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EXAM PREP > O&G - Shanaye's Deck > Flashcards

O&G - Shanaye's Deck Flashcards

1
Q

History qns to ask at 1st antenatal visit

A
  • current pregnancy: planned or unplanned, wishes to proceed. LMP
  • medical: pmhx, medicines, family hx, cervical smears, immunisation
  • Obstetric: previous experience of pregnancy and birth
  • SNAP + drug use
  • expectations, social support, culture and spirituality, concerns, knowledge, breastfeeding and infant feeding options
  • Previous mental health disorders
  • Edinburgh Postnatal Depression Scale
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2
Q

Clinical assessment tasks to perform on first antenatal visit.

A
  • Discuss conception and date of LMP
  • Measure ht and wt
  • Measure BP
  • Test for proteinuria
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3
Q

Screening tests at first antenatal visit.

A
  • Blood group and antibodies
  • HIV, hepatitis B (and C if necessary), rubella, syphilis, chlamydia, gonorrhoea
  • FBC, U+Es, LFTs
  • Urine MCS
  • Offer chromosomal abnormality screening to be carried out between 11 and 14 weeks of pregnancy
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4
Q

RF for breech birth

A 
Maternal:
- Nulliparity
- Previous breech birth
- Uterine anomaly
- Placental abnormalities
- Oligohydramnios
- Polyhydramnios
- Multiple pregnancy
- Grand multi
Fetal
- Short umbilical cord
- Prematurity
- Fetal abnormality
- Poor fetal growth
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5
Q

Features of breech presentation on examination

A
  • Presenting part feels irregular and a hard, round, ballotable head is found in the fundus
  • Fetal heart sounds are heard high in the abdomen
  • Thick, formed meconium may be present once the membranes are ruptured
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6
Q

Clinical approach to suspected breech at or beyond 37wks

A

USS

  • Confirm type of breech
  • Estimate fetal weight
  • Exclude hyperextension of the fetal head (if hyperextended need C-section)
  • Exclude placenta praevia
  • Assess fetal morphology
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7
Q

When to offer external cephalic version (ECV)

Success rate of ECV

A

At 36-37wks. All women with uncomplicated breech presentation at or near term unless contraindications exist.

40% for nulliparous, 60% for multiparous with trained operator

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8
Q

Contraindications to ECV

A
  • APH in current preg.
  • Ruptured membranes
  • Multiple pregnancy
  • severe fetal abnormality
  • Caesar necessary for other indications
  • Poor fetal growth
  • Significant HTN or pre-eclampsia
  • Uterine anomaly
  • Cord around fetal neck
  • Abnormal CTG
  • Hyperextension of the head
  • Previous CS (relative contraindication)
    RARE: uterine rupture
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9
Q

Procedure for ECV

A

Confirm breech presentation with no contraindications to ECV and gain consent.

Record pulse and BP and obtain CTG

Perform ECV

Monitor CTG for 30mins after and use USS to confirm success.

If unsuccessful, consider salbutamol tocolysis and repeat

Give anti-D to Rh -ve woman

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10
Q

Management of breech delivery

A
  • Book LSCS after 38.5wks or planned vaginal delivery if appropriate
    If vaginal delivery:
  • No pushing until full dilatation and breech descended to pelvic floor
  • If delivery not imminent after 60mins of pushing - CS
  • Episiotomy generally advised
  • Intervene and use manoeuvres where necessary
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11
Q

Criteria recommended for a planned vaginal breech term birth.

A
  • Consent and counselling about risks and outcomes of vaginal vs LUSCS
  • Appropriate experienced personnel available
  • Clinically adequate pelvis
  • No growth restriction or macrosomia
  • No footling or kneeling breech (only frank or complete)
  • Fetus has a flexed head
  • Theatre facilities available for LUSCS if required
  • No previous c-section
  • No fetal anomaly
  • No fetal or maternal compromise
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12
Q

How to deliver a breech baby vaginally if no complications present

A

Allow spontaneous delivery to the level of the umbilicus. Correct position to sacro-anterior if necessary

  • Deliver the legs by abduction of the thigh and flexion of the fetal knee
  • Allow fetus to hang from vulva until scapula is seen
  • Encourage woman to push to deliver shoulders and arms
  • Delivery of rest of body to level of fetal mouth over next 1-2 contractions
  • Delivery of head with forceps or Mauriceau-Smellie-Veit manoeuvre +/- bracht manouvre
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13
Q

What to do if arms don’t deliver spontaneously in breech presentation?

A

Lovset’s manoeuvre

  1. Grasp baby’s thighs with thumbs on sacrum and gently pull downwards and turn baby through 180 degrees until posterior arm is anterior and released
  2. Elbow appears under pubic symphysis and can be delivered by sweeping across the fetal body
  3. Repeat in reverse to deliver other arm
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14
Q

Management of cord presentation/prolapse.

A 
Call for help -obstetrician, anaesthetist, paediatrician
Expedite delivery
If cord pulsating:
- Immediate caesarean
- Reduce risk of cord compression with maternal position (place woman in deep knee/chest position or on L side with head down, legs up) and manual elevation of the cord
- Consider tocolysis
- Consider bladder filling
- Minimalise handling of the cord

If in 2nd stage of labour:
- Prepare for immediate delivery using vacuum or instrumental

Take cord blood gases immediately after delivery.

If cord not pulsating confirm fetal death

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15
Q

Risk factors for cord prolapse

A
  • Breech and other malpresentations
  • Multiple gestation
  • Preterm labour, low birth weight
  • Transverse, oblique and unstable lie
  • High head at onset of labour
  • Grand multi
  • Polyhydramnios
  • Abnormal placentations
  • Fetal congenital abnormalities
  • Abnormally long umbilical cord
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16
Q

What to do if a woman presents with suspected pre-term labour?

A

Hx - assess for signs and sx (pelvic pressure, cramping, back pain, vaginal loss, uterine activity)
O/E - vital signs, abdo palp, CTG, speculum examination to identify ROM and take high vaginal swab and low vaginal/anorectal GBS swab. Check for fFN Assess cervical dilatation
US
Labs - send high vaginal swab and low vaginal swab for MCS and MSU for MCS

17
Q

When to admit woman with suspected pre-term labour?

A

Consider admission if any of the following

  • fFN . 50ng/ml
  • Cervical dilatation
  • Cervical change over 2-4 hrs
  • ROM
  • Contractions regular and painful
  • Further obs or Ix indicated
  • Other maternal or fetal concerns
18
Q

Management for a woman in pre-term labour.

A
  • Transfer to tertiary centre equipped with NICU
  • Give corticosteroids if <35+0 wks (2 doses of IM betamethasone 24hrs apart), if risk of PTB ongoing, repeat in 7 days
  • Give tocolysis: Nifedipine 20mg oral, if contractions persist repeat after 30mins and again after another 30mins if still persisting. Give maintenance therapy every 6hrs for 48hrs.
  • If established labour give GBS prophylaxis
  • If chorioamnionitis give amoxycillin + gentamicin + metronidazole
  • If no labour and no chorioamnionitis with intact membranes –> cease ABs
  • If PPROM then convert to erythromycin
    Give Mag Sulf if 24-30wks with labour established or birth imminent.
  • Prepare for birth
19
Q

Maternal characteristics associated with preterm birth

A 
Age of mother (<18 or >35)
Ethnicity (African, South asian, ATSI)
Smoking
Psychological stress
Late/no antenatal care
Low SES
High or low BMI
20
Q

Medical and pregnancy conditions associated with pre-term birth.

A 
Presence of fetal fibrinonectin
Short cervical length (<25mm)
Previous PTB and no of PTBs
Genital tract infections (bacterial vaginosis doubles risk)
UTI/pyelonephritis
Assisted reproduction
PPROM
Surgical procedures on the cervix
Uterine anomalies
Poly/oligohydramnios
Multiple gestation
Chronic medical conditions
Acute medical conditions (APH, preeclampsia)
21
Q

Contraindications to tocolysis

A 
In-utero fetal death
Lethal fetal anomalies
suspected fetal compromise
maternal bleeding with haemodynamic instability
severe preeclampsia
placental abruptions
chorioamnionitis
22
Q

Signs of chorioamnionitis

A 
Fever >38
Tachycardia
Fetal tachycardia > 160
Uterine tenderness
Offensive smelling vaginal discharge
Increased WCC
Elevated CRP
23
Q

Components of a normal CTG

A

Baseline FHR 110-160
Baseline variability 5-25
Accelerations- 15 beats above baseline, lasting 15 seconds
No deceleration

24
Q

Causes of fetal bradycardia

A 
Low inherent rate (post-term)
Drugs
Maternal hypothermia
Fetal heart conduction defect
Maternal hypotension
Prolonged cord compression
Hypoxia
25
Q

Causes of fetal tachycardia

A 
High inherent rate(premature)
Maternal tachycardia
Maternal fever
Drugs
Fetal tachyarrhythmia
Hypoxia
Infection (chorioamnionitis)
Dehydration

EXAM PREP (6 decks)

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