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Flashcards in Obstetric Management Deck (20):
1

PPROM (medications)

Erythromycin (chorioamnionitis prophylaxis), BenPen (intrapartum, GBS prophylaxis), Betamethasone (if < W34), MgSO4 (if < W30), tocolytics (ONLY if transfer)

2

Breech presentation

External cephalic version (W36), also give tocolytics (eg. Terbutaline) beforehand

3

Uterine atony

1) Fundal massage, (2) 10 unit bolus syntocinon (3) IV Oxytocin 40U in 1L Hartmann’s running over 4 hours, (4) IM and IV Ergometrine 500mcg, (4) PR Misoprostol 2-4 200mcg tablets Per vagina/rectum, (5) Intramyometrial PG-F2a into four quadrants of uterus, (6) Bakri balloon and surgical ( uterine artery ligation, last line hysterectomy

4

Lactational mastitis

Fluclox, analgesia, frequent breastfeeding, technique

5

Chorioamnionitis

Ampicillin + Metronidazole + Gentamicin

6

Indication for forceps delivery

Fully dilated
Occiput located
Rupture of membranes
Catheter in situ
Engaged below ischial spines
Pain relief
Scissors - episiotomy

7

Definitions of
Amenorrhoea vs Menorrhagia
Polymenorrhoea vs Oligomenorrhoea

Amenorrhoea - no periods for 3/12 in a regular cycle/ no periods for 6/12 in non regular cycle

Menorrhagia >80ml in a cycle

Polymenorhoea course<21 days
Oligomenorrhoea course >35 days

8

Menorrhagia management x 3
Medical (4)
Surgery (2)

1. Identify underlying cause
2. Medical
- NSAID
- Transexamic acid
- COCP
- Mirena IUD
3. Surgical management
- ablation
- hysterectomy

9

What are indications for a biophysical profile? Name the 5 components [4U/S, 1 non U/S]

Concern for foetal development. Abnormal CTG or risk of IUGR
1. AFI
2. Foetal tone
3. Foetal body movement
4. Foetal breathing movement
5. Non stress CTG

10

Name the five components of a Bishop score

Cervical length (effacement)
Cervical dilation
Cervical consistency
Foetal station (relative to ischial spine)
CERVICAL POSITION

11

Name 8x maternal risks for C section

1. Anaesthetic risk if GA
2. Infection
3. Bleeding
4. Damage to surrounding structures
5. DVT, PE
6. Incisional hernia
7. Adhesions
8. Risk in subsequent pregnancies - accrete, uterine rupture, Cx scar pregnancy

12

Name 6x neonatal risks for C section

1. Sepsis
2. Respiratory distress syndrome
3. Hypoglycaemia
4. Respiratory support
5. NICU admission
6. Longer hospital admission

13

Management of cholestasis of pregnancy

1. Ursodeoxycholic acid
2. Symptomatic management (moisturiser, topical steroid, antihistamine at night)
3. Vit K
4. Monitoring
- Maternal weekly LFT, foetal movement and CTG
5. Full obstetric care
6. Deliver based on severity of maternal symptoms

14

Name three MOA of the COCP

1. Inhibition of ovulation
2. Thickening of cervical mucous
3. Thinning of endometrium

15

How to manage patient who has missed a pill for >48 hours ?

>48 hours + first 2 weeks - keep taking pills+ barrier for 7 days
>48 + third week - keep taking pills, skip sugar pills, barrier for 7 days
<48 - take forgotten pill immediately, resume normal process

16

Indications for a forceps delivery?

Fully dilated
Occiput presentation
Rupture of membranes
Catheter* - empty bladder
Engaged - station below ischial spines
Pain relief adequate
Scissors - episiotomy

17

For abortion, what procedures are suggested for what dates ?

Surgical suction abortion: W9-14
Medical abortion : week 7 and before method of choice. Best for Incomplete miscarriage. 400 mcg misoprostol. Vaginal or oral

18

Treatment for endometritis

Metronidazole + Clindamycin

19

Ideal date for cervical cerclage

W14-17

20

Management for shoulder dystocia

HELPERRD

Call for help
Episiotomy
Legs - mcroberts
Supra public pressure
Enter:
Rotational maneuveres
Roll on all fours
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