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Other Important Topics Flashcards

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1
Q

What is a bradycardia?

A

Deceleration (drop in the baseline >15 for >15 seconds) that goes on longer than 3 minutes

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2
Q

Causes of fetal bradycardia

A

drop in blood pressure, change in position

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3
Q

Management of fetal bradycardia

A

Change position (usually try left lateral)
Examine
If does not recover, immediate delivery by quickest / safest route

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4
Q

Is a CTG invasive?

A

No, it is a non-invasive method of monitoring foetal heart rate and uterine contractions during pregnancy and labour.

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5
Q

Mnemonic for interpretation of a CTG

A

DR C BRAVADO
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall Impression

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6
Q

When defining risk on a CTG, what pre-existing features suggest a high risk?

A

Gestational diabetes
Hypertension
Asthma
Multiple gestation
Post-term pregnancy
Previous C-section
IUGR
PPROM
Congenital malformations
Pre-eclampsia

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7
Q

When assessing contractions on a CTG, what should you do?

A

Record number of contractions over a 10 minute period
1 big square = 1 minute
Assess duration and intensity of contractions

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8
Q

When assessing contractions on a CTG, how long should you do it for?

A

10 mins

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9
Q

What does 1 big square on a CTG equal?

A

1 minute

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10
Q

When assessing baseline rate on a CTG, what is the normal range?

A

Normal Range: 110-160 bpm

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11
Q

What is a bradycardia on CTG?

A

<100 beats per min

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12
Q

What is a tachycardia on CTG?

A

> 160 beats per min

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13
Q

Causes of fetal tachycardia

A

Foetal hypoxia
Hyperthyroidism
Anaemia
Infection

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14
Q

Causes of foetal bradycardia

A

Cord prolapse
Cord compression
Anaesthesia
Maternal seizures

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15
Q

What is the normal baseline variability on a CTG?

A

5-25BPM

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16
Q

Causes of abnormal baseline variability

A

Foetal sleep

Hypoxia
Infection
Drugs (e.g. opioids, magnesium)
Prematurity
Congenital heart defects

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17
Q

What are accelerations defined as?

A

Definition: Increase in baseline heart rate of > 15 bpm for > 15 seconds

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18
Q

What do the presence of accelerations on a CTG suggest?

A

The presence of accelerations during contractions is reassuring and suggestive of a healthy foetus

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19
Q

What are decelerations defined as?

A

Definition: Decrease in baseline heart rate of > 15 bpm for > 15 seconds

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20
Q

Types of deceleration

A

Early
Late
Variable
Prolonged
Sinusoidal

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21
Q

What are early decelerations?

A

Begins with the onset of a contraction and recovers once the contractions ends
This is physiological and caused by increased vagal tone and intracranial pressure during a contraction

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22
Q

What are early decelerations caused by?

A

physiological and caused by increased vagal tone and intracranial pressure during a contraction

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23
Q

What are late decelerations?

Study These Flashcards
A

Begins at the peak of a contraction and recovers after the contraction ends
Caused by reduced uteroplacental blood flow which results in foetal hypoxia and acidosis
Causes include maternal hypotension, pre-eclampsia and uterine hyperstimulation

24
Q

What are late decelerations caused by?

Study These Flashcards
A

Caused by reduced uteroplacental blood flow which results in foetal hypoxia and acidosis
Causes include maternal hypotension, pre-eclampsia and uterine hyperstimulation

25
What are variable deeclerations?
There appears to be no relationship between the decelerations and uterine contractions Caused by compression of the umbilical cord
26
What are variable deceleraitons caused by?
Caused by compression of the umbilical cord
27
What are prolonged decelerations?
If lasting 2-3 minutes it is considered non-reassuring, and if it is > 3 mins it is considered abnormal
28
When are decelerations classed as non-reassuring?
If lasting 2-3 minutes it is considered non-reassuring,
29
When are decelerations classed as abnormal?
> 3 mins it is considered abnormal
30
What is a sinusoidal pattern of decelerations?
Extremely concerning sign that is associated with severe foetal anaemia or hypoxia
31
What are a sinusoidal pattern of decelerations associated with?
severe foetal anaemia or hypoxia
32
How can an overall CTG be described?
as reassuring, non-reassuring or abnormal
33
What post-partum mental health conditions are there?
Baby Blues Postnatal Depression: persistent low mood, low energy and/or lack of enjoyment of usual activities that begins around the time of birth and lasts for longer than 2 weeks Puerperal Psychosis: development of delusions and hallucinations in the peripartum period
34
What is postnatal depression?
persistent low mood, low energy and/or lack of enjoyment of usual activities that begins around the time of birth and lasts for longer than 2 weeks
35
What is puerperal psychosis?
development of delusions and hallucinations in the peripartum period
36
Presentation of the baby blues
Features: Low mood, irritability and emotional lability
37
Management of the baby blues
Management: Resolves spontaneously relatively soon after childbirth
38
Features of postnatal depression
Features: Persistent low mood, low energy and/or lack of enjoyment of usual activities. Patients may complain of feelings of worthlessness, inadequacy and difficulties bonding with the baby.
39
PACES: What is important to screen patients with postnatal depression for?
thoughts about harming themselves or harming their baby
40
PACES: What screening tools can be used for postnatal depression?
Edinburgh Postnatal Depression Scale Whooley Questions
41
Management of postnatal depression?
Important to avoid separating mother and baby where possible CBT SSRIs Sertraline and paroxetine are generally considered safe options in pregnancy and breastfeeding
42
Which SSRIs are safe to use in pregnancy and breastfeeding?
Sertraline and paroxetine are generally considered safe options in pregnancy and breastfeeding
43
Features of puerperal psychosis
Features: Delusions and hallucinations usually relating to the baby. May also demonstrate unusual behaviour, disinhibition and irritability. Usually presents within the first 6 weeks of childbirth.
44
Management of puerperal psychosis
If the patient is thought to pose a risk to themselves or their baby, they need to be admitted to a mother and baby unit They are likely to be started on antipsychotic medications Electroconvulsive therapy may be considered Talking therapies
45
If the mother is thought to pose a risk to themselves or their baby, where should they be admitted?
mother & baby unit
46
What medication are patients with puerperal psychosis likely to be started on?
Antipsychotic medications
47
What is post partum thyroiditis?
Abnormal thyroid function arising in the first year after childbirth.
48
Stages of post partum thyroiditis
Hyperthyroid (usually for the first 3 months) Hypothyroid (occurs once the stores of thyroid hormone are depleted and the follicular cells are too damaged to generate more thyroid hormone) Euthyroid (usually occurs within 1 year)
49
How does post partum thyroiditis present?
Features of hyperthyroidism or hypothyroidism
50
Investigations for post partum thyroiditis
Bloods TFTs Anti-TPO Antibodies Anti-Thyroglobulin Antibodies Imaging & Other Thyroid Uptake Scan
51
Management of post partum thyroiditis
Hyperthyroid Phase Symptomatic management usually with propranolol Carbimazole may be considered in some cases Hypothyroid Phase Thyroxine replacement
52
Risks associated with smoking in pregnancy
Miscarriage Preterm Birth Stillbirth Intrauterine Growth Restriction Sudden Infant Death Syndrome
53
Risks associated with alcohol in pregnancy
Foetal Alcohol Syndrome
54
Presentation of foetal alcohol syndrome
Smooth or absent philtrum Learning difficulties Microcephaly Growth retardation Cardiac malformation
55

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