Rhesus status
- Vaccination status
- Maternal medical disorders, blood diseases
Examination
- APGAR 1, 5, 10 (0-10)
- Vitals, weight, HC, length
- General signs eg dysmorphism, skin lesions, wrinkled skin, gender
- Head/neck: fontanelle, trauma, conjuntiva haemorrhages, cleft lip and palate
- Chest: clavicles, auscultation, check for equal movement, heart sounds, normal appearance of chest, rate of heart, thrill, systolic ejection murmurs are benign.
- Abdomen: palpate for hepato-splenomegaly, rashes, spine, hernias, femoral pulses
- Genitals: male/female, hip clicking, perforate anus
- Limbs: fingers, toes, grasping
- Reflexes, plantar, moro, grasping, rooting
Inves/Management
- Vit K IM
-
Communication to parents
- Congratulations
- Normal but atypical anatomy, can be just the way baby is or underlying medical or congenital abnormality that needs investigating and treating
Fibroid uterus risks
Cause - unreliable FH, pain
Risk: IUGR, labour obstruction, degeneration, PTB, malpresenation
