Obstetrics Flashcards
(31 cards)
Syntometrine route
IM
Shoulder Dystocia - Treatment
1) McRoberts
2) Gentle axial traction, up to 30s
3) Suprapubic pressure, 30s, +/- axial traction
4) Rocking suprapubic pressure, up to 30s, +/- axial traction
5) All 4’s +/- axial traction
6) Walk to ambulance and pre-alert to obstetric unit
Cord cutting
- Delayed until white
- At least 1 minute
- Unless concerns about mother or baby.
- Cut 5cm from umbilicus
Eclampsia - management
- CABC
- Lateral position
- IV access (Large bore)
- Titrate O2 94-98%
- Convulsions >2-3 mins - give Magnesium Sulphate 4g over 10 minutes
(Or Diazepam IV)
Causes of PPH
Tone - Failure of uterine contraction (Uterine atony)
Trauma - tears
Tissue - Retained placenta
Thrombin - coagulation abnormalities
PPH Management
If Placenta delivered start with Fundal/uterine massage.
If no placenta delivered progress to next stage. If fundal massage not success progress to next stage
1) Syntometrine IM (1ml)
2) If hypertensive, give misoprostol (800mcg) sublingual
3) IV access & fluids
4) TXA 1g
5) Pre-alert to hospital
Benefits of delayed versus immediate cord clamping in term infants
Avoidance of bradycardia seen after ICC and the abrupt cardiovascular changes associated with that
Improved early haematological indices:
- peak haemoglobin in first 24 hours
Improved iron stores in infancy
Management of Cord prolapse
Apply dry sanitary pad, walk to ambulance, and convey to Obstetric unit. Knees to chest bum in the air
Physiological changes in pregnancy
- 20-30% increase in cardiac output
- HR increase by 10-15bpm
- Decrease in BP due to decrease SVR
- Increase in blood volume up to 45%
- Increase in resp rate but decrease in vital capacity
Reasons to convey an obstetric emergency to an ED
- Cardiac arrest
- Major airway problems
- Ongoing eclamptic seizures
- Severe uncontrollable bleeding
Fundal height of the umbilicus is approximately ____ weeks gestation
22
Risk of maternal death during pregnancy by ethnic group
White women
Asian Women (2x)
Mixed ethnicity (3x)
Black women (4x)
EMOTIVE Treatment for PPH
Escalate / Early recognition
Massage
Oxytonics (Syntometrine/Misoprostol)
TXA
IV access/ Fluids
Exit
Airway changes in the pregnant woman
Increased oedema in oropharynx
Capillary engorgement of nasal mucosa
Delayed gastric emptying - risk of regurgitation
Breathing changes in the pregnant woman
Increased resp rate
Increased tidal volume
Increased O2 requirement
Decreased functional residual capacity
Splinting of diaphragm
Circulation changes in the pregnant woman
Increased stroke volume
Increased HR
Decreased BP in 1st trimester
Increase in clotting factors
Physiological anaemia
Compression of the aorta and IVC
Potential, early and viable pregnancy definitions
Potential pregnancy includes all women of child bearing age
Early pregnancy should be used for the women of child bearing age who is or suspected to be pregnant, with gestation less than 20 weeks.
Viable pregnancy shall be the term referring to women with a pregnancy is greater than 20 weeks.
Delivery of the placenta can take?
15 to 20min post birth of baby
Describe the first, second and third stage of labour
1 = contractions. If 3 to 4 contractions every 10min, this is established labour
2 = Cervix fully dilated. Contractions every 1-2min.
3 = Delivery of baby. end with delivery of placenta
During pregnancy, cardiac stroke volume and heart rate do what?
Increases gradually and heart rate rises by 10-20bpm.
By the second trimested, cardiac output has increased by approx 40%
During the late second trimester and third trimester, the uterus compresses what vessle which can lead to reduced venous return and syncope
vena cava
If the fundus is at the heigh of the umbilicus, then the fetus is atleast
20wks old
Management of eclampsia
ABCDE
Oxygen to 94-98%
Left lateral tilt
magnesium sulphate
diazepam
NO IV FLUIDS!
Pre-eclampsia is classified as?
BP >140/90
Severe if BP 170/110
proteinurea
with or woithout oedema
Usually occurs >24wks, but can occur as late as 6wks post birth
