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35 Cards in this Set
- Front
- Back
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What is APH? |
Bleeding from or in to the genital tract in a pregnant lady from 24 weeks onwards. |
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What are the risk factors for APH? |
Abruption: previous abruption, early bleeding, Factor V leiden. Praevia: Previous CS, TOP, Smoking, multiparity, Old, Endometrial trauma, Assisted conception.
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How should women with placent praevia be diagnosed? |
Presentation: Painless PV bleed, scarred uterus, no vaginal or cervical bleeding. Tests: Speculum exam very carefully with no digital exam, CTG. Uterine Ultrasound with Doppler FBC to see extent of anaemia Crossmatch for transfusion.
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How should placenta praevia be managed? |
- No digital exams should be performed, in case they exacerbate the bleeding. - Ressuscitate the woman with fluids / blood - Urgent ultrasound should be done to find the source of the bleed - If bleeding is not controlled, send for urgent C Section. - Give anti-D treatment to pregnant lady.
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How do women with placental abruption present and how is it treated? |
PV bleed +/- abdominal pain, contractions, tenderness. Pooled blood found on Ultrasound. Risk factors are trauma, cocaine, HTN, fibroids. 1) CTG 2) Ultrasound 3) FBC, Coagulation and crossmatch. |
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What is the management of Placental Abruption? |
1) Stabilise Mother by keeping Hb above 10 and preventing DIC with transfusion and FFP. 2) Continuous CTG
>34 weeks - Expedite the delivery.
< 34 weeks - Conservative if stable, CS if not. Conservative = Steroids, Nifedipine/MG Sulphate (tocolytic). Unstable = Caesarean Section
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Unstable Mother -> Urgent Caesarean Section, blood and Syntocin afterwards.
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How do you expedite or prolong a delivery? |
Expedite: Caesarean if mother is unstable. Syntocin and amniotomy if mother and baby are stable. Tocolysis: Nifedipine and Magnesium Sulphate. |
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How are Breech Presentations managed? |
< 37 weeks - Watch and wait > 37 weeks - External Cephalic version unless - fetal anomaly, ruptured membranes, oligohydramnios, placenta praevia. Give tocolytic Salbutamol at the same time. Give Anti-D. If unsuccessful then do a Caesarean section.
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What is Pre-eclampsia? What are the risk factors? |
Pre-eclampsia is HTN, proteinuria and oedema that occurs after 20 weeks of gestation due to failure of the placental arteries to fully invade the uterus. It affects the liver, the kidneys and coagulation. RFs: Short, overweight, young or old, Migraine, pre-existing HTN. Multips |
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How is Pre-eclampsia managed? |
Lower BP - Labetalol is 1st choice. Methyldopa or nifedipine are fine as well. Fluid management Delivery Plan - Deliver if >36 weeks, otherwise give steroids and wait. Avoid complications Unstable patients(seizures/uncontrolled HTN) should have an immediate CS.
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What are the complications of Pre-eclampsia? |
Eclampsia - Magnesium sulphate and deliver HELLP syndrome - Magnesium Sulphate After Delivery - Fluid overload is a risk, so fluid restrict the woman, and consider diuretics. |
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What are the risk factors for Shoulder dystocia? |
Large baby, Large mother, Short mother, Diabetes, Instrumental delivery, induction of labour. |
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How is shoulder dystocia managed? |
1. Downward pressure on the fetal head. 2. McRoberts position + suprapubic pressure 3. Episiotomy 4. Internal Maneuvres 5. Try on all fours. |
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How is Placental Abruption managed? |
1. Ressuscitate mother 2. CTG monitor baby
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When should labour be induced? |
HTN/Pre-eclampsia |
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How do PP, PA and VP present? |
PP is painless PV bleed causing shock to the mother with low insertion of the placenta. PA is painful small PPV bleed, large associated shock and distressed fetus. VP is bleeding at time of labour, usually with ROM causing severe fetal distress in an asymptomatic mother. CS is necessary and transfusion. |
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What are the indications for a routine CS? |
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What are the causes of sustained fetal tachycardia? |
Hypoxia, fetal distress, maternal pyrexia and salbutamol use. |
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What are the causes of sustained fetal bradycardia? |
Fetal distress due to placental abruption or uterine rupture. Maternal sedation. Below 90 is very severe and needs immediate action. |
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When should women be offered an induction of labour? |
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How is a labour induced? |
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What is the management of the 1st stage of labour? |
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What is the definition of delay in 2nd stage of labour? |
When birth has not happened 2 hours after full dilation. Refer to an obstetrician for an operative birth. |
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How is the gestation of the baby measured using ultrasound? |
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What are indications for Induction of Labour? |
Diabetes in Pregnancy PROM Maternal Request IUGR
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A woman has jaundice, anaemia, low platelets and High AST level late on in pregnancy. What is the diagnosis? What is the management? |
HELLP syndrome is a liver manifestation of HTN in pregnancy. It presents with nausea, vomiting and abdominal pain, leading to renal failure later on. Treatment is anti-seizure Mag Sulph and control coagulation and give anti-hypertensives. The complications are Maternal death, renal failure, deterioration after pregnancy and recurrence in future pregnancies. |
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What is the most common ovarian cancer? |
Serous tumour (benign = serous cystadenoma) Histology shows psmmoma bodies, bilateral in 40% of cases. |
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What are treatments of Atonic Uterus causing PPH? |
Rub up a contraction Carbaprost stimulates contraction. B-lynch suture holds it together. Balloon tamponade. |
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What are the types of vaginal prolapse? |
Cystocele is the descent of the bladder into the vagina causing urinary symptoms as well as the dragging feeling of prolapse. It can be seen on specullum exam. Uterovaginal prolapse is the descent of the pelvic organs into the vagina, causing a dragging fullness down there. There are different levels of prolapse. Risk factors are multiparity, obesity, constipation. |
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How does cervical ectropion present? |
Cervical ectropion is abenign change in the mucosa which is normally asymptomatic, but may cause bleeding post sex. STIs and cervical cancer must be ruled out. |
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What are endometrial polyps and how do they present. |
Small adenomatous growth in the uterus which may fall down into the cervix, causing dysmenorrhoea or postcoital bleeding. They should be removed and histologically tested. |
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What difference does placental position make? How are the variations managed? |
Low placenta may cause placenta praevia neccesitating a CS, or causing a bleed and fetal compromise. On the other hand, a Fundus placenta increases the risk of uterine inversion when the placenta is coming out. It is important to guard the uterus while traction is placed on the cord, only after signs of placental detachment. Uterine inversion stimulate a vasovagal response causing disproportionate shock.
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What are the risks of a Caesarean section? |
Serious: hysterectomy, need for further surgery, ITU admission, bladder damage, fetal damage, increased risk of uterine rupture in the future. Common: persistent wound pain, need for CS in the future. Things that may be necessary: blood transfusion, bladder repair. |
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What antibiotics should NOT be used in PROM? |
Co-Amoxiclav causes NEC Gentamycin causes ear issues |
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A pregnant woman is found to be Sickle Cell trait, how should it alter her management? |
1. Test genetic status of her partner. 2. Give Penicillin prophylaxis. 3. Give Folc Acid daily 4. Stop any hydroxy carbamide or ACE inhibitors.
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