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3rd yr clinical > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What times should female hormone testing be done for fertility during her cycle

A

Serum LH and FSH on days 2-5

Serum progesterone on day 21 or 7 days before the end of the cycle

Anti-mullerian hormone - low level = low ovarian reserve

Thyroid function

Prolactin

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2
Q

What are the pre-testicular causes of infertility

A

Hypogonadotrophic hypogonadism- low LH and FSH causing low testosterone

Pituitary or hypothalamus issues
Suppression due to stress
Kallman syndrome(delay/ absent puberty with no smell)

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3
Q

What are some testicular causes of infertility

A

Mumps
Undescended testes
Trauma
Radiotherapy
Chemotherapy
Cancer

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4
Q

What investigations are done for a pregnancy of unknown location?

A

Serum hCG monitored over time- repeated after 48 hrs

Rise of over 63%- indicates intrauterine pregnancy- repeat USS in 1-2 weeks

Rise of less than 63%- ectopic pregnancy

Fall of more than 50%- miscarriage- pregnancy test again in 2 weeks

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5
Q

What is the criteria for management with methotrexate for an ectopic

A

-HCG level <5000 IU/L
-Confirmed absence of intrauterine pregnancy
-Follow up needed
-Ectopic mass enraptured
-Adenexal mass<35mm
-No visible heart beat
-No significant pain

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6
Q

How is methotrexate given in Ectopics

A

IM into bum
Can’t get pregnant for 3 months after

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7
Q

What is the surgical management for an ectopic and when is it used

A

Done if
-Pain -Adnexal mass>35mm -Visible heart beat -HCG>5000 IU

Can be laparoscopic salpingectomy- first line- removing affected tube

Laparoscopic salpinotomy- avoid removing the tube but remove the ectopic

Anti-D propylaxis is given to Rh -ve women

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8
Q

What are the USS findings in keeping with a miscarriage

A

CRL is >7mm but no fetal heart beat is found
Repeat this scan in one week to confirm miscarriage

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9
Q

What is the management of a patient less than 6 weeks with vaginal bleeding

A

Expectant - waiting - USS not helpful here as cannot see Heart beat anyway

Repeat pregnancy test 7-10 days and if negative miscarriage confirmed

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10
Q

What is the management of a patient more than 6 weeks with vaginal bleeding

A

Refer to early pregnancy
Transvaginal USS

Expectant management
If no risk factors or infection- give 1-2 weeks for miscarriage to occur

Medical
Misoprostal as a vaginal suppository or an oral dose

Surgical
Misoprostal given before
Manual vacuum aspiration - need to be less than 10 weeks

Electric vacuum aspiration

Anti-D given if rhesus positive

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11
Q

How is an incomplete miscarriage managed

A

Medical - misoprostal
Surgical- evacuation of retained products of conception

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12
Q

What is antiphospholipid syndrome

A

Antiphospholipid antibodies make the body prone to clotting - hyper coagulable state

Autoimmune condition can be secondary to SLE

Multiple miscarriage and DVT history

Treatment with aspirin and LMWH (enoxaparin)

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13
Q

What hereditary thrombophilias can cause miscarriage

A

Factor V leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency

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14
Q

When can an abortion before 24 weeks be carried out/ at any time

A

If continuing pregnancy is greater risk to physical or mental health or mum or baby

Abortion at any time if continuing will risk the woman’s life or substantial risk of physical/ mental abnormalities of child

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15
Q

What is used in medical abortion

A

Mifepristone- anti progesterone to halt pregnancy and relax cervix

Misoprostol- prostaglandin analogue to stimulate uterine contractions - from 10 weeks onwards additional misoprostal doses are added- every 3 hrs till explosion

Urine pregnancy test 3 weeks after to confirm

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16
Q

What are the two surgical abortion options

A

Cervical dilation and suction of contents up to 14 weeks

Cervical dilation and evacuation from 14-24 weeks

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17
Q

What is the criteria for hyperemesis gravidarum

A

-More than 5% weight loss compared with before pregnancy
-Dehydration
-Electrolyte imbalance

PUQE score will give score out of 15
<7- mild
>12- Severe

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18
Q

How is hyperemesis gravidarum management

A

Antiemetics
1. Prochlorperzine
2. Cyclizine
3. Ondansetron
4. Metoclopramide

Can use omeprazole if acid reflux

Consider admission if
Can’t take oral tablets/ keep anything down
Ketones in urine
>5% weight loss

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19
Q

How do you manage severe hyperemesis gravid arum

A

IV/IM antiemetics
IV fluids - Normal saline and K
Daily U&Es
Thiamine supplementation
Thromboprophylaxis

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20
Q

What is a complete mole

A

When two sperm cells fertilise an egg that has no genetic material - sperm combine genetic material

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21
Q

What is a partial mole

A

Two sperm cells fertilise a normal ovum at once and the ovum has 3 sets of chromosomes - some fetal material may form

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22
Q

What are the symptoms of molar pregnancy

A

-Severe morning sickness
-Vaginal bleeding
-Increased enlargement of uterus
-Abnormally high bHCG
-Thyrotoxicosis (HCG can mimic TSH and stimulate thyroid)

USS will show snowstorm appearance

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23
Q

How is a molar pregnancy managed

A

-Evacuation of uterus and histological examination
HCG levels monitored until normal

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24
Q

What does gravida and para mean

A

Gravida- number of pregnancies

Para- number of times a woman has given birth past 24 weeks

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24
Q

What vaccines should a pregnant woman get

A

Whooping cough (Pertussis) from 16 weeks
Influenza (flu)

Avoid live vaccines (MMR)

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25
Q

What lifestyle advice is given to a pregnant woman

A

-Folic acid 400mg
-Vitamin D (10mcg)
-Avoid vit A
-No alcohol
-No smoking

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26
Q

What screening is done at booking

A

-Blood group, antibodies, Rhesus
-FBC (Anaemia)
-Thalassaemia/ sickle cell
-HIV, hep B, syphillis
-Urine- protein and bacteria
-BP

Risk assessment
-RH -ve
-Gestational diabetes
-FGR
-VTE (give enoxaparin if high risk)
-Pre-eclampsia (give aspirin if high risk)

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27
Q

How is hypothyroidism treated in pregnancy

A

Levothyroxine needs to be increased during pregnancy by 25-50mcg
As it can cross the placenta

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28
Q

How is hypertension treated in pregnancy

A

ACE, ARB and thiazide diuretics STOPPED

Labetalol used
CCBs (nifedipine) can be used
Alpha blockers can be used (Doxazosin)

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29
Q

How is epilepsy treated in pregnancy

A

Epilepsy should be controlled on a single anti-epileptic before pregnancy

Levetriacetam, lamotrigine and carbamazepine- safer in pregnancy

Sodium valproate avoided- neural tube

Phenytoin avoided- cleft lip/palate

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30
Q

How is rheumatoid arthritis treated in pregnancy

A

Methotrexate contraindicated
Hydroxychloroquine- safe and first line
Sufasalazine - safe
Can use steroids in flare ups

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31
Q

What medications should be avoided in pregnancy

A

NSAIDs- block prostaglandins - esp in 3rd trimester can cause premature closure of ductus arteriosus - also delay labour

Beta blockers- can use labetalol - FGR, Hypoglycaemia and bradycardia in neonate

ACE and ARB- affect foetal kidneys

Opiates- fetal withdrawn

Warfarin- fetal loss/ malformations

Sodium val- teratogenic neural tube

Lithium- congenital cardiac abnormalities

SSRI’s -Congenital heart defects and withdrawal

Roaccutane- teratogenic

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32
Q

What infections must be avoided in pregnancy

A

Rubella- maternal infection before 20 weeks - congenital deafness, cataracts, heart disease, learning disability

Chickenpox- fetal varicella syndrome, more severe infection in mother

Exposure to chicken pox - if woman has had chickenpox- safe
If they are not sure- immunity tested and if IgG levels positive- safe
If not immune treat with IV varicella immunoglobulins within 10 days

Listeria - unpasteurised dairy products

CMV/ Congenital toxoplasmosis- this will cause hearing loss, low birth weight, petechial rash, microcephaly and seizure- hepatosplenomegaly

Parovirus B19 - Slapped cheek - miscarriage, hydrops fetalis, maternal preeclampsia

Women with suspected infection
IgM- acute infection
IgG - previous immunity
Rubella antibodies

Zika virus

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33
Q

When are anti-D injections given and what is their purpose

A

28 weeks and then at birth if baby is rhesus positive
Also given in
Antepartum haemorrhage, amniocentesis and abdo trauma

Kleinhauer test shows how much fetal blood passed into mother circulation

Anti-D injection will destroy foetal RBC to prevent mother’s immune system making her own antibodies against the antigen

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34
Q

What are the risk factors for Small gestational age

A

Previous SGA baby
Obesity, smoking, diabetes, exisiting HTN, pre-eclampsia, mother over 36, multiple pregnancies, antepartum haemorrhage, antiphospholipid synd

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35
Q

What is the management for a foetus that is SGA

A

Low risk women- symphysis fundal height measured from 24 weeks

High risk women- serial growth scans with umbilical artery doppler and amniotic fluid volume

Identify underlying cause

When growth is static on growth chart- early delivery with corticosteroids and planned C-section

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36
Q

What are the causes and risks associated with a baby that is LGA. What is the management

A

Causes: Constitutional, maternal diabetes, macrosomia, maternal obesity/ rapid weight gain, overdue, male baby

Risks: Shoulder dystocia, failure to progress, perineal tears, instrumental/Csection, postpartum haemorrhage, uterine rupture

Neonatal hypoglycaemia, obesity in childhood, type 2 diabetes in adulthood

Management: USS to exclude polyhydraminos, OGTT for gest Diabetes

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37
Q

What is the management of a UTI in pregnancy

A

7 days of nitrofurantoin 1st and 2nd trimester

Amoxicillin or cefalexin

Avoid trimethoprim in first semester - folate antagonist

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38
Q

What is the management for anaemia in pregnancy

A

Iron supplementation - ferrous sulphate 200mg 3x daily

B12 deficiency - test for pernicious anaemia (intrinsic factor antibodies), Give IM hydroxycobalamin or oral cyanocobalamin

Folate deficiency- folic acid 5mg

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39
Q

When is VTE prophylaxis given to a pregnant woman

A

at 28 weeks if there are 3 risk factors

First trimester if there are four or more risk factors

Given enoxaparin

Risk factors- smoking, parity >3, over 35, BMI>30, low mobility, pre-eclampsia, varicose veins, fam history, thrombophilia, IVF

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40
Q

How is a DVT/PE in pregnancy managed?

A

Enoxaparin (LMWH) for remainder of pregnancy and 6 weeks postnatally or 3 months in total (whichever is longer)

41
Q

What is the triad of pre-eclampsia

A

Hypertension
Oedema
Proteinuria

Happens after 20 weeks gestation

Abnormal formation of spiral arteries of placenta causes high vascular resistance

42
Q

What are the risk factors for pre-eclampsia

A

High risk
-Pre-existing HTN
-Previous HTN in pregnancy
-Autoimmune condition- SLE
-Diabetes
-CKD

Moderate risk
-Over 40
-BMI>35
->10 yrs since last pregnancy
-First pregnancy
-Fam history

Women given aspirin from 12 weeks if they have one high risk factor or more than one moderate risk factor

43
Q

What are the symptoms of pre-eclampsia

A

Headache, visual disturbance, nausea and vomiting, epigastric pain (liver swelling), oedema, reduced urine output, brisk reflexes

44
Q

How is pre-eclampsia diagnosed

A

Systolic above 140
Or diastolic above 90

PLUS
-Proteinuria (1+>)
-Organ dysfunction (raised creatinine, high LFTs, seizures, haemolytic anaemia, thrombocytopenia)
-Placental dysfunction (FGR or abnormal dopplers)

Proteinuria= Urine protein:creatinine ratio > 30
Urine albumin:creatinine ratio> 8

45
Q

How is pre-eclampsia / eclampsia managed

A

Pre-eclampsia
Labetalol (1st line)
Nifendipine (2nd line)
IV magnesium sulphate given during labour and 24 hrs after to prevent seizures

early birth with corticosteroids given

Eclampsia
IV magnesium sulphate
IV hydralazine
Fluid restriction

46
Q

What is HELLP syndrome

A

Complication of pre-eclampsia

-Haemolysis
-Elevated Liver enzymes
-Low platelets

47
Q

What are the risk factors for gestational diabetes and when should they get an oral glucose tolerance test

A

Previous gestational diabetes
Previous macrocosmic baby (>4.5kg)
BMI>30
Ethnic origin
Fam history of diabetes (1st degree)

OGTT between 24-28 weeks

also get an OGTT if
-Large for dates foetus
-Polyhydraminos
-Glucose on urine dip

48
Q

What is a OGTT and what are the values for gestational diabetes

A

75g glucose drink- blood sugar done fasting and 2 hrs after

5,6,7,8 easy to remember cut off

Normal results
Fasting- lower than 5.6
2 hrs- lower than 7.8

Above these is gestational diabetes

49
Q

How is gestational diabetes managed?

A

Four weekly USS from 28-36 weeks

-Fasting glucose<7- diet and exercise 1-2 weeks then metformin then insulin

-Fasting glucose >7- insulin and metformin

-Fasting glucose >6 and macrosomnia (or other complication)- insulin and metformin

50
Q

How is pre-exisitng diabetes managed in pregnancy

A

5mg folic acid
Retinopathy screening
Planned delivery between 37 and 38+6 weeks
Sliding scale insulin regime during labour for type 1 diabetics- detrose and insulin infusion

51
Q

What is the treatment for neonatal hypoglycaemia

A

Regular glucose checks and frequent feeds
Aim to keep blood sugars above 2
If they fall lower- IV dextrose or NG tube feeding

52
Q

What are the symptoms of obstetric cholestasis

A

Itching to palms of hands - and soles of feet - reduced outflow of bile acids

Fatigue
Dark urine
Pale greasy stool
Jaundice

NO RASH

Will have abnormal LFTs and raised bile acids (ALP will always be raised in pregnancy)

53
Q

What is the management of obstetric cholestasis

A

Ursodeoxycholic acid
Emollients and antihistamines for itch

Sometimes prothrombin time can be deranged so may also give water soluble via K - bile acids usually help absorb Vit K so this can cause deficiency

Early delivery after 37 weeks

54
Q

What is the cause and symptoms of Acute Fatty Liver of Pregnancy. How is it managed

A

LCHAD deficiency in fetus- impaired fatty acid processing in placenta

Acute hepatitis symptoms- fatigue, nausea and vomiting, jaundice, abdo pain, anorexia, ascites

Bloods: Elevated ALT and AST
-Raised bilirubin, WBC, deranged clotting (INR and PTT)
-Low plts

Emergency- prompt delivery

55
Q

What are the top 3 causes of antepartum haemorrhage

A

Placenta praevia, placental abruption and vasa praevia

56
Q

What is placental praevia and what are the risk factors associated

A

Placenta is attached in lower part of uterus, lower than foetus presenting part

Low lying placenta
Or placenta praevia (covering the internal cervical OS)

Risk factors
previous C-section
Previous placenta praevia
Older age
Maternal smoking
Structural abnormalities (fibroids)
IVF

20 week anomaly scan can see this
Can also have painless vaginal bleeding around 36 weeks

57
Q

How is placenta praevia managed

A

Repeat transvaginal USS at 32 and 36 weeks
Corticosteroids between 34 and 35+6 due to preterm delivery risk
Planned delivery between 36-37 weeks
Emergency C section if premature labour or antenatal bleeding

58
Q

What are the features and risk factors of vasa praevia

A

Fetal vessels are exposed outside the umbilical cord and placenta (umbilical arteries and umbilical vein) travel across the internal cervical OS

Risk factors
Low lying placenta
IVF pregnancy
Multiple pregnancy

Can be diagnosed on USS or antepartum haemorrhage

Also detected during labour- dark red bleeding when waters break

59
Q

What is the management of vasa praevia

A

If asymptomatic
Corticosteroids from 32 weeks
Elective C-section from 34-36 weeks

When antepartum haemorrhage occurs- emergency C-section

60
Q

What are the risk factors and presentation of placental abruption

A

Risk factors
Previous abruption
Pre-eclampsia
Bleeding in early pregnancy
Trauma (dom violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine, amphetamine use

Presentation
Sudden onset severe abdo pain
Vaginal bleeding (antepartum haemorrhage)
Shock (hypotension, tachycardia)
CTG abnormalities
Woody abdomen - large haemorrhage

61
Q

How is antepartum haemorrhage categorised

A

Minor haemorrhage- less than 50mls blood loss

Major haemorrhage- 50-1000ml blood loss

Massive haemorrhage- 1L blood loss or more and signs of shock

62
Q

What is the management of placental abruption

A

Emergency
ABCDE
CTG monitoring
Emergency C-section
Crossmatch 4 units of blood
Anti-D prophylaxis
Active management of third stage to reduce risk of postpartum haemorrhage

63
Q

What are the different types of placental attachment issues

A

Placenta accreta- attaches to the surface of the myometrium

Placenta increta- imbeds INTO the myometrium deeply

Placenta percreta- invades past the myometrium and perimetrium

64
Q

What are the risk factors, presentation and management of placenta accreta

A

Risk factors
Previous placenta accrete
Previous endometrial curettage
Previous C section
Multigravida
Increased maternal age
Placenta praevia

no symptoms- maybe some bleeding - diagnosed on USS usually

Can cause post partum haemorrhage

Management
MDT
Planned delivery 35-36 weeks - C-section with
Hysterectomy
Uterus preserving surgery
Expectant management - high risk infection and bleeding

65
Q
A
66
Q

What is an ECV

A

Can be done at 37 weeks in previous birth women and 36 weeks in first born

Turn foetus from breech to cephalic

Tocolysis given to relax uterus
Rhesus D neg women will need anti-D

67
Q

What is the management of stillbirth

A

USS to diagnose intrauterine fetal death
Rh D prophylaxis
Vaginal birth - induction (mifepristone and misoprostal) or expectant management
Dopamine agonists to surpress lactation after birth - cabergoline

68
Q

What are the main causes of cardiac arrest in pregnancy

A

Obstetric haemorrhage
Pulmonary embolism
Sepsis leading to metabolic acidosis and septic shock

69
Q

What are the main causes of obstetric haemorrhage

A

Ectopic pregnancy (early)
Placental abruption (also concealed)
Placenta praevia
Placenta accrete
Uterine rupture

70
Q

What is aortocaval compression and how do you prevent it

A

After 20 weeks uterus can compress the IVC and aorta

Compression of IVC reduces blood returning to heart (venous return) - decreased cardiac output and hypotension can cause cardiac arrest

Place woman in left lateral position

71
Q

What tests and management are done in preterm prelabour rupture of membranes

A

Speculum exam to look for pooling of amniotic fluid

Insulin like growth factor binding protein
Placental alpha microglobin-1

Management
Propylactic antibiotics - erythromycin 250mg four times daily for 10 days

Induction of labour from 34 weeks

72
Q

What is the management of preterm labour

A

Fetal monitoring
Tocolysis with nifedipine - between 23-33+6 weeks to delay delivery
Antenatal cortcosteroids before 35 weeks - reduce respiratory distress syndrome
IV magnesium sulphate - protect fetal brain- within 24 hrs delivery in less than 34 weeks baby

73
Q

When is labour induced

A

Between 41 and 42 weeks or if
Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death

Score of more than 8 in Bishop score indicates successful induction of labour

74
Q

What are the options for labour induction

A

Membrane sweep- finger in cervix to begin process within 48 hrs - not a full method of induction

Vaginal prostaglandin E2- pessary- releases prostaglandins over 24 hrs

Cervical ripening balloon- silicone balloon inflated to dilate cervix

Oral mifepristone and misoprostal if intrauterine foetal death

Monitoring with CTG and bishop score

75
Q

What are the features of uterine hyper stimulation

A

Individual contractions lasting more than 2 mins in duration

More than 5 uterine contractions every 10 mins

Can cause uterine rupture, fetal distress

Management
Remove vaginal prostaglandins and stop oxytocin infusion
Tocolysis with terbutaline

76
Q

What are some indications for continuous CTG monitoring

A

Sepsis
Maternal tachycardia
Meconiium
Pre-eclampsia (BP >160/110)
Fresh antepartum haemorrhage
Delay in labour
Oxytocin use
Extreme maternal pain

77
Q

What is the function of ergometrine

A

Given to stimulate smooth muscle contraction for delivery of placenta and reduce post part bleeding- can be used in third stage and to prevent/ treat postpartum haemorrhage

Can cause HTN, vomiting , diarrhoea and angina- avoid in eclampsia

synometrine- oxytocin and ergometrine for prevention or treatment of PPH

78
Q

What is the function of terbutaline

A

Suppress uterine contractions
Used in tocolysis during uterine hyper stimulation in induction of labour

79
Q

What is the function of carboprost

A

Prostaglandin analogue given as deep IM injection during PPH when ergometrine and oxytocin are inadequate

Avoid in patients with asthma

80
Q

What is the function of tranexamic acid

A

Antifibrinolytic to reduce bleeding
Prevention and treatment of PPH

81
Q

What is the management of umbilical cord prolapse

A

Umbilical cord descends below fetal presenting part into vagina- risk of cord compression and fetal hypoxia

Risk when foetus is lying abnormally

Management with emergency C-section

82
Q

How is shoulder dystocia managed

A

Presents with turtle neck sign- head goes back into vagina - difficulty delivering the face and head - failed restitution- head faces downwards and doesn’t turn sideways

Management
Episiotomy
McRoberts manoeuvre- posterior pelvic tilt - hyeprflexion of mother at hip
Pressure to anterior shoulder - press on suprapubic region
Rubin’s manoeuvre - reach into vagina
Wood’s screws manoeuvre- performed during a rubins
Zavanelli manoeuvre- push head back in and go to section

83
Q

What risks are associated with the various types of instrumental deliveries

A

Ventouse- suction cup- cephalohaematoma

Forceps- Facial nerve palsy and facial paralysis, bruising and fat necrosis

Femoral or obturator nerve damage to mother

84
Q

What are the different degrees of perineal tears

A

1st degree- limited to frenulum of labia minor and superficial skin

2nd degree- including perineal muscles but not anal sphincter

3rd degree- anal sphincter but not rectal mucosa

4th degree- rectal mucosa

3rd and 4th need repair in theatre

85
Q

How is a post partum haemorrhage classified

A

Atleast 500ml blood loss after vaginal delivery
1L blood loss after C-SECTION

Minor PPH- under 1L
Major PPH- over 1L (moderate 1-2 and severe <2)

Primary PPH- within 24 hrs of birth
Secondary PPH- 24 hrs to 12 weeks

86
Q

What are the causes of PPH

A

4T’s
Tone
Trauma
Tissue
Thrombin

87
Q

How is a PPH managed

A

ABCDE- two large cannulas, Bloods, group and cross match 4 units, warmed IV fluids, oxygen, FFP when clotting abnormalities)

Activate major haemorrhage protocol- 4 units of crossmatched blood or O negative

88
Q

What medical and mechanical and surgical treatment is used in a PPH

A

Rubbing uterus to stimulate uterine contraction
Catheterisation

Oxytocin- 40 units in 500mls , ergometrine, carboprost, miso-rostov, trxnexamic acid

Intrauterine balloon tamponade
Blynch suture
Uterine artery ligation
Hysterectomy

89
Q

What is the treatment of secondary PPH

A

USS for retained products
Endocervical and high vaginal swabs for infection

Surgical evaluation for retained products
Antibiotics for infection

90
Q

What are the two key causes of sepsis in pregnancy

A

Chorioamnionitis - infection of chorioamniotic membranes and amniotic fluid
Abdo pain, uterine tenderness, vaginal discharge

UTIs

91
Q

How is maternal sepsis managed

A

Monitoring on MEOWS chart
Blood cultures, lactate
Urine dip and culture, high vaginal swab

Continuous maternal and fetal monitoring
Emergency C section under GA
Broad spectrum antibiotics- tazocin + gent or amoxicillin, clindamycin and gent

92
Q

What are the risk factors, features and management of amniotic fluid embolism

A

Amniotic fluid passes into mothers blood- similar to anaphylaxis

Risk factors
Increasing maternal age, induction of labour, C-section, multiple pregnancy

Presents around the time of labour

Symptoms like anaphylaxis

Supportive treatment
ABCDE

93
Q

What are the features and management of uterine rupture

A

Main risk factor is previous C-section
Vaginal birth post C-section
Previous uterine surgery
Increased BMI
High parity
Increased age
Induction of labour
Oxytocin use

Presents with acutely unwell mum and abnormal CTG
Abdo pain, bleeding, no uterine contractions,hypotension, tachycardia

Management - emergency c-section and hysterectomy

94
Q

What are the features of uterine inversion

A

fundus of uterus drops through uterine cavity and cervix - uterus turns inside out

postpartum haemorrhage and collapse

Johnson manoeuvre - push the fundus back

Hydrostatic methods- inflate the uterus

Surgery

95
Q

What are the rules around contraception after childbirth

A

Lactational amenorrhoea is effective for up to 6 months if fully breastfeeding

POP and implant are safe and can be started any time after birth

COP needs 6 weeks postpartum before starting

96
Q

What is the presentation and management of post partum endometritis

A

Foul smelling discharge, bleeding getting heavier, sepsis, fever, abdo/ pelvic pain

Vaginal swabs, urine culture
USS to rule out products of conception

Broad spectrum abx

97
Q

How are postpartum retained products of conception managed

A

Evacuation of products in surgery under GA
Cervix widened with dilators and vacuum aspiration and curettage

Complications- endometritis and ashermans syndrome (adhesions within uterus)

98
Q

What are the time scales for postnatal mental health issues

A

Baby blues- first week or so
Post natal depression- 3 months after
Puerperal psychosis- a few weeks after birth

Edinbrugh postnatal depression scale- score>10 indicates post natal depression

99
Q

What are the features and management of mastitis

A

Breast pain and tenderness
Erythema of breast tissue
Nipple discharge
Fever

Complication of breast feeding - staph aureus infection

Flucloxacillin first line or erythromycin
Milk sample for culture and sensitivies

Continue breast feeding

100
Q

What are the features and treatment of candida of the nipple

A

Often after a course of abx
Cracked skin
Sire nipples bilaterally, nipple tender and itchy, cracked and flaky, white patches in baby mouth

Topical miconazole 2% after each feed and
Nysatin for baby

101
Q

What are the features of post party thyroiditis and how is it managed

A

3 stages
1.Thyrotoxicosis (first 3 months)
2. Hypothyroid (3-6 months)
3. Back to normal within 1 yr

Signs and symptoms of hypo or hyper

Management
Symptomatic control of thyrotoxicosis and hypothyroid

3rd yr clinical (22 decks)

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