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23 Cards in this Set

  • Front
  • Back

indications for caesarean in twin delivery

obstetric causes



  1. placenta previa
  2. severe pre eclamsia
  3. previous section
  4. cord prolapse of the first baby
  5. abdnormal utrine contractions
  6. contracted pelvis



foetal causes



  1. both fetus / first fetus not in cephalic presentation
  2. both cepalic but non has engaged
  3. twins with complications (iugr, conjoint)
  4. monoamniotic twins
  5. monochorionic twins with TTS

indication of the urgent delivery of 2nd baby

  1. sever intrapartum vaginal bleeding
  2. cord presentation of 2nd baby
  3. adminitration of ergometrin after the delivary of the firt baby
  4. first baby delivard under GA
  5. apperiance of foetal distress

delivery of 2nd baby in a twn

longitudinal lie



  1. rupture of the membrain
  2. 5 IU of oxytocin after 30 min
  3. interfearance if delaying too much
  4. cephalic - low down - forceps / high up - vaccume delivary or internal version and breach extraction (exclud cpd)
  5. breach - breach extraction



Transverse lie



  1. external version
  2. if failed internal version

occipito posterior VE findings

sagital suture
post fontnella near to sacrum


ant fontanelle is in anterioly

breech VE findings

complete breech



  • soft irregular parts



frank breech



  • hard feel of sacrum

face presentation VE findings

mouth


hard alviolar margins


alviolar margins


absence of meconium

brow presentation VE findings

supra orbital ridges and ant fontanelle

indications for electronic fetal monitering (continuous)
  1. fetal growth restriction
  2. maternl pyrexia
  3. significant meconium stained liquor
  4. fresh vaginal bleeding
  5. abnormal heart sounds detected at intermitant auscultation
  6. TOLAC / scarred uterus
  7. oxytocin use
  8. epidural analgesia

contraindications for dinoprostone induction
  1. ruptured foetal membranes
  2. pelvic inflammatory disease
  3. pts whom are on oxytocin
  4. scared uterus
  5. cpd
  6. foetal distress
  7. grand multipara with 6 or more previous term pregnancies

Shoulder dystocia
  1. H - call for help
  2. E - evaluate for episiotomy
  3. L - legs - McRoberts position
  4. P - supra pubic pressure
  5. E - enter and rotational maneuvers
  6. R - remove post arm
  7. R - role the pation to all 4

chorioamnionitis

3 out of 6



  1. mataernal pyrexia >36
  2. foetal tachycardia >160
  3. mataernal tachycardia >100
  4. utrine tenderness
  5. offesnsive vaginal dyscharge
  6. crp > 3x upper limit

atonic PPH
  1. utrine mssage
  2. remove vaginal clots
  3. ergometrin malate .5mg IV / methyl ergometrin .2mg IV
  4. oxytocin 5IV IV and 40IU in 500ml NS
  5. bimanual compression of utrus
  6. repeat .5mg ergometrin
  7. misprostrol 800mcg
  8. tranexamic acid 1g
  9. baloon tamponade
  10. aortic copression
  11. brace sutures
  12. devascularization
  13. histrectomy

delayed 3rd stage of labour

placenta not delivered within 30 min



  1. umbilaical vein oxytocin - 50 IU in 30 ml of NS
  2. after that wait controlled cord traction for another 30 min
  3. manual removel of placenta

secondary PPH
  1. retained placenta
  2. infections
  3. endometritis

Cord prolapse

  1. Cesarean category 1
  2. Put pt on all 4
  3. Warm 500ml ns in to blader
  4. Ppl ush upward the presenting part
  5. Keep cord back in vagina. Do the minimal cord handling. May keep warm saline soked pack
  6. May consider tocolytics. (but can cause pph)

Obstetric coholestasis
  • otherwise unexplained pruritus involving palms and soles
  • abnormal LFT
  • rised bile acids
  • resolve after delvary of baby

mx obstetric choleostatis

  1. early delivery at 37 weeks
  2. ursodeoxycholic acid - improve liver profile and pruritus
  3. topical emoliants
  4. vitk if PT is prolonged

HELLP syndrome
  • haemolysis
  • elevated liver enzymes
  • low platelets




  • hypertension
  • proteinuria
  • abd pain
  • nausea, vomiting, malaise




  • delivery


Breech delivary
  1. Spontaneous in preterm
  2. Ecv
  3. Internl podilic version (t2 in twin
  4. Assisted breech / breech extraction
  5. Lscs

teratogens

live and liver related enzymes in preganancy

  1. TSB - normal
  2. ALT/AST - normal
  3. ALP - Increased
  4. GGT - normal
  5. INR - normal
  6. Albumin - rediced
  7. platelets - normal
  8. cholesterol and TG - increased

in preganacy causes of ALT AST elevation
  1. acute fatty liver of pregancy
  2. Hellp / preeclamsia (AST>ALT)
  3. obstetric cholestasis
  4. hyperemesis gravidarum



---------


5. dengue




marked elevation in


6. acute viral hepatitis


7. hypoxic hepatic injury


8. hepato toxic drugs

serum bilirunin rise in preganacy

mild elevartion


  1. hyperemesis gravidrum
  2. AFLP
  3. HELLP
  4. sepsis



Marked elevation


5. Obstetic cholestatis


6. later stage of AFLP