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Flashcards in Obstetrics Deck (58)
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1

Methods of TOP

<9w mifepristone (anti progesterone) 48hrs later - PG to stimulate uterine contraction

<13w
surgical dilation and curettage of uterine contents

>15w surgical dilation and evaluation of uterine contents or late medical abortion

2

What is the upper limit of abortion?

24 weeks

3

Types of CS

Lower segment CS
Classical CS

4

Indications for CS (emergency)

Placental abruption with abnormal FHR
Cord Prolapse
Scar Rupture
Prolonged bradycardia
Foetal distress
Failure to progress with pathological CTG

5

Indications for CS (scheduled)

Pre-eclampsia (early delivery)
Failed induction of labour
IUGR

6

Indications for CS (elective)

Breech presentation
Twin pregnancy with non-cephalic 1st twin
Maternal HIV
Primary genital herpes in 3rd trimester
Placenta praevia

7

Risk from CS

Maternal:
Emergency hysterectomy
Need for further surgery at a later date
Admission to intensive care unit
Thromboembolic disease
Bladder injury
Ureteric injury
Persistent wound and abdominal discomfort in the first few months
Increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies
Readmission to hospital
Haemorrhage
Infection (wound, endometritis, UTI)

8

Presentation of a pregnancy

Cessation of periods
breast tenderness/heaviness
N&V 1st trimester
micturition
Fatigue
Foetal movements 18-20w

9

HCG test for pregnancy timing

peak at 8-12 week
+ if >50
can be confirmed within 1 w of missed period

10

Calculating gestation

LMP - 3m +1 yr 7 days (if 28 day cycle), if longer add the extra days on

USS - crown rump length 11-13 weeks

SFH 24 weeks

11

Hyperemesis gravidarum presentation and risk factors

Excess vomiting due to raised HCG 8-12w

Linked with multiple,e obesity, thyroid, trophoblastic. Smoking reduces this.

12

Hyperemesis gravidarum management

Promethazine
metoclopromide

13

Complications of hyperemesis gravidarum

Wernickes
Mallory weiss tear

Central pontine myelinolysis
Acute tubular necrosis
SGA, preterm

14

Types of miscarriage

Threatened
Missed
Inevitable
incomplete
Missed

15

What gestation does miscarriage include?

<24 weeks
most occur <12w

16

Presentation of a threatened miscarriage

Painless vaginal bleeding <24 w typically 6-9 w
Closed os
USS: intrauterine sac, foetal pole and heart activity

17

Presentation of a missed miscarriage

Dead foetus in sac <20 weeks, no expulsion symptoms
mother may have light bleeding/discharge and Sx of pregnancy disappear
closed os
USS pole >7 no foetal heart rate
mean gestation sac diameter >25

18

Presentation of an inevitable miscarriage

Heavy bleeding with clots and pain, open os

19

Presentation of an incomplete miscarriage

Not all products expelled
Heterogenous tissue of USS +/- sac, endometrial thickest, pain, bleed, open os

20

Causes of miscarriage

Embryonic: chromosomal
Maternal: systemic illness, infection, toxic, rhesus, cervical incompetence

21

Types of management of miscarriage

Early pregnancy assessment unit
TVS/HCG
Expectant
Medical
Surgical

22

Medical management of miscarriage

PG analogues (misoporostol)
bleeding may occur for 3w post procedure
may get heavy bleeding and pain after

23

Surgical management of msicarriage

ERPC under GA
for excess or persistent bleed or request
Suction curretege

24

Expectant management of miscarriage

If not heavy bleeding
Good for incomplete
Repeat TVS 2w to ensure completed. Surgery if not.

25

Define recurrent miscarriage

3 or more consecutive spontaneous miscarriages

26

Causes of recurrent miscarriage

APL
Endocrine abnormalities
Chromosomal
Smoking

27

RF for ectopic pregnancy

Damage to tubes - surgery, infection
Hx of ectopic
PID
endometriosis
IUCD
POP
IVF

28

Presentation of ectopic pregnancy

6-8 w of amenorrhoea
shoulder tip pain
PVB - dark brown
Collapse
Excitation

29

Diagnosis of ectopic

HCG serum
USS
laparoscopic
Serum progesterone - <20 failing pregnancy. Take 48 hours apart - if rises then IUP

30

Management of ectopic

Expectant. if small and enraptured, stable, declining HCG - monitor until below 20

Medical
if stable, unruputred with mass <35, no visible heartbeat or IUP on USS, serum hug <500 - methotrexate then measure hcg <20

Surgical
laparoscopy is performed if stable. Salpingectomy/salpinostomy if infertility factors