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Medicine Year 2 (Bear) > Week 235 - Pregnancy 2 > Flashcards

Week 235 - Pregnancy 2 Flashcards

1
Q

Week 235

What is Labetalol used for?

A

The treatment of high blood pressure.

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2
Q

Week 235

What are the foetal indications for operative vaginal delivery?

A

Foetal compromise. If it looks like baby is in crisis, call ghostbusters (AKA the guys with the suction cup and forceps)

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3
Q

Week 235

What are the Maternal indications for operative vaginal delivery?

A

Basically anything seriously bad with momma Bear

  • Spinal cord damage or injury
  • cardiac high risk or injury
  • Hypertensive crisis AKA eclampsia
  • Stuff like myasthenia gravis

(excuse the lack of my normal loquacity, just, it’s 3am and I’m at the point where I think I will tear my eyes out soon).

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4
Q

Week 235

What are the “inadequate progress” indications for operative vaginal delivery?

A

Nulliparous women:

  • Lack of progress after 3 hours with regional anaesthesia
  • Lack of progress after 2 hours without regional anaesthesia

Multiparous women:

  • As above, but one hour less for each.
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5
Q

Week 235

What are C.A.B requirements for instrumental vaginal delivery?

A
  • Cervix Fully dilated
  • Appropriate analgesia
  • Bladder empty
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6
Q

Week 235

What position is this? What is the best appropach for operative surgical delivery (method/tools used)?

A

Direct Occiput anterior

Can use forceps of ventouse

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7
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Direct Occiput posterior

Often accompanied by extension of the fetal head presenting part too large
Aim for rotation of 180º with the ventouse or with rotational forceps

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8
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Left Occiput anterior

Forceps or ventouse

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9
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Left occiput posterior

Often accompanied by extension of the fetal head presenting part too large
Aim for rotation of 180º with the ventouse or with rotational forceps

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10
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Left Occiput Transverse

Usually due to insufficient descent of head to cause rotation
Ventouse to achieve descent, and hopefully rotation
Rotational forceps to achieve rotation in situ and then descent

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11
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Right Occiput Anterior

Use Forceps or Ventouse

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12
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Right Occiput Posterior

Often accompanied by extension of the fetal head presenting part too large
Aim for rotation of 180º with the ventouse or with rotational forceps

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13
Q

Week 235

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

A

Right Occiput Transverse

Usually due to insufficient descent of head to cause rotation
Ventouse to achieve descent, and hopefully rotation
Rotational forceps to achieve rotation in situ and then descent

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14
Q

Week 235

Significant vaginal and perianal trauma for th mother occurs with which operative vaginal delivery intervention?

A

Forceps.

Are you surprised?

Have you SEEN how HUGE they are? !

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15
Q

Week 235

What is the name given to this particular incision site for C section?

A

Pfannensteil

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16
Q

Week 235

What are the absolute indications for C section?

A

ABSOLUTE INDICATIONS

  • Placenta praevia
  • Severe antenatal fetal compromise
  • Uncorrectable abnormal lie
  • Previous classical caesarean section
  • Pelvic deformity
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17
Q

Week 235

What are the relative indications for C section?

A

RELATIVE INDICATIONS

  • Breech presentation
  • Diabetes mellitus and other medical diseases
  • Previous caesarean sections
  • Older nulliparous women
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18
Q

Week 235

What is a dichorionic-diamniotic (DCDA) twinning?

A

When each baby of the twin has its own
placenta, there will be two chorions and two
amnions and it is known as dichorionic
-
diamniotic (DCDA) twinning.

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19
Q

Week 235

What is a monochorionic diamniotic (MCDA)
twinning?

A

When each baby of the twin pregnancy
has its own amniotic sac, but share a
single placenta, there will be one chorion
and two amnions and it is known as
monochorionic diamniotic (MCDA)
twinning.

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20
Q

Week 235

What is a monochorionic-monoamniotic
(MCMA) twinning?

A

When the twin babies share both the
amniotic sac and the placenta there will be
one chorion and one amniotic sac and it is
known as monochorionic
-
monoamniotic
(MCMA) twinning.

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21
Q

Week 235

What are the risks associated with multiple chorionicty (more than one placenta)?

A

Miscarriage,
Congenital abnormalities
Preterm,
IUGR,
Perinatal loss,
TTT

22
Q

Week 235

Which clotting factors are increased in pregnancy?

A
  • I
  • VII
  • VIII
  • IX
  • X
  • XII
23
Q

Week 235

What are the symptoms of threatened miscarriage?

A

Bleeding, foetus alive, OS closed.

24
Q

Week 235

What are the symptoms of inevitable miscarriage?

A

Bleeding heavier, foetus may be alive, OS open

25
Week 235 What are the symptoms of incomplete miscarriage?
Bleeding, Some foetal parts passed, OS open
26
Week 235 What are the symptoms of **complete** miscarriage?
All pregnancy tissue passed, bleeding settling, OS closed
27
Week 235 What are the symptoms of **missed** miscarriage?
Foetus not developed or died in utero. OS closed. Often asymptomatic
28
Week 235 What are the symptoms of **septic** misccariage?
Infected uterine contents. Offensive loss, tender uterus .
29
Week 235 When should **Anti-D prophylaxis** be administered, and why?
**Should be administered to all rhesus negative mothers after all surgical and medical intervention regardless of gestation**, within 72hrs of bleed. Spontaneous miscarriages after 12+0 weeks gestation should be administered anti-D. 250 IU should be given up to 19 +6 weeks. 500 IU after 20+0 weeks. Why? Mothers antibodies are against babies blood. Bad for baby.
30
Week 235 What is placental abruption?
Can be seen or be hidden. ## Footnote **Separation of the placenta from the wall of the womb during pregnancy, especially when it occurs prematurely.**
31
Week 235 What are the clinical signs of **placenta praevia**?
* Asymptomatic * Painless * bright red bleed * Malpresentation/highpresenting part
32
Week 235 What is **Placenta Accreta**?
This is a firmly adherent placenta.
33
Week 235 What is Placenta **increta**?
In this condition, the placenta invades the myometrium
34
Week 235 What is Placenta **Percreta**?
In this condition, the placenta invades through to the serosa and beyond.
35
Week 235 What is Vasa Praevia?
In this condition, the placental vessels overlie the cervix.
36
Week 235 What make up the HEELP syndrome?
* Haemolysis, * Elevated Liver enzymes, * Low platelet
37
Week 235 What are the aetiologies of pre-existing (chronic) hypertension in pregnancy?
* Essential hypertension - idiopathic * Chronic renal disease - present in 5% of hypertensive disorders of pregnancy
38
Week 235 What is **gestational hypertension**?
* HTN arising after 20 weeks (2nd trimester), and resolving within 3 months of delivery * No symptoms of pre-eclampsia
39
Week 235 Pre-eclampsia is hypertension arising after how long?
20 weeks
40
Week 235 **Severe pre-eclampsia** is pre-eclampsia with one or more of (list):
* SBP/DBP \> 160/110 * Pulmonary oedema * Cyanosis * Persistent headache * Thrombocytopaenia * Severe proteinuria (\>5g/24hrs) * Oliguria (\<400mls/24hrs) * Liver pain/impaired hepatic function * \>foetal growth/placental abruption
41
Week 235 What is the Pathophysiology of HELLP syndrome?
Impaired trophoblastic invasion of maternal spiral arteries * Placenta pre-disposed to hypoxia * \>vasodilator/anticoaglant production (i.e. prostacyclin) * Increased angiogenic and prothrombic factors produced (i.e. thromboxane) * Widespread coahulation causing systemic effects * Reduced GFR therefore renal injury
42
Week 235 How does pre-eclampsia present?
* Usually after 34 weeks * often Asymptomatic * Neuro - headache, visual disturbance * Epigastric/RUQ pain * Oliguria, cloudy urine * High blood pressure
43
Week 235 What is **Eclampsia**?
This is convulsion associated with pre-eclampsia . May occur before **OR AFTER** delivery. Prophylaxis = low dose aspirin from early pregnancy for those with risk factors.
44
Week 235 What is **Labetalol**?
This is an **anti-hypertensive** that can be used to treat eclampsia. It is a **Beta-Blocker**, which **inhibits adrenergic receptors** (these\< peripheral vascular resistance)
45
Week 235 What is **Methyldopa**?
This is **antihypertensive** drug used in the treatment of **pre-eclampsia**. It **reduces dopamine production**.
46
Week 235 What is **Nifedipine**?
* This is an **anti-hypertensive** medication used in the treatment of **pre-eclampsia**. It it a **calcium channel blocker,** which **inhibits vascular muscle contraction**.
47
Week 235 What is hydralazine?
This is an **antihypertensive** medication used in the treatment of **pre-eclampsia**. IT **blocks Calcium channels**, but isn't a calcium channel blocker!
48
Week 235 Are ACE inhibitors safe for use in pregnancy?
NO!
49
Week 235 What is Magnesium sulphate?
**This is used for severe preeclampsia/eclampsia** **Seizure prophylaxis (mechanism unknown!)** Given IV: **4mg Loading dose, followed by 1mg/hr, with 2mg after convulsions.**
50
Week 235 When is phenytoin/Lorazepam used in pre-eclampsia/eclampsia?
May be used as 2nd line treatment if non responsive to MgSO4 (post 34 weeks if possible)
51
Week 235 What is **Betamethasone**? Why is it used in premature birth?
This steroid is used to **stimulate foetal lung maturation and surfactant production** NB: Ergometrine is contraindicated - increase BP.
52

Medicine Year 2 (Bear) (30 decks)

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