Specific questions (2) Flashcards
what is difference between ephedrine AND epinephrine
ephedrine- medication given for hypotension
epinephrine- aka adrenaline.
given for anaphylaxisis, asthma attack, maternal shock
Inhibits myometrial activity esp in early labour
norepinephrine (aka noradrenaline)
surge promotes 2nd stage labour
what are recommendations for BP and BMI
Important to get right BP cuff size
measure the Mid arm circumferenace at first visit
IF BMI> 35, use large (33cm x 16)
listen until korotkoff sound V (4) ( If V is not present, use IV (silence)
what is a laparotomy
surgical procedure- incision in abdomen to examine organs (used after CS for suspected uterine rupture)
what is intrapartum mgmt of VBAC
Close/continuous FHR monitoring
regular maternal obs/ be aware of continuous pain
routine IV line not necessary
regular VE’s
what is rx process for VBAC
Consult in 1st half of pregnancy
what is MODY
what causes it
mgmt in pregnancy
“maturity onset diabetes of young”- gene mutation that disrupts insulin production.
DIfferent to T1/T2 DM
signs- high BGL’s
Inherited- (dominant)= child of affected parent has 50% chance of inheriting it
mgmt- TRANSFER
don’t give insulin
What BGL range do we aim for, in labour
4-7mmol (measure hourly)
what is dyspnoea
shortness of breath
what are resp changes in pregnancy?
what are mechanical changes
how is change to ventilation achieved
why can this cause dyspnoea
20% increase in oxygen consumption
mechanical
diaphragm pushed up. breathing changes from abdominal to thoracic- increased diaphramatic breathing
increased o2 consumption achieved via 40% increase in ventilation
driven by DEEPENING resps (increased tidal vol) (NOT Increasing frequency of resps)
increased tidal volume achieved via
- chemoreceptors are more sensitive to co2 in blood (PaCO2) –> stimulated via progesterone
Can cause hyperventilation and sensation of dyspnoea
what is physiology of asthma
bronchioles (airways) become oversensitive to ‘triggers’.
2 key effects = “narrowed airways”
* inflammation (Swollen, excess mucous)
* vasoconstriction (muscle tightens)
Cause difficulty breathing
how do we diagnose asthma
FEV >12%
low Pao2 / high PaCo2 (these should be opposite in normal pregnancy)
what are risks of asthma
what is MW advice
congenital malformations
SGA
Placenta praevia
GDM
PTL/ NICU / ELCS
Very important to control Asthma + avoid exacerbations.
**medication - safe for mum and baby
**- salbutamol (beta 2 agonists)
- inhaled corticosteroids
- oral corticosteroid less clearly safe in T1 (Cleft lip)
Avoid triggers
Smoking
NSAIDs/ Aspirin
Gastro oesophageal Reflux
stress
respiratory infection / sinusitis
dust
What is rx for asthma
moderate (2 uses / wk)- PRimary
severe (continuous / oral corticosteroids)- CONSULT
What is rx for TB
Active- Transfer
Pertussis vaccine
indication
when
indication
-reduce risk of mum getting whooping cough
- passes on AB’s to baby to provide protection until baby has vaccine (natural passive immunity)
recommended every pregnancy
ideally 16-26 wks but can be from 13 -38 wks
vaccine is combined with tetanus + diptheria
what is TB?
what are cosniderations / mgmt in pregnancy
Bacterial infection that usually affects lungs.
2 types
- inactive (latent) - asymptomatic, but TB bacteria is present in body
- active
Recommendations for mum
- if active / first diagnosed- continue taking meds (these are safe in pregnancy)
- MW should Screen ALL whanau in pregnancy- check risks
- Will baby live with someone from High risk area (living >5yrs) / prev TB, for >6mths
- will baby live in hgih risk country for >3mths, in next 5 years
(high risk country is >40 / 100k population)
if yes, offer referral for FREE BCG vaccine <5yrs
what is criteria for high risk TB population
> 40 cases / 100k people
- Amanda, is a grand multipara, is in transition but the presenting part is high. The fetal heart rate is dipping with contractions but recovering quickly. What is the most likely cause of the fetal distress?
a. Poor placental circulation to the baby
b. The mothers distressed state affecting the baby
c. The baby rotating from an OP to OA position
d. The presenting part descending
PP descending
- Mary has decided to have a homebirth. At 12 weeks you visit her to do a booking visit. When identifying risk factors ALL of the following would be considered EXCEPT:
a. Having been in contact with sprays on the farm
b. Drinking unpasteurised milk with the chance on contracting Listeria
c. Eating a vegetarian diet which will lead to anaemia
d. Working with the pigs that have leptospirosis
eating veg diet which will lead to anaemia
what is leptospirosis
bacterial infection spread by infected animals
- Mary asks what the effects of Listeria might be. ALL of the following are effects EXCEPT:
a. Miscarriage
b. Fetal abnormality
c. Premature delivery
d. Fetal death
fetal abnormality
- At one of her antenatal visits Mary has 1+ protein in her urine and complains of a dull pain in her lower abdomen. What is the most appropriate action in this situation?
a. Take bloods to exclude PET
b. Take a MSU to confirm a provisional diagnosis of a UTI
c. Take her to DS to assess if she is going into premature labour
d. Tell her she is not resting enough, and she needs to rest for at least an hour during the day
MSU to confirm a UTI
What is a battledore cord insertion
aka marginal cord insertion
cord inserted on edge of placenta
what is a succenturiate placenta
2 globes