Obstetric Newborn Paediatric Day Flashcards
What is the risk of head not being engaged? and how to tell if it is?
The risk comes from the space created between the foetus and pelvis. This provides an area for the cord to prolapse. Failure to engage may be assessed through palpation of the pelvis assessing movement of fatal head and position.
Name the trimesters and corresponding weeks:
Trimester 1: 1-13
Trimester 2: 14-27
Trimester 3: 28-40
What is oligohydramnios and the risks associated?
oligohydramnios is a lower than expected amniotic fluid volume. This is associated with poorer outcomes with risk of pulmonary hypoplasia (if midtrimester oligohydramnios), fetal deformation (if prolonged oligohydramnios), and umbilical cord compression.
What are some of the different appearances of amniotic fluid at rupture and what do they correspond with?
Yellow tinge: normal
Pink/red tinge: may be normal
Green/brown: baby has passed bowels. this has a high risk of meconium aspiration syndrome.
Red/bloody: haemorrhage/trauma likely with potential abruption.
Why do we see a reduced level of umbilicus from 36 through to 40 weeks.
This is a sign that metal engagement is occurring.
At what week do we consider a foetus viable and why should this be used very cautiously.
Viability is considered to be at 22 weeks. The date of conception is not a specific science and although we may know that 22 weeks is a good gauge the date of conception is largely unknown and may be out by weeks.
Not completed without instruction from a trained professional but an episiotomy may be performed in what setting and in what direction?
Indications:
failure to progress.
foetus requires expedited delivery (ie foetus is at risk).
shoulder dystocia.
History of female genital cutting.
This should be performed in a horizontal fashion to avoid the highly vascular tissues in the vertical aspects.
some signs that delivery may be imminent and delivery at home may be indicated:
Purple line above anus.
vomiting
voice change
What course of action should you take for a cord prolapse:
Pad on
Modified sims position (head down/bum up)
Rapid transport.
Seek advice.
Treatment of seizures in eclampsia:
Basic care
Midazolam
Call for direction on Mag vs Keppra
Prep for immediate delivery/resus.
When calling medstar for obstetric case what is important to note?
haemorrhage and obstetric kits/drugs.
What is the MOA of oxytocin post delivery?
Activation of oxytocin receptors on the myometrium triggers a downstream cascade that leads to increased intracellular calcium in uterine myofibrils which strengthens and increases the frequency of uterine contractions
What is shoulder dystocia?
shoulder dystocia occurs when delivery of the head has occurred but foetus is unable to deliver head or rest of body. This occurs due to the shoulder unable to clear the anatomical space of the anterior aspect of the pelvis. Often characterised by turtle sign.
What does the mnemonic HELPERR stand for in shoulder dystocia?
H - help
E - evaluate/episiotomy
L - leg to McRobet’s position
P - pressure (super pubic)
E - entre (robin’s/woods screw manœuvre)
R - remove posterior arm
R - roll pt to hands and knees.
how do placental abruptions and previa present differently?
Abruption:
pain and rigid abdominal
Previa:
painless
Talk about circulation changes from intrauterine and extrauterine life:
intrauterine blood blood flow is R
) sided dominant bypassing the lungs through ducts in the aorta, atria and ventricles. This changes in the extrauterine life where these ducts close increasing L) sided dominance and ensuring perfusion to the lungs.
What umbilical vessel do we cannulate if push comes to shove? and what should it look like?
where possible cannulation should occur in the umbilical vein. If the umbilical cord is short this should be at 12 o’clock. The appearance the vein should look large and floppy.
