repro Flashcards
CPR on pregnant woman?
keep woman supine with let uterine displacement
30 compressions (100-120 bpm) - depth 5-6cm
2 breaths: 30 compressions
if no response to CPR in 4 mins = C-section!!
Shockable rhythms process?
defib adrenaline 1mg after 3rd shock - then every 4 mins
amiodarone 300mg after 3rd shock
non-shockable rhythm process?
adrenaline every 3-5 mins
drugs for VF/VT? opiate overdose? magnesium toxicity? local anaesthetic toxicity?
VF/VT = 300mg amiodarone
opiate = naloxone
Mg = calcium gluconate
LA = intralipid
anaphylaxis ABCDE?
remove allergen
high flow oxygen
IM adrenaline 500mcg every 5 mins and IV crystalloid bolus
chlorohreniramine
20mg IV hydrocortisone
200mg IV salbutamol neb
Diabetic emergencies?
Hypo
* STOP INSULIIN
* glucose <4mmol/l = 50ml of 10% dextrose IV/1mg glucagon IM/glucogel
DKA
* insulin
* fluids - saline
NOTE - CAN BE NORMOGLYCAEMIC IN PREGNANCY
amniotic fluid embolism presentation? Tx?
not predictable or preventable acute presentation
* profound foetal distress
* sudden respiratory distress
* seizure
* DIC
Tx = ITU - supportive
PE s/s preg + postnatal?
symptoms
* dyspnoea
* pain
* cough
* haemoptysis
* collapse
signs
* temp >37
* raised JVP
* enlarged liver
* parasternal heave
* fixed splitting of 2nd heart sound
* cyanosis
* tachycardia
Dx PE preg/postnatal? Tx?
ECG - tachy, RVH (rarely S1Q3T3)
CXR - pleural effusion, raised hemi, wedge collapse
ABG - hypoxia + normal CO2
ECHO - rule out dissection and tamponade
CTPA!!
Tx = thrombolysis!!
stroke Ax pregnancy?
PRE-ECLAMPSIA!!!
thrombosis
amniotic fluid embolism
haemorrhagic infarct - infection, cocaine, vasculitis
cord prolapse risk factors
Tx
breech
preterm labour
2nd twin
AROM
Tx = tocolysis + all 4’s/immediate delivery
shoulder dystocia risk factors? Signs?
obesity
diabetes
macrosomia
prolonged 1st + 2nd stage
instrumental delivery
Signs = turtle sign!
Complications shoulder dystocia? Tx?
Comps
* stillbirth
* hypoxic brain injury
* brachial plexus injury - Erb’s palsy
* fractures
* PPH
Tx = HELPERR
* Help
* Episiotomy
* Legs (McRoberts manouvre)
* Pressure (suprapubic)
* Enter (rotational pringle-can manouvre)
* Remove posterior arm
* Roll patient onto her hands and knees
admission to mother + baby unit when?
rapidly changing mental state
suicidal ideation
significant estrangement from infant
guilt or hopelessness
beliefs of inadequacy as mother
psychosis
bipolar in pregnancy?
50% relapse rate if untreated
baby blues? Tx?
50% women
tearful, irritable, anxiety, poor sleep + confusion
3-10 days
Tx = self-limiting! support + reassurance
puerpueral psychosis? risk factors?
presents within 2 weeks of delivery
* sleep disturbance
* confusion + irrational ideas
* develops into mania, delusions, hallucinations
Risk factors
* bipolar
* previous puerperal psychosis (50%)
* 1st degree relative with history of bipolar
Tx puerperal psychosis? Main complication?
EMERGENCY - needs admission to mother baby unit
Tx
* antidepressants
* antipsychotics
* mood stabilisers
* ECT
25% go on to develop bipolar disorder
postnatal depression symptoms? onset? Tx?
tearful, irritable, anxiety, anhedonia, poor sleep, weight loss - can present with concerns regarding baby and parenting skills
onset = 2-6 weeks postnatally (later than puerpural psychosis and baby blues), lasts weeks to months
Tx = CBT, antidepressants, if very severe consider admission
complication postnatal depression?
70% lifetime risk of depression
bipolar tx pregnancy?
lamitrogine safest in pregnancy?
* valproate gives neural tube defects
* carbamezapine can cause cardiac defects, neural tube defects
* lithium can cause ebstein’s anomaly + heart defects
should bipolar treatment be stopped in pregnancy?
breastfeeding?
no - 50% relapse without Tx
lithium is contraindicated in breastfeeding
shizophrenia Tx pregnancy?
antipsychotics are safe in pregnancy
clozapine contraindicated in breastfeeding!!! - life threatening
avoid anticholingerics in pregnancy!!
risk to foetus if mother is bipolar?
schizophrenic
bipolar = 1 in 7
schizophrenia = 10%














































