Revision - Obs 7 Flashcards
What are the 2 key causes of sepsis in pregnancy?
1) chorioamnionitis
2) UTIs
What is a major risk factor for chorioamnionitis?
Preterm premature rupture of membranes
What is the mainstay of initial treatment of chorioamnionitis?
1) prompt delivery of foetus (via c-section if necessary)
2) administration of IV Abx
What type of anaesthesia is generally indicated in delivery in pregnant women with sepsis?
GA
What type of anaesthesia is avoided in pregnant women with sepsis?
Spinal
1) Septic vasodilated hypotensive patients may not tolerate the sympathetic block associated with spinal anaesthesia.
2) There may be associated coagulopathy or thrombocytopaenia.
When does early onset neonatal sepsis (EOS) occur?
Within 72 hours of birth
What are some RED FLAGS for neonatal sepsis?
1) Confirmed or suspected sepsis in the mother
2) Signs of shock
3) Seizures
4) Term baby needing mechanical ventilation
5) Respiratory distress starting more than 4 hours after birth
6) Presumed sepsis in another baby in a multiple pregnancy
1st line medical management of suspected or confirmed early onset neonatal sepsis?
1) IV benzylpenicillin with gentamicin
2) Add cefotaxime (IV) if there is microbiological evidence of Gram-negative infection
1st line medical management of late onset neonatal sepsis?
Flucloxacillin (or vancomycin) plus gentamicin (IV)
How often should CRP be checked following Abx management in neonatal sepsis?
1) Check the CRP again at 24 hours
2) Check the CRP again at 5 days if they are still on treatment
If meningitis is suspected in neonatal sepsis, what should be given?
Cefotaxime + amoxicillin
If necrotising enterocolitis (NEC) is suspected in neonatal sepsis, what should be given?
Metronidazole
Presentation of an amniotic fluid embolism?
Has features more similar to anaphylaxis than VTE.
What are the 2 key risk factors for amniotic fluid embolus?
1) increasing maternal age
2) IOL
Management of amniotic fluid embolism?
Supportive (no specific treatments).
Likely transferral to ICU
What is uterine rupture?
When the muscle layer (myometrium) of the uterus ruptures.
What are the 2 main types of uterine rupture?
1) incomplete
2) complete
What is an incomplete uterine rupture (or uterine dehiscence)?
Where the uterine serosa (perimetrium) overlying the uterus remains intact.
In this case, the uterine contents remain within the uterus.
What is a complete uterine rupture?
The serosa ruptures along with the myometrium, and the contents of the uterus are released into the peritoneal cavity.
What is the greatest risk factor for uterine rupture?
Previous c-section –> especially vertical incisions
What are early foetal indicators for uterine rupture?
1) Changes in fetal heart rate pattern (such as recurrent or late decelerations)
2) Prolonged fetal bradycardia
What is uterine inversion?
A rare complication of birth, where the fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out.
It is a life-threatening obstetric emergency.
What are the 2 types of uterine inversion?
1) incomplete
2) complete
What is an incomplete (partial) uterine inversion?
Where the fundus descends inside the uterus or vagina, but not as far as the introitus (opening of the vagina).
What is a complete uterine inversion?
Involves the uterus descending through the vagina to the introitus.
What may uterine inversion be the result of?
May be there result of pulling too hard on the umbilical cord during active management of the third stage of labour.
