REPRO 6 Flashcards
when does blood pressure normally fall in pregnancy
second trimester
when is htn in pregnancy diagnosed (3)
> = 140/90 on two occasions
DBP >110 or SBP >160
rise of SBP by 30 or DBP by 15 or more from booking
complications of hypertension during pregnancy
PET, IUGR, abruption
when is pregnancy induced hypertension diagnosed and when does it resolve
second half of pregnancy and resolves 6 weeks PN
what percentage of patients with hypertension go on to develop PET and what is the recurrence rate
15%
high
treatment - in order of hypertension - and CI/SE
Labetalol PO/IV asthma, IUGR
Nifedipine PO
IV hydralazine
Methyldopa - can cause rebound hypertension
what is the triad of PET
oedema
hypertension
proteinuria >=3g/24h
when is maternal artery doppler done
what is it checking for
20-24weeks
placentation
what is abnormal placentation
failure of trophoblasts and placentation leading to low flow and high pressure
what is HELLP syndrome
haemolysis, elevated liver enzymes and low platelets
what is the normal amniotic fluid index and what is it in PET
6-22
<6
complication involving mean arterial pressure
MAP >=150 -> cerebral haemorrhage
what should the blood pressure aim be
140-150/90-100
what is eclampsia
PET and tonic clonic gen seizures
how many patients have seizures before the onset of hypertension/proteinuria
1/3
when do most patients have seizures
in labour or after
what is eclampsia associated with
ischaemia/cereberal vasospasm
treatment of eclampsia - htn
Labetalol, nifedipine, hydralazine
treatment for eclampsia - seizures
if further seizure
if even further seizure
4g IV magnesium sulphate loading dose over 5-10mins
then 1g/hour infusion for 24 hours
2g magnesium sulphate
Diazepam 10mg IV
eclampsia fluid balance and why is this important
run patient dry at 80mls/hour
giving fluids can lead to pulmonary oedema
what is given to induce labour in eclampsia and what should be avoided
syntocin
ergometrine - causes hypertension
steroids in pregnancy - what and till when
12mg beclamethasone IM 2 doses 24h apart
up to 36 weeks
mod risk factors of PET
first pregnancy >=40 pregnancy interval >10y FH multuple preg BMI >35
high risk factors for PET
prev PET/htn CKD AI disease like SLE antiphos DM type 1 or 2 chronic hypertension
when should aspirin be started
what dose and how often
2 mod or 1 high risk factor
75mg once daily
stage 1 of labour
onset of labour to full dilatation
stage 2 of labour
full dilatation to delivery of the baby
stage 3 of labour
delivery of the baby to deliver of the placenta
normal position of baby
lie
presentation
occipitoanterior
longitudinal
cephalic
normal labour takes how long from active phase
<24 hours
types of analgesia available (6)
enterox IV remifentanil PCA spinal block epidural pudendal nerve block
which works faster spinal block or epidural
spinal
what is epidural - whats in it
does it impair uterine activity
what can it do
effects
levobupavicaine +/- opiate
no
can delay second stage
maternal hypotension, headache, back pain, atonic bladder
risk of epidural
dural puncture
severe headache and photophobia due to CSF leak
induction of labour (4)
membrane sweep
prostaglandins
amniotomy
IV syntocin
failure to progress in stage 1 nulli v parous
nulli <2cm in 4h
multi <2cm in 4h or slowing in progress
causes of delay in stage 1 of labour
passage, passanger, power
delay in second stage of labour para and mult
para 0cm in >2h or 3h with epidural
multi 0cm in 1h or 2h plus epidural
approach for delay in second stage
change position
amniotomy
syntocin
deliver
fatal distress risk factors
small fetes, prem/post, APH, htn/pet, DM, epidural, PROM >24h, sepsis, IOL, vaginal birth after CS
causes for fatal distress
abruption, vasa praevia, cord prolapse, cord prolapse, uterine rupture, haemorrhage, regional anaethesia, hypoxia
what does CTG show in fatal dsitress
variable decel or late decel
fatal blood sampling
> 7.25 normal
7.2 to 7.25 repeat in 30mins
<7.2 deliver
treatment for fatal distress
change maternal position IV fluids stop syntocin terbutaline 250mcg - stops contractions deliver
Downs test in first trimester
nuchal thickness measurement 11-13(+6) combined with HCG and PAPPA
downs quadrouple test
14-20w bloos test
bHCG, AFP, inhibin A, unconjugated bilirubin
genetic tests for downs
amniocentesis 15w miscarriage risk 1%
CVS 12w misc risk 2%
