Obstetrics Flashcards
(154 cards)
1
Q
Which patients are vaginal progesterone offered to?
A
Hx of spontaneous prterm birth (< 34 weeks)
Hx of midtrimester loss (>16 weeks)
Cervical length on USS (between 16-24 weeks) shows cervical length < 25mm
2
Q
When is vaginal progesterone offered for prevention of preterm birth?
A
16-24 weeks until at least 34 weeks
3
Q
When is prophylactic cervical cerclage offered?
A
Hx of spontaneous preterm birth (<34),
mid trimester loss (>16) and cervical length < 25mm
Hx of Cervical trauma AND cervical length < 25mm
cervical length scan between 16-24 weeks
4
Q
When is rescue cervical cerclage provided?
A
Cervical dilation in the absence of uterine contractions between 16-27+6 weeks
5
Q
What is offered in Preterm labour but NOT PPROM?
A
Tocolytics, increased risk of infection in PPROM
6
Q
How is preterm labour managed?
A
IM Betamethasone 24mg, 2 doses 12 hours apart
Tovolytics given simultaneously, either:
- nifedipine (CCB)
2nd line: atosiban (Oxy receptor antagonist)
7
Q
When are tocolytics contraindicated?
A
PPROM, active bleeding, signs of infection
8
Q
When is magnesium sulphate given pre-term?
A
if birth is likely / planned within 24h
9
Q
What is the dosing of mag sul for neuroprotection?
A
4g loading dose over 5-15 mins
then IV 1g / hour
until birth or for 24h
10
Q
What can mag sul overdose lead to?
A
toxicity - RR depression and arrhythmia
monitor HR RR BP reflexes every 4h
11
Q
What is the antidote for mag sul overdose?
A
10% 10mL calcium gluconate over 10 mins (stop mag sul)
12
Q
What Ix are performed for diagnosing PPROM?
A
Sterile Speculum
Check for pooling in posterior vaginal fornix
if -ve: check for IGF protein 1 OR placental alphamicroglobulin 1
13
Q
If PPROM is diagnosed, what is the Mx?
A
- Admit to antenatal ward
- Prophylactic ABx: 250mg Erythromycin QDS 10 days
OR oral penicillin 10 days - Offer Steroids, IM Betamethasone 24mg, 2 doses 12hours apart
14
Q
What are the risk factors for PPROM?
A
smoking, STI, previous PPROM, multiple pregnancy
15
Q
PACES: what do you need to explain for PPROM?
A
RF need to admit want to keep baby in as long as possible ABx as infection can be dangerous Will be closely monitored with CTG Explain why steroids are given
Discuss whether delivery is likely
16
Q
What is the Mx for PROM?
A
- Admit to antenatal if evidence of chorioaminionitis or foetal distress, if no issues after check up they can go home to await onset of labour
- ABx prophylaxis after 24h if no labour still : erythromycin 250mg QDS
- intense clinical surveillance:
- CTG
- signs of infection - Expectant management for 24h after ROM, as 60% go into labour
- if past 24h, offer IOL - Monitor neonate for 12 hours after
17
Q
How is shoulder dystocia identified?
A
Turtling of foetus
18
Q
How is shoulder dystocia managed?
A
- STOP PUSHING
- Call for senior help
- McRoberts
- Suprapubic Pressure
- Evaluate for Episiotomy
- Wood’s Screw Maneouvre - pressure on anterior aspect of posterior shoulder
Rubin II - force anterior shoulder toward chest, turning foetus diagonal - All fours
- Consider symphisiotomy, cleidotomy or Zavanelli
19
Q
What are the types of breech position?
A
Frank - extended (most common)
Complete - flexed
Footling
20
Q
How is breech position managed?
A
- ECV at 36 weeks
- Vaginal breech
- C - Section
21
Q
When is ECV performed?
A
36 weeks if nulliparous
37 if multip
22
Q
What is the success rate of ECV?
A
50%
23
Q
When is ECV contraindicated?
A
C section inevitable Recent APH wihtin 7 days abnormal CTG ROM Multiple pregnancy
24
Q
What are the advantages of c-section over vaginal breech?
A
small reduction in foetal and maternal mortality
small increase in risk of complications for mother
affects future pregnancy e.g. praevia
25
What are the advantages of vaginal breech vs c-section?
40% reqiure c section anyway
ABSOLUTELY CONTRAINDICATED IF FOOOTLING
26
PACES: What needs to be explained for breech presentations?
RF: fibroids, poly/oligohydramnios, placenta praevia, uterine malformations, prematurity, fetal abnormalities
Explain what breech means
Offer ECV and explain risks (50% success, placental abruption, distress --> c section)
benefits of vaginal breech vs c section
27
What medication must be given following an ECV?
Anti-D within 72 hours
28
Describe the vaginal breech delivery
Induction NOT recommended
maternal position on all fours
1. Hand's off - only place thumbs on sacrum on ASIS
2. Delivery of legs and lower body - flexed will deliver spontaneous, extended: perform Pinnard's
3. Shoulders: Winging of scapulae indicates baby is stuck, Loveset's manoeuvre - rotate to transverse and pull arm down
4. Head: Mariceau-Smelly-Veit manoeuvreL place baby on your forearm and flex head downward
29
What are the other malpresentations and how are they delivered?
Face:
- chin anterior: vaginal delivery possible
- chin posterior: delivery by c section only
Brow: Deliver by c section
30
What are the components of the BISHOP score?
Dilation of cervix
Consistency of cervix
Length of cervical canal
Position of cervix
Station of presenting part
all graded 0-3
31
What is the order of Induction of labour?
Vaginal Prostglandin E2:
- tablet and gel: 1 dose, 2nd after 6 hours
- pessary: 1 dose over 24 h
ARM: only if cervix is dilating and effacing, avoid if high / mobile presenting part -
IV Syntocinon:
- offer if 2 hours after ARM labour not started
- max 3-4 contractions over 10 mins
32
What are the risks of ARM?
inc risk of cord prolapse
33
What are the risks of iv syntocinon?
uterine hyperstimulation and uterine rupture (not good for VBAC)
34
What happens if induction fails?
rest period, attempt again, c-section
35
When is membrane sweeping offered?
40 weeks for nulliparous
41 weeks for multiparous
* only if cervix beginning to dilate and efface*
* exclude placenta praevia*
36
What can be used to induce labour following intrauterine death?
Mifepristone (anti-progesterone) and misoprostol (prostaglandin)
37
Which types of miscarriage is mifepristone contraindicated for?
missed or incomplete
38
How is unstable lie managed?
if mechanical - LSCS
37 week onward admission
ECV, ARM or LSCS considered
39
What is the success rate of VBAC?
72-75%
40
What factors improve success of VBAC?
spontaneous onset,
previous successful VBAC,
normal size baby and
vertex presentation
41
What are the risks of VBAC?
Uterine rupture
Scar rupture
Cord prolapse if augmented labour
42
What are the risks of Elective repeat C section?
Risk of accreta / praevia
likely needs C Section in future
avoids scar rupture and uterine rupture
43
What are some relative contraindications for VBAC?
>2 previous c sections
need for IOL
Previous suggestions of cephalopelvic disproportion
44
What are some ABSOLUTE contraindications?
previous classical scar
previous uterine rupture
placenta praevia
45
PACES: what needs to be explained about VBAC?
Discuss options of VBAC and ERCS
Explain risks of uterine rupture
Explain risks of ERCS
46
How is umbilical cord prolapse managed?
1. CALL FOR HELP
2. Prepare for emergency delivery in theatre
3. if cord outside of introitus, avoid handling but maintain warmth and moisture
4. Elevate presenting part (manually or fill bladder)
5. Reposition mother, knee to chest or left lateral and head down
47
How is uterine rupture managed?
1. CALL FOR HELP
2. ABCDE
- 2x large bore cannulae
- bloods, G&S, clotting, FBC
Transfuse blood
3. expedite delivery and urder laparotomy
48
What is the doseage of prophylactic uterotonic drugs?
IM oxytocin 10iv if vaginal
IM oxytocin 5iu if c section
49
How is a minor PPH managed?
ABCDE
HELP
1x IV Access
Bloods for G and S, FBC
Warm, crystalloid infusion
HR RR and BP every 15 mins
50
How is major PPH managed?
HELP
2222 and major obstetric haemorrhage protocol
1. lie patient flat
2. 2x large bore cannulae
3. urgent bloods, FBC, clotting, group and save
transfuse
4. HR, RR and BP constantly
5. Massage uterus
6. IV/IM sytocinon / IM ergometrine (unless hypertensive or heart disease) or IV syntometrine
7. IM carboprost (unless asthmatic)
8. balloon tamponade
9. surgical measures, iliac artery ligation, UAE, hysterectomy
51
What advice is given pre-conception to mothers with chronic HTN?
stop ACEi, ARBs, thiazide-like diuretics and thiazides within 2 days of positive pregnancy test
contact GP for alternatives:
1. labetalol unless asthmatic
2. nifedipine
52
What advice is given antenatally for women with chronic HTN?
c: stop smoking, reduce salt and exercise
monitoring: BP, weekly if poorly-controlled and every 2-4 if well controlled
serial growth scans every 4 weeks from 28-36 weeks
Medical :75mg aspirin from 12 weeks to delivery
53
What is the cut off for offering induction for women with chronic HTN < 37 weeks?
if <160 / 110 do not offer induction < 37 weeks
54
how are women with chronic HTN managed postnatally?
monitoring: BP daily for the first two days after birth
once on day 3 and 5
follow up with GP at 2 weeks
55
What advice is given to mothers with diabetes mellitus pre-conception?
stop all meds except insulin and metformin
5mg folic acid - needs to be prescribed
56
Which conditions require high dose folic acid?
DOSEI
diabetes, obese, sickle cell, epilepsy, (auto)immune
57
What antenatal advice is given for women with diabetes?
seen in joint obstetric and diabetic clinic every 1-2 weeks
ensure she is up-to-date with retinal / renal screening (within the last three months, otherwise offer)
HIGH DOSE FOLIC ACID AND 75MG ASPIRIN FROM 12WEEKS TO PREVENT PRE ECLAMPSIA
58
How are women with diabetes monitored?
cap BM 7x a day
pre prandial < 5.3
1 hr post prandial < 7. 8
specialist foetal cardiac scan 19-20 weeks
SERIAL GROWTH SCAN EVERY 4 WEEKS 28-36
REPEAT RETINAL AND RENAL (IF ABNORMAL AT BOOKING - 16-20 WEEKS, IF NORMAL: 28 WEEKS)
59
What medications do diabetic women need to take when pregnant?
high dose folic acid - pre conception to 12 weeks
low dose aspirin (75mg) - 12 weeks to delivery
advise metformin increase in 2nd half of pregnancy
60
When are women with diabetes advised to give birth?
37-38+6 elective
IOL or c section
be careful of adminstering corticosteroids
NO LATER THAN 40+6
61
What is the ideal BM during labour and how is this controlled?
4-7, sliding scale of insulin
62
What postnatal checks are done for diabetic women?
check BM within 4 hours of birth
return to pre-pregnancy metformin and insulin dose immediately after delivery
63
How are hypothyroid women monitored antenatally?
every 2-4 weeks, TSH < 4
FOR HYPOTHYROID, INCREASE THYROID DOSE BY 25MG
64
When are TFTs checked postnatally?
at 6-8 week postnatal check
65
How are hyperthyroid women monitored antenatally?
every 2-4 weeks, TSH < 4
continue carbimazole / propylthiouracil at lowest possible dose
- safety net about agranulocytosis
- lower dose if nec. throughout pregnancy
66
How are asthmatic women managed?
ALL medication safe
advise about technique, smoking cessation
intrapartum: no ergometrine or carboprost, regional anaesthesia >general for c section
NO LABETALOL
67
How are women with heart disease advised pre-conception?
avoid all ACEi, ARBs, thiazide diuretics and statins and warfarin
68
How are women with heart disease managed antenatally?
jOINT CARDIAC AND OBSTETRIC CLINIC EVERY 2-4 WEEKS UNTIL 20 WEEKS, EVERY 2 WEEKS UNTIL 24 AND WEEKLY AFTER
maternal echo at booking scan and at 28 weeks
specialist foetal cardiac scan at 22 weeks
VTE prophylaxis with LMWH SC
69
How are women with heart disease managed intrapartum?
```
avoid IOL
Epidural where possible
Prophylactic ABx for structural defect
NO ERGOMETRINE only syntocinon
minimise 2nd stage (e.g. intrumental)
```
70
How are women with heart disease managed postnatally?
transfer to HDU for 12-48h
| arrange obstetric and cardiac F/U
71
Which conditions needLMWH from 12 weeks?
```
Previous hypertension in pregnancy
Small baby
Chronic HTN
CKD
autoImmune
Diabetes
Sickle Cell Disease
```
HACCSSD
72
What advice are epileptics given pre-conception?
reduce to monotherapy, ideally lamotrigine
NEVER VALPROATE
5MG FOLIC ACID PRE CONCEPTION UNTIL 12 WEEKS
73
How are epileptics managed antenatally?
joint epilepsy and obstetric clinic
serial growth scans from 28-36 weeks eery 4 weeks
advise to joining the UK EPILEPSY IN PREGNANY REGISTER
74
How are epileptics managed postnatally?
advise on safe handling
recommend breast feeding
start on contraception
baby needs 1mg of Vitamin K especially if on phenytoin
consider long acting benzo / clobazam if high risk of intrapartum seizure
75
What conservative measures are taken to manage UTIs
plentiful fluid intake
simple analgesia
76
Which analgesiac is absolutely ocntraindicatedi n breastfeeding?
aspirin
77
What is the medical management for UTI?
nitrofurantoin 50mg QDS 7 days
- avoid if full term
2nd line: amoxicillin or cefalexin (if no improvement in 48h)
trimethoprim is a folate synthesis inhibitor
78
How is syphillis managed?
benzylPenicillin IM + GUM for contact tracing
79
Describe primary manifestation of syphillis
painless genital ulcer 3-6 weeks after infection (condyloma lata)
80
Describe the secondary manifestation of syphillis
6 weeks to 6 months after
| widespread maculopapular rash
81
When is toxoplasmosis most dangerous to baby?
first trimester but low infectivity
82
When is toxoplasmosis most infective?
3 rd triemster
83
What is the management of toxoplasmosis in pregnancy?
spiramycin 2-3g OD 3/52
consider TOP or more aggressive Tx e.g. sulfadiazine
84
How can toxoplasmosis be avoided?
avoid raw meat and cat litter
85
How is CMV treated?
no tx availale
refer to tx foetal medicine specialist for regular surveillance
foetal US examination every 2-4 weeks from Dx and MRI at 28-32
if evidence of foetal infection: continue with expectant management or TOP
postnatal Anti viral therapy (valganciclovir, ganciclovir)
86
How is chickenpox managed during pregnancy?
Antenatal:
VZIG up to 10 days after exposure
800mg Aciclovir 5x/day for 7 days
refer to a specialist at 16-20 weeks for detailed US assessment
87
What happens if chicken pox develops <7 after delivery, prior to delivery?
delay elective until 7 days after rash
arrange neonatal ophthalmic exam
give neonate VZIG and monitor for 28 days
88
How is maternal parvovirus infection managed?
Bed rest, fluids
REFER TO FOETAL MEDICINE SPECIALIST WITHIN 4 WEEKS FOR REGULAR SURVEILLENCE
89
What are the management options if foetal anaemia or foetal hydrops are suspected due to parvovirus?
expectant: spontaneous resolution occurs in 50% of cases
In utero transfusion: always offer if infection occurs in the first 20 weeks
sample blood from middle cerebral artery
90
How is Listeria managed?
IV amoxicillin 2g every 6 hours for 14 days
91
What sign may raise suspicion of listeria infection?
meconium staining of amniotic fluid
92
When HSV infection the most dangerous?
primary infection within 6 weeks of delivery
93
How is primary in first/second trimester Herpes managed?
Refer to GUM
PCR
400mg oral aciclovir TDS for 5 days
daily suppressive aciclovir from 36 weeks to delivery
OFFER VAGINAL
94
How is primary herpes in the third trimester managed?
continue oral aciclovir until delivery (400mg TDS)
recommend elective C SECTION
if she chooses vaginal: intrapartum iv aciclovir
avoid ARM
95
What are the risks of GBS for the neonate?
early onset sepsis
96
How is GBS managed antenatally?
if detected incidentally, treatment NOT recommended as no reduction in GBS colonisation for delivery
97
How is GBS managed intrapartum?
IV benzylpencillin 3g ASAP after onbset of labour
then 1.5g every 4 hours until delivery
mild allergy to pen = cephalospori n
severe = vancomycin
98
When are antibiotics not needed for GBS?
elective c section
no sign of labour
intact membranes
99
What are some risk factors requiring GBS prophylaxis intrapartum?
previous GBS
intrapartum fever
prolonged ROM > 18 h
GBS bacteriuria
incidental GBS finidng in current pregnancy
100
How is GBS sepsis managed in the neonate?
IV penicillin and gentamicin
101
How is chlamydia managed in pregnancy?
erythromycin or azithromycin
AVOID TETRACYCLINES
102
How is HIV managed antenatally?
contact with joint HIV physicians and obstetrician clinic every 1-2 weeks
monitor viral load every 2-4 weeks at 36 weeks and delivery
if on ART, continue
if not: advise start of ART by 24th week
103
How is HIV managed intrapartum?
DEPENDS ON VIRAL LOAD AT 36 WEEKS
< 50 copies - reassure that vaginal is possible
> 50 / co-existent HCV - elective c-section (at 38 weeks to reduce chance of spontaneous labour), intrapartum IV zidovudine
CLAMP CORD ASAP
104
How is HIV managed postnatally?
advise not to breastfeed (in resource limited settings this may not be possible)
all newborns should receive ART within 4 hours of birth
- low risk: zidovudine monotherapy 2-4 weeks
- high risk: triple ART (zidovudine, lamivudine and nevirapine) for 4 weeks
direct viral amplification by PCR at birth, discharge, 6 weeks and 6 months)
105
PACES: HIV counselling
- explain need for joint obs and HIV clinic
- explain need to monitor viral load every 2-4 weeks at 36 weeks and delivery
- stress importance of compliance of ART
- discuss delivery is dictated by viral load
- advice against breastfeeding
- explain neonatal treatment with ART for 4 weeks
106
How is Hep B managed antenatally?
Refer to hepatologist
tenofovir with high HBV viral load (HBV DNA > 10^7)
start in third trimester and stop 4-12 weeks after delivery unless she qualifies for long term treatment
monitor HBV viral load every 2 months
LFTs monthly
107
How is Hep B managed postnatally?
Hep B Ig and immunisation for neonata
HBV Ig - given within 24h delivery
HBV immunisation - 4 dose, birth, 1 month, 2 months and 12 months
blood test of neonate to confirm or deny diagnosis
ENCOURAGE BREASTFEEDING - NO RISK OF TRANSMISSION
108
How is Hep C managed antenatally?
refer to hepatologist
Tx usually contrainidcated e.g. ribavirin
no special delivery needed
109
define mild HTN
s: 140-149
d: 90-99
110
define moderate HTN
s: 150-159
d: 100-109
111
define severe HTN
> 160
>110
112
Which forms of gestational HTN are admitted?
severe
113
is proteinuria tested for in gestational HTN?
mild and moderate: at every visit
severe: daily
114
How often is BP measured in gestational HTN?
mild: once a week
mod: twice a week
severe: 4 times a day
115
which forms of pre-eclampsia are treated?
all
116
is proteinuria measured after the admission in pre-eclampsia?
no
117
Which forms of pre-eclampsia are admitted?
mild, moderate and severe
118
How is gestational HTN managed antenatally?
admit if severe
monitoring: BP and urinalysis 1-2x/week until BP controlled
Bloods (FBC, UEs and LFTs) weekly
US foetal surveillence every 2-4 weeks
119
Which anti-hypertensives are used in gestational HTN?
1st - labetalol unless asthma
2nd nifedipine
3 = methyldopa
aim for BP <135/85
120
How is gestational HTN managed postnatally?
monitor BP daily for first 2 days
once on days on 3 and 5
if on methyldopa stop within 2 days post birth
reduce antihypertensive if BP <130/80
F/U with GP at 2 weeks from discharge
F/U at 6-8 weeks, should be fully resolved by then
121
When are pre-eclamptic women delivered?
34 weeks if severe
37 if mild / mod
give steroids if 34 weeks
122
What are the high risk factors for pre-eclampsia?
HACCD
HTN in previous pregnancy
Chronic HTN
CKD
Autoimmune
Diabetes
123
What medication is contraindicated in pre-eclampsia
ergometrine
124
How often is BP measured in pre-eclampsia?
every 2 days and more freq if admitted
FBC, LFTs and UEs 2x/week
US foetal surveillence every 2 weeks
125
When is mag sul given to pre-eclamptic women?
if delivery is imminent within 24h, prevent eclampsia
126
What intrapartum advice is givne to pre-eclamptic women?
labour ward and continuous CTG
127
How are pre-eclamptic women managed post-natally?
observe for at least 24h
monitor BP: at least 4x/day
128
PACES: pre-eclampsia
RF: explain RF
Explain admission likely
explain risks of PRE-eclampsia to baby and mum
explain treatment
explain BP will be monitored closely
explain delivery may be earlier than normal
129
How is eclampsia managed?
call for help
222
IV mag sul, 4g loading over 15 mins and then 1g every hour for 24h / until delivery
130
What are the BM targets in GDM?
pre-meal < 5.3
1 hour post meal < 7.8
131
How is GDM managed?
1st - lifestyle (as long as fasting BM <7)
2nd - after 1-2 weeks of lifestyle, metformin
3rd = add insulin / glibenclamide if insulin declined
132
How is GDM managed intrapartum?
delivery no later than 40+6
133
How is GDM managed post natally?
discontinue meds immediately
Fasting BM at 6-13 weeks:
- < 6 moderate risk of T2DM --> annual HbA1c
-6-6.9: high risk, annual HbA1c
>7 - likely has T2DM now
134
How are women with GDM managed in future pregnancies?
OGTT asap after booking and at 24-28 weeks
135
PACES: GDM
RF: age, FH, PMH, previous, ethnicity
- Explain Dx
- Explain risks - macrosomia, operative, stillbirth, traumatic
- explain Tx: lifestyle, metformin and insulin
- explain how to monitor BM
- need to be seen within 1 week by joint diabetes and ANC, then every 2 weeks
- ultrasound every 4 weeks between 28-36
- medication stopped after delivery and follow up
136
How is anaemia managed antenatally?
100-200mg ferrous sulphate and recheck Hb in 2-3 weeks
137
how is anaemia managed intrapartum?
```
advise delivery in labour ward
IV access plus group and screen
active management of third stage
active PPH mx
consider prophylactic syntocinon
```
138
How is obstetric cholestasis managed antenatally?
monitoring LFTs and bile acid weekly, doppler and CTG twice weekly unitl delivery
wear loose clothes, emollients, cool baths
ice packs and topical emollients
139
What medical options are available for obstetric cholestasis?
Antihistamines
ursodeoxycholic acid
vit K
140
How is obstetric cholestasis managed intrapartum?
induction at 37 weeks
| labour ward and continuous CTG
141
How is obstetric cholestasis managed postnatally?
LFTs 6 weeks postnatal (to ensure resolution)
142
PACES: obstetric cholestasis
- RF: personal / FH, liver disease and multiple pregnancy
- explain Dx and risks
- Explain early delivery by 37 weeks
- explai nneed for regular monitoring and bloods and doppler
- pay close attention to foetal movements
- symptomatic Tx with ursodeoxycholic acid and emollients
143
How is acute fatty liver of pregnancy managed?
supportive: ITU, continuous maternal and foetal monitoring, correct coagulopathy, electrolytes and hypoglycaemia
expedite delivery
144
How is IUGR managed antenatally?
serial growth scans every 2 weeks
doppler 2x/week
advise mothers to monitor foetal movements
145
What are the indications for delivery in IUGR?
abnormal CTG / doppler waveform
delivery by 37 weeks usually needed
consultant led decision
146
How is an asymptomatic low-lying placenta managed?
identified at 20 week
avoid sex
rescan at 32, if low rescan at 36
if low - recommend elective c-section at 38 weeks
147
How is a symptomatic placenta praevia managed?
ABCDE
IV access, bloods and continuous CTG
ANTI-D IF RHESUS NEGATIVE
expedite delivery if mum is unstable or foetal distress
stable and no evidence of distress - rescan at 36 weeks
148
PACES: Placenta Praevia:
RF: previous PP, multiple, previous c section, smoking, drugs
- asymp: 90% resolve, rescan at 32, avoid sex,
- symp: admit until bleeding has stopped +48h more, deliver if unstable i
149
How is placental abruption managed?
ABCDE:
- 2x IV access
- bloods (FBC, Rhesus, cross match and clotting)
- continuous CTG
- fluid, afibrinolytics, blood replacement
anti-D if rh negative
expedite if unstable or distress
if stable, >37 deliver, <37 steroids and admit to antenatal ward
150
Where will the abnormalities on an ECG be seen in a woman who has a PE?
S1Q3T3
151
If a woman is investigated for a PE and CXR is abnormal, what should be done next?
Straight to CTPA
152
In any woman presenting with suspicious signs of DVT or PE, how should they be managed?
Treatment dose of LMWH until diagnosis is excluded
153
What is the reversal for Unfractionated heparin?
Protamine Sulphate
154
What are some risk factors for a VTE in pregnancy?
Maternal: smoking, SLE, obesity, previous VTE, thrombophilia
Gestational: Pre-Eclampsia, multiple pregnancy, GDM, stasis
