obs and gynae emergencies Flashcards
(22 cards)
signs of an ectopic on USS
free fluid in abdomen (ie. blood in pelvis)
‘bagel shaped’ mass
empty uterus
management of haemodynamically compromised ectopic patient
surgical - salpingectomy / salpingotomy
ANTI D IF RH-VE MOTHER and post ?11wks - check/..
findings on abdo uss to distinguish ovarian torsion from standard ovary
torsion - impaired venous blood flow
Tx:
risk factors for torsion of ovary
ovarian cycst ovarian neoplasm (dermoid cyst usually) - usually benign hyperstimulation
when to surgically manage a cyst?
persistent simple custs >5cm
symptomatic
cyst accidents
MALIGNANCY OR SUSP MALIGNANCY
what do you look for on an endocervical swab?
high vaginal swab
chlamydia / gonorrhea
hvs - other organisms
complications of PID?
tubo-ovarian abcess
fitz-hugh-curtis syndrome
management of pid post IUCD
IV access - bloods / ivi abx - ceftiaxone + doxy... remove IUCD - send for cultuire acinomyces analgesia surgery (laparascopy / open?)
management of pid post IUCD
IV access - bloods / ivi abx - ceftiaxone + doxy... remove IUCD - send for cultuire acinomyces analgesia surgery (laparascopy / open?)
?complete / ?missed miscarriage
ALWAYS BEWARE OF PREGANNCY OF UNKNOWN ORIGIN - serial BHcG follow-up
though if have had previous scan confirming IU pregnancy - if you now see an empty uterus can now diagnose
UPT at 3 weeks to confirm….
shoulder dystocia - who gets them?
80% no rfs!!!!
other RF’s - macrosomia / gest D / obese mum
mx of shulfer dystocia
mcroberts suprapubic pressure episiotomy / wood screw manoueve repeat syphysiotomy zavanelli
LAST RESORT - replacement of the head + rush to theatre for CS
compications of shoulder dystocia
mum:
baby:shoulder dytocia /
risk factors for cord prolapse
multiparity lbw preterm labour AROM low lying placenta
how to ID a cord prolapse
management
fetal bradycardia on CTG
vaginal exam DONT HANDLE THE CORD IF YOU SEE IT - more likely to get vasospasm
mx:
elevate presenting part with hand
fill urinary bladder
knee-chet / Lt-lat position
Tocolysis
if mum still in pain when contractions finished on CTG - what are you worried about?
uterine rupture????
what is an amniotic fluid embolus?
amniotic fluid enters maternal circulation…
features:
resp distress
dyspnoea
DIC - bruising etc…
leading cause of death in pregnancy? in dev world
PE!!!
what anticoagulant is safest in pregnancy
lmwh
define a primary PPH
what is a major PPH
what is a massive PPH
> 500ml
1L
1.5L
causes of painless APH post sex
placenta praevia
cervical ectropion
management of eclampsia
- ABCDE approach and call for help
- Magnesium sulphate IV
(NB - stop MgSO4 if resp rate falls / loses tendon reflexes - give calcium gluconate) - labetalol
- CCB - ?nifedipine? - may need to jump to this as often B-blockers don’t work in women of Afro-caribean origin
check clotting!!! - platelets- HELPP syndrome
urine protein/creatinine ratio
