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
what is circumvallate placenta
when amnion and chorion double back around placneta = thick ring of membranes
- A baby is born. At one minute she is found to have a pink body with blue extremities, a weak cry, a limp body, a heart rate below 100 and grimaced. The APGAR scare is most likely to be:
- 3
- 4
- 5
- 6
4
describe Apgar and rating
https://hiehelpcenter.org/apgar-scores/
HPV screening
what is HPV
indication
frequency / type of test
MW role
What is it
Virus that infects skin and can cause cervical cancer. Sexually transmitted
test-
lower vaginal swab-touches vaginal walls only
(not appropriate for woman with prev abnormal result/ regular bleeding after sex)
can be a self swab
Every 5 years (or 3yearly if woman is immuno compromised)
safe in pregnancy- should be offered to any woman who is due for smear. Anyone with positive result should be referred for colposcopy in pregnancy
MW role
cervical screening is in MW scope of practice
how do you take fundal height
top of fundus to symphysis pubis
notifiable disease
diseases that you need to notify medical officer of health (legal requirement )
e.g. listeriosis, TB, Syphilisis hep b, HIV, hep c, measles,
What are normal changes to BP in pregnancy
systolic is unchanged
diastolic drops mid pregnancy, then returns to baseline at term
ACE Inhibitors
indication
use in pregnancy
indication: to treat hypertension
pregnancy- Contraindicated as can cause congeinital abnormalities.
switch to beta blocker (labetalol) or cal channel inhibitor (nifidipine) or methyldopa (alpha agonist)
what is the cardinal sign of eclampsia
hyperreflexia
mag sulphate toxicity
what do we monitor
effect
depress neuromuscular transmission at myoneural junction= paralysis.
risk of respiratory arrest
monitor
- patella reflex (loss of patellar reflex precedes respiratory depression/ arrest)
- resps
- loss of consciousness
- Urine output
- temperature
if respiration is depressed -call for help, STOP mgso4 infusion, give calcium gluconate + oxygen
what is most important sign of renal failure
diminished urine output
hydralazine
indication
anti-hypertensive (vasodilator)
severe hypertension
- The non pregnant uterus lies in the abdominal cavity
a. just below the bladder
b. just above the bladder
c. between the bladder and the os
d. between the rectum and the ascending colon
just above the bladder
what is Icterus neonatorum
Icterus neonatorum, also known as neonatal jaundice
when writing prescriptions, when do we use generic vs brand name
always use generic name, except for oral contraceptives, use brand name
what is law for oral communication with prescriptions
can request prescription orally, then must send written prescription within 7 days
what is duration that MW can prescribe medication
3mths except oral contraceptives can be prescribed for 6mths
tramadol
what is max supply?
when must prescription be presented to pharmacy?
1mth
within 4 days of writing
what can MW use PSO for
1mth supply of required items- use for emergency, teaching, to administer to women
- Ovulation is brought about by
a. surge of FSH
b. drop in LH level
c. surge of LH
d. surge of oestrogen
LH surge
- Pregnant woman may develop varicose veins because of
a. increase venous pressure in the veins of the legs
b. increased blood flow in the veins in the legs
c. uterine compression of the great saphenous veins
d. increase venous muscle tone
uterine compression on saphenous veins
- When using nitrous oxide it is important for the woman to breathe on the mask
a. at the peak of her contraction
b. just after the contraction has started
c. when the contraction first becomes painful
d. prior to the contraction
b - just after cx has started
- When the fetal arms are extended in a breech delivery the manoeuvre of choice is the
a. wigan-artin
b. loveset
c. bracht
d. pinard
loveset
- The term puerperium refers to
a. return of reproductive organs to their normal condition following birth of the infant
b. the adjustment period of mother and infant following childbirth
c. period between the birth of the infant and discharge of mother and infant from the hospital
d. the first four weeks post partum
return of organs to normal after birth
- The organism most likely to cause mastitis is
a. staphylococcus aureus
b. haemolytic streptococcus
c. bacteroides fragilis
d. Escherichia coli
staph A
- Cephalohaematomas in the neonate indicate
a. bleeding between the skull bone and periostium
b. soft swelling on the scalp
c. intracranial bleeding
d. increased intracranial pressure
bleeding between skull and periostium
what is tonic neck reflex
when baby is supine and head isturned- limbs extend on side teh baby is facing, flex on other side
strong reflex seen between 30-36wks, may not be seen in early newborn, returns 4-6wks later.
what is babinski reflex vs plantar
babinski- toes splay out when you stroke the bottom of foot
plantar- toes curl in, when you touch under toes
- When working in a hospital setting the MW who wishes to prescribe an approved medication to her client
a. writes a prescription on a prescription for and takes it to the hospital
b. writes a prescription in the client’s chart
c. obtains the medicine from a local pharmacy
d. uses medication from her practitioner’s supply
writes prescription in client’s chart
endocervical swabs
what for?
where from?
gonorrhea
taken from cervical os
vulvovaginal swabs
what for?
where from
chlamydia + gonorrhea
from vaginal wall and introitus
high vaginal swab
what for
where from
BV, GBS, trichomonas, candida
use speculum- swab posterior fornix of vagina
What are ‘normal’ Fetal blood samples
Lactates ≤4.1, pH ≥ 7.25
“Abnormal” / Acidic
lactates ≥ 4.8
pH ≤7.2
what is neonatal encephalopathy
“disturbed neurological function in early life”
signs-difficulty wtih resps, depressed tone + reflexes, abnormal level of conscionsuness, seizures
possible causes
hypoxia
metabolic disease
infection
drug exposure
what is cerebral palsy?
which period do most issues develop?
What are major risk factors
describes group of motor disorders, stemming from malfunction of brain (not spinal cord / muscles)
usually developed preconception or prenatally
only 6-8% during birth (PRETERM BIRTH IS MAJOR ISSUE)
10% postpartum
Risk factors
-preterm birth
IUGR
PE / infections / Placenta issues / multiples
NOTE- CP rates are not falling - despite significantly more intervention aimed to reduce asphyxia
what is 4 criteria required to prove cystic fibrosis is caused by hopxia intrapartum?
1) metabolic acidosis in cord bloods (ph<7)
2) baby is ≥34 wks
3) CP is spastic quadriplegic or dyskinetic type
4) we have excluded other possible reasons
what is aneuploidy
condition where there is an extra / missing chromosme
e.g. Downs syndrome
Fetal movements
when do most women start feeling these
what advice should be given to women
timing- nulliparous- 18-20wks, multips- 16wks
advice:
- be aware of movements daily from 28wks
normal to have DIURNAL (24hr) pattern- more active at night than during day .
and types of movement will change, however movements should be felt throughout whole pregnancy (normal to have longer breaks closer to term. but movements should still feel strong)
- movements are a reassuring sign that baby is developing and growing
if you are concerned about decreased / absent movements- contact MW immediately, Don’t wait
MW will asses you immediately-
* CTG, movements, SFH measurement, consider risk factors, maternal obs
* consider USS, AFI, dopplers
Reduced fetal movements
what is the care pathway
what is the care pathway recommended
what is the AN non-stress test
assesses response of baby’s HR, to baby’s movements
“reactive”= baby responds 2x : 20mins
“non-reactive”= baby doesn’t meet criteria- but maybe because baby was asleep!
when does smoking become a major risk factor
> 10 cigarettes daily
>16wks
how does FHR baseline change between premature / term/ post dates baby
Premature -FHR higher baseline
post term- 90-110 baseline
how do we define baseline variability
what is ‘normal’
minor fluctuations in baseline FHR
calculate by difference in peak and trough over 1min
5-25bpm
what is a bradycardia vs prolonged decel
brady- fall in baseline FHR >5mins
prolonged decel- fall in baseline FHR 90sec-5mins
- When writing a prescription, the MW must
1 write on a ministry of health prescription form
2 use legible writing
3 sign it or use a stamp with her usual signature
4 include her address and phone number
5 include the address of the person for whom the medicines are prescribed
6 include the age of the person for whom the medicines are prescribed
a 1,2,5
b 1,3,6
c 2,3,6
d 2,4,5
2,4,5
- The first infication/s of a tracheo-oesphogeal fistula in a baby is
a. periods of apnoea
b. peripheral cyanosis
c. projectile vomiting
d. persistent salivation
salivation
oesophageal atresia (when oesophagus ends in a blind pouch) / Fistula *When oesophagus and trachea are connected) should be suspected when there is excess polyhydramnios
screen for co-existing abnormaliites
initial mgmt- nuse baby ‘heads up’ with IV fluid + suctioning. good surgery success rates
- What is the MOST important sign that would indicate that a woman’s uterus was in danger of rupturing during labour?
a. fresh uterine bleeding
b. tenderness over the fundus of the uterus
c. continuous contraction causing great pain
d. fall in blood pressure and rapid pulse
continuous painful cx
Signs of neonatal sepsis
Temperature changes: Fever or hypothermia
Breathing problems: Fast or slow breathing, respiratory distress, or apnea
Feeding issues: Poor feeding, reduced sucking, or difficulty feeding
Skin changes: Pale or clammy skin, cold hands and feet, or jaundice
Other symptoms: Vomiting, diarrhea, seizures, irritability, lethargy, or reduced activity
- Moulding is the result of both an increase and reduction of diameters of the fetal skull. In a persistent occipito posterior position the diameters are altered in the following way
a. occipito frontal is reduced, mento vertical increased
b. sub occipito frontal is reduced. Mento vertical increased
c. mento vertical is reduced, occipito frontal increased
d. sub occipito brematic reduced, sub mento vertical increased
sub occipito frontal reduces
Mento vertical increases
What is diameter of OP position
occipito frontal (11.5)
fully extended- occipito mento (Brow) 13.5cm
- The PRIMARY advantage of using inhalation anaesthesia over intravenous anaesthesia is that it is
a. better tolerated by the client
b. easier to administer
c. easier to control the circulating concentration
d. lower in the number of toxic effects
D- lower toxic effects
- Prior to giving an epidural an intravenous infusion is commenced. The main reason for this is that
a. augmentation of labour may be necessary
b. systemic access is needed to correct hypotension
c. vaso constriction reduces the blood supply to main organs
d. vaso dilation causes a decrease in blood pressure
vasodilation causes decrease in BP
- On a vaginal examination you find a diamond shape fontanelle near the apex of the left anterior quadrant of the pelvis. You conclude that the fetus is
a. a brow presentation
b. LOP
c. ROA
d. ROP
ROP
- Which of the following would be most indicative of a breech presentation
a. deeply engaged presenting part
b. fetal heart sound heard high
c. an irregular mass in the upper pole
d. a recognisable neck grove in the upper pole
Fetal heart sound heard high
- To deliver a baby in breech presentation with extended arms, the MW should rotate the anterior shoulder
a. 90 to bring shoulders into the Antero-posterior diameter
b. 90 to allow it to move into the plane of the pelvic outlet
c. 180 to allow the posterior shoulder to escape under the symphysis pubis
d. 180 and bring the babys arm across the chest
180 to allow posterior arm to escape under SP
- The fetus is in a LSA position. During the breech mechanism after the buttocks internally rotates the Bi-trochanteric diameter is in the
a. antero posterior diameter of the brim
b. antero posterior diameter of the outlet
c. transverse diameter of the outlet
d. oblique diameter of the cavity
AP diameter of outlet
https://breechbirth.org.uk/2013/05/14/mechanisms-of-upright-breech-birth/
- Lacerations of the perineum is likely to occur in a persistent occipito posterior position. This is because the diameter distending the perineum is the
a. biparietal
b. sub occipito bregmatic
c. sub mento vertical
d. occipito frontal
Occipito frontal (11.5)
what are 3 diameters for vertex presentation
9.5- fully flexed. suboccipito bregmatic
10cm-partially flexed suboccipito frontal
11.5- occipito- frontal (posterior)
if posterior and deflexed - 12.5cm occipito mento (short rotation 45 degrees)
what is diameter for brow presentation
mento vertical
13.5
what is diameter for face presentation
submentobregmatic - 9.5
or
submentovertical 11.5
what is acetonuria
same as ketosis
what is ‘traumatic bleeding’ vs atonic bleeding
bleeding caused by trauma (e.g. laceration)
bleeding caused by insufficient uterine cx
Symptoms of post date baby
dry / hairy / creasy/ low fat
Dry, loose, peeling skin
Overgrown nails
Large amount of hair on the head
Visible creases on palms and soles of feet
Small amount of fat on the body
Green, brown, or yellow coloring of skin from baby passing stool in the womb
More alert and “wide-eyed”
- Alex is a preterm infant born at 34 weeks gestation and he is appropriate weight for gestational age. The MW is concerned about Alex’s ability to maintain a normal body temperature. She is aware that Alex has limited heat production capabilities as exhibited by his
a. extended posture
b. small muscle mass
c. proximity of blood vessels to the skin surface
d. limited amount of subcutaneous fat
limited amount of SC fat
what are indications for continuous monitoring
pyrexia
tachycardia
suspect chorio / sepsis
significant mec (not light mec(
fresh vaginal bleeding
hypertension
delay in 1st /2nd stage
hypertonus/ tachysystole
oxytocin (not ARM)
SFH measurements
when/ process/ rx
All low risk women- From 26-28wks
measure from top of fundus to SP
fortnightly
plot on customised GROW chart
Refer for USS if
- fundal height <10th centile
- slowing of growth (decrease by 30centiles since 28wks )
if USS not normal, check dopplers
What are risk factors for IUGR
Major Risk factors (anyone with 1 of these, should have mthly USS from 28 wks)
- nulliparous + >40
- Freq smoker (>10 /day, >16wks)
- recreational drug use
- prev IUGR/ stillbirth
- Hypertensive (PIH/ chronic/ PET)
- GDM with vascular disease
- renal impairment
- antiphospholipid syndrome
- APH/Heavy bleeding early pregnancy
Minor risk factors (>3 risks- 2 scans, ~30 wks and 36wks)
- infrequent smoker
- >40
- nulliparous
- short/long (5yr) interval since birth
- ART
-BMI high/low >30
placenta praevia
low gestational weight gain
What is definition of SGA vs IUGR
SGA= any baby with EFW / birth weight <10th centile
IUGR=
(LATE ONSET)
AC/EFW <3rd
OR 2 or more
- EFW <10th
- Slowing of growth (>30 centile since 28wks)
- UA / Uterine index >95th centile (indicates constriction)
CPR <5th (describes both fetal circulation + placental function)
bilateral notching
what are reasons for ‘unreliable’ scans and mgmt
high BMI >35
Polyhydramnios
fibroids
2 USS
-30wks
36wks
how do we measure fundal heigh
1) uppermost part of fundus
2) top rim of Symphysis pubis
aim to measure size of uterus (not just fetus)
should be done by same person each time
what is definition of hypoxia
low oxygen level in the fetal tissues
abortion reporting
- who holds list of providers
- what are MW reporting requirements? to whom
director general of health
report each abortion <1mth, to Moh
what does ‘Te Tatau’ mean
refers to the gateway to a marae.
what does kahu refer to
Kahu refers to ‘the membrane enveloping the unborn baby’. Whare kahu emphasises the protective nature of Council’s role to protect the public by ensuring midwives are competent to practise.
what does tangata whenua and tangata tiriti mean
tangata whenua-first people of the land
tangata tiriti- all other people- represented by the crown
what does hauora mean
‘breath of life’
health
what does tikanga mean
norm, tradition, rituals
what is turanga kaupapa
GUIDELINES on cultural values FOR maori
to ensure cultural requirements are met
developed by nga maia (2006)
adopted by NZCOM / MCNZ
what is te wakahuia o hine
established to ensure integrity / quality of maternity services, to achieve the intent of te tiriti
what is te whare tapa wha?
wellbeing model by mason durie
represented by a traditional house -
what is taha waiura
spiritual component of te whare tapa wha
what is haputanga
pregnancy
what is myasthenia gravis
Myasthenia gravis is an autoimmune disorder that can cause muscle weakness and tirednes
lignocaine
normal dose (concentration mg + ml)
max dose in 24hrs
lignocaine 1% 20ml (200mg)
300mg /24hs
nipple thrush
Symptoms, treatment
maternal symptoms
- deep / breast pain
- stabbing nipple pain that continues after feedign
- may appear pink and shiny
treatment
- maternal - topical antifungal cream
- neonatal- nystatin liquid (NOT gel)
what is tetracycline? when is it indicated
Group of AB
CONTRAINDICATED IN PREGNANCY- teeth staining + inhibited bone growth
What is tenofovir
Antiviral for Hep B- mum takes it in 3rd /4th trimester to reduce Hep B viral load
BF safe
What is fluconazole
indication- Oral Anti-fungal (for thrush)
NOT SAFE in pregnancy( category D). Breastfeeding safe in small doses.
what is Nitrofurantoin
indication
AB for UTI.
indication - first choice of AB in pregnancy
Contraindication
- not >36wks pregnant / 1st month breastfeeding (risk of haemolytic anaemia)
what is trimethroprin
indication
AB for UTI-
Don’t use in 1st trimester (disrupts folate metabolism)
warfarin
anticoagulant contraindicated in pregnancy
labetalol-
mechanism, indication + contraindication
mechanism- beta blocker (stops adrenic cells that promote heart activity)
indication- hypertension in pregnancy + breastfeeding (replace ACe with labetalol)
contraindication - Asthma + bronchospasm
- To- What medication is used to reverse hypotension with epidural use?
Ephedrine/ phenylephrine (vasopressor- that causes constriction)
what is hinengaro
mental
what is Tino rangatiratanga
self determination
what is tinana
physical
manaakitanga
support
MSS1 serum test- when and what is tested
9-13+6wks
PAPP A and HcG
when is CVS / Amniocentesis done?
CVS-<14wks
Amnio- >14 wks
what is the measure of a UTI
100 K (10^5) CFU
Describe uterine inversion
- what is it? what are types
- when does it occur
- causes
- how to recognise it
- mgmt - at home vs hospital
what is it
when fundus folds into uterine cavity
types
partial
* 1st degree (fundus reaches cervix)
complete
* 2nd degree- fundus passes through cervix but can’t be palpated
* 3rd -fundus inverted outside vagina
- complete fundus descends to introitus
- prolapse- fundus is outside vulva
timing
usually occurs in 3rd stage
* (“<24hrs = “acute”)
* subacute (24hrrs- 4wks)
* chronic
causes
- cord traction before separation, or CCT with fundal pressure (most common)
- placenta accreta
Signs
severe abdominal pain
signs of shock (greater than visible bleeding)
blood loss
uterus may be visible at introitus
Mgmt- home
- Call for help (ambulance)
- assess signs of shock / bleeding / obs
- DON’T remove placenta
- Give fluids
Mgmt- hospital
call for help
reposition Uterus asap (DON’T give uterotonic)
Resus woman (oxygen, lie flat, Fluids, take Cross match)
Remove placenta (once uterus is repositioned correctly)
insert IDC
Give uterotonic (To promote cx + manage likely PPH)
-
what is the o’sullivan technique
used for uterine inversion
use to reposition uterus (Partial)
hydrostatic pressure to help realign uterus
what are normal liver enzyme levels
A
ALT <30
AST- 10-50
What are signs of cholestasis
itching on palms/ soles- without rash
jaundice
dark urine / pale stools
bile salts >40
what is sign of renal insufficiency
creatinine >90
urine output <80ml 4hrs
what are 3 components of cultural competence
partnership
cultural safety
turanga kaupapa
what are Contraindications for ARM
- Contraindications for ARM?
- HIV / Herpes
- Presentation (cephalic / breech / shoulder) - unknown / unstable
- Cervix <4cm
- Fetus not engaged (risk of cord prolapse)
- Cord presentation
maternal hypotension
90/60
what is the cardinal sign of impending eclampsia
hyperreflexia
what is the most important clinical feature of imminent eclampsia
renal failure (creatinine >90, PCR >30, urine <80ml/4hr)
is oedema considered an important clinical sign of impending eclampsia
no
