Womens health Flashcards
Basic EmONC signal functions (7)
1/parenteral abx
2/uterotonic drugs
3/parenteral anticonvulsants (pre-eclampsia; eclampsia
4/manually remove placenta
5/remove retained products
6/assisted vaginal delivery
7/basic neonatal resus
comprehensive signal functions EmONC:
all basic functions
+ ability to perform C-section
+ blood transfusion
timing of maternal and neonatal mortality?
maternal 50% first 24h birth
neonatal 40% first 24h
WHO recommendations for increasing maternal outcomes:
ANC from 4->8 contacts
respectful, holistic mat care
active labour from 5cm dilation
partograph use
MDT approach
4 PNCs - first 24h, D3, 7-14/7, 6/52
define pre-eclampsia
HTN >20/40 + 1 Cx:
proteinuria, maternal organ dysfunction, uteroplacental dysfunction
Cx mother pre-eclampsia
CV risks post-survival
reduced life expectancy
CX neonate pre-eclampsia
pre-term birth, perinatal death, ND Cx, increased risk later life
Define eclampsia:
pre-eclampsia + seizures
Ddx - epilepsy, CM, meningoencephalitis, hypos
Mx eclampsia:
Mg S04
infusion pump often not available, give IM following loading dose
also used first-line to prevent eclampsia in pre-eclampsia
Mx of eclampsia - monitoring considerations
Do not overload the woman
care, monitoring of GCS
-avoid MgS04 toxicity - UO>100ml/h 4h
-reflexes present
-RR>16
-check BP, Plt, UE, LFTs
?delivery in pre-eclampsia?
37+/40 - aim to deliver
<37 weeks depends on severity and risk to mother and foetus (mother priority)
Key messages for pre-eclampsia (4)
control BP
prevent convulsions
fluid restrict
decision re delivery
maternal sepsis definition:
life-threatening condition due to organ dysfunction resulting from infection during preg, delivery, PP, post-abortion
maternal sepsis mx dependent on BEmOC facility vs CEmOC facility?
both sepsis 6
BEmOC - SBAR, transfer
CEmOC - additional bloods available, find cause, treat
antibiotics commonly used in maternal sepsis (3):
ampicillin 2g IV 6h
Gent 5mg/kg OD
Metronidazole 500mg IV 8h
(also CRO)
WHO recommends which abx for endometritis?
Gent and clindamycin
reducing maternal sepsis in LMICs:
raise awareness in community
early recognition in health facilities
lab diagnostics available, affordable
evidence based guidelines for quality of care
strengthen IPC programmes
vaccinate pregos
introduce audits
PPH definition:
> 500ml blood loss <24h VD or >1L if CS
ANY blood loss -> instability of BP
(37% pregnant women anaemic - smaller blood loss can lead to shock)
severe PPH -
> 1500ml blood loss <24h LSCS
massive PPH -
> 2L blood loss <24h birth
or any loss -> haemodynamic instability/shock
secondary PPH -
excessive blood loss from genital tract >24h from birth - 6 weeks PP
causes PPH:
4 T’s
Tone 70%
Thrombin 1%
Tears/Trauma 20%
Tissue 10% (retained POC)
can be combo
care bundle to Dx, Mx PPH:
WHO:
EMOTIVE
Early detection
Management of Uterus
Oxytocin drugs
TXA
IVI
Examination, resuscitation
Immediate mx PPH (general):
Teamwork
A-E
Obs <15mins
Doc blood loss <15 mins
Check drugs given - oxytocin loading, maintenance
TXA
2L fast
G+S, crossmatch
catheterise and keep bladder empty
