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Cross reference - year 5 > PACES obstetrics > Flashcards

PACES obstetrics Flashcards

1
Q

P-PROM RFs

A

smokers
STI
previous P-ROM
mutliple pregnancy

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2
Q

PACES P-PROM counselling…explain

A
  • need for admission
  • risks (infection when can cause damage to the baby)
  • risks of prematurity (ideally like to keep baby inside for as long as possible but this has to be balanced with infection risk)
  • importance of close monitoring (CTG, maternal infections)
  • role of antenatal steroids
  • likelihood of delivery
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3
Q

Breech RFs

A 
uterine malformation
fibroids
placenta praevia
poly/oligohydramnios
foetal anomaly (chromosomal disorders)
prematurity
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4
Q

Breech counselling

A
  • explain what breech means
  • offer ECV and explain risks (50% success rate, placental abruption, foetal distress, requiring emergency CS)
  • explain benefits of vaginal (if successful, fewest complications, 40% risk of needing emergency CS)
  • explain benefits of CS (small reduction in perinatal mortality, implications on future pregnancy = praevia, VBAC, uterine rupture)
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5
Q

VBAC PACES couselling

A
  • options: ERCS or VBAC
  • VBAC (uterine rupture risk of 1/200, 75% success rate, others need emergency CS)
  • ERCS (implications on future pregnancies, uterine rupture/abruption)
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6
Q

HIV counselling

A
  • need to be seen at a joint HIV physician and obstetric clinic every 1-2 weeks
  • need to monitor viral load every 2-4 weeks, 36 weeks and delivery
  • stress important of good compliance with ART
  • discuss options for delivery (depending on viral load at 36 weeks)
  • advise not to breastfeed
  • neonatal treatment with ART for 2-4 weeks and testing for HIV transmission
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7
Q

Pre-eclampsia RFs

A
  • previous HTN disease in pregnancy
  • mutliple pregnancy
  • DM
  • kidney disease
  • 1st pregnancy
  • obseity
  • > 35y or <20y
  • FH
  • PCOS
  • IVF
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8
Q

Counselling of Pre-eclampsia

A
  • admission is needed (at leas until BP controlled)
  • explain early delivery and risks (early delivery, reduced placental function, IUGR, risks to mother)
  • treatment = labetalol
  • BP monitored closely with regular blood tests (2/ week) and foetal surveillance (every 2 weeks)
  • early delivery before 37 weeks may be needed
  • 15% risk of recurrence
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9
Q

GDM RFs

A
  • age
  • FH
  • obesity
  • multiple pregnancy
  • Asian background
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10
Q

GDM counselling

A
  • diabetes that occurs in pregnancy because body isn’t able to produce enough insulin to meet demands of carrying a baby
  • Maternal risks: HTN disease, traumatic delivery, stillbirth
  • Foetal risk: macroscomia, neotnatal hypoglycaemia, congenital abnormalities
  • treatment options: CDE, metformin, insulin
  • importance of good glycaemia control
  • explain to monitor blood glucose using glucometer
  • need to be seen at joint diabetes and antenatal clinic within 1 week and every 2 weeks thereafter
  • US growth scans every 4 weeks from 28-36 weeks
  • medication stopped at delivery but followed by GP
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11
Q

OC RFs

A
  • personal/family Hx of OC
  • history of liver disease
  • multiple pregnancy
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12
Q

OC counselling

A
  • explain diagnosis and risks (still birth and premature birth)
  • need for early delivery (37 weeks)
  • regular monitoring and weekly LFTs
  • pay close attention to foetal movements
  • symptomatic treatment with ursodeoxycholic acid, emollients, Vit K
  • high recurrence rate (up to 90%)
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13
Q

Placenta Praevia RFs

A 
previous placenta praevia
multiple pregnancy
previous CS
smoking and drug use
advanced maternal age
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14
Q

counselling if placenta praevia presenting with asymptomatic low-lying/placenta

A
  • importance of the finding (increases risk of bleeding)
  • 90% of placentas will move away from os
  • rescan at 32 weeks and go from there
  • advise to avoid having sex
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15
Q

counselling if placenta praevia presenting with symptomatic placeta praevia (with bleeding)

A
  • admit until bleeding has stopped and for further 48 hours
  • importance of findings and foetus needs to be monitored
  • prompt delivery needs to be discussed (based on gestation)
  • risks of delivery: major blood loss, may require blood transfusion, may require hysterectomy
  • Anti-D
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16
Q

important to ask about previous pregnancies

A

how born and WHY

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17
Q

what to do if the situation is an emergency

A

ABCDE

alert seniors

18
Q

Hyperemesis Gravidarum counselling

A
  • unlikely to harm the baby but if you lose a lot of weight, baby can be smaller than expected
  • condition usually resolves after 14 weeks, hopefully treatment we will give you can help reduce symptoms
19
Q

when to do CTG

A

if come with problems and in third trimester

20
Q

Tests in PROM

A
  • IGF binding protein 1
  • placental alpha-microglobulin 1 test
  • TVUSS can be used to assess cervical length and determine likelihood of birth in 48 hours
21
Q

what to monitor in eclampsia?

A 
urine output
reflexes
RR
Oxygen sat
LFTs and plt
22
Q

pathophysiology of GD

A
  • placenta produces substaicnes that have anti-oestrogen effect
    = increased insulin resistance = hyperglycaemia
  • maternal glucose crosses placenta = foetal hyperglycaemia
  • foetal pancreas starts producing high levels of insulin = foetal hypoglycaemia
23
Q

target levels for glucose in GDM

A

fasting < 5.3

2 hour post meal < 6.4

24
Q

chance of successful VBAC after 1 previous CS

A

70%

25
Q

what is the multiple pregnancy support group>

A

TAMBA (twin and multiple birth association)

26
Q

MCDA sign and when split

A

T-sign

conceptus split 4-8 days

27
Q

OC features of history and care

A

jaundice
ask about urine and poo
consultant led care
F/U after delivery to ensure LFTs returned to normal

28
Q

physiological skin changes

A

linea nigra
striae gravidarum
striae albicans

29
Q

SGA PACES counselling

A
  • may be a sign your placenta is getting a little bit tired and not being able to feed the baby as well as it did before
  • we would like to keep an eye on growth of baby by scanning your regularly now
  • serial growth scans, CTG and doppler US every 2 weeks
  • ask mum to pay attention to foetal movements
30
Q

important question to ask in ROM

A

fever

31
Q

if discharging with ROM, what safety net?

A

call midwife if:

  • raised temp
  • any fluid discharge/bleeding from vagina
  • reduction in foetal movements
32
Q

Couselling features in PPROM

A

balancing risks of prematurity with risks of infection
early delivery likely to be necessary
come in x2/ week for CTG and obs
consider delivery at 34 weeks

33
Q

questions to ask in pre-eclampsia

A
  • headaches
  • epigastric pain
  • visual disturbances
  • oedema (feel more swollen recently)
  • N/V
  • previous BP before and during pregnancy
  • previous urine dipstick results
34
Q

investigations to do in pre-eclampsia

A
  • full CV and abdo exam
  • examine legs and reflexes
  • feel for liquor volume, SFH
  • FBC, U&Es, uric acid, LFTs, Albumin, clotting screen
  • USS
35
Q

antenatal management plan for patient with pre-eclampsia

A
  • keep inpt
  • BP every 4 hours
  • urinalysis daily
  • 3x week FBC, U&Es, LFTs
  • FUSS and CTG regularly
  • Labetaolol
36
Q

intrapartum management of pre-eclampsia

A

IV labetaolol

continous fetal monitoring on CTG

37
Q

postnatal management

A

discharged to primary care if no symptoms of pre-eclampsia
BP 149/99 or lower
blood tests stable and improving
individual care plan, GP to check BP in community

38
Q

how to manage woman at risk of pre-eclampsia?

A
  • healthy lifestyle
  • refer for consultant led care at booking
  • aspirin 75mg daily from 12 weeks
  • urine and BP at every visit
  • safety net to seek urgent help if signs of pre-eclampsia
39
Q

explaining pre-eclampsia to a patient

A

Pre-eclampsia is a complication of pregnancy that causes you to have high blood pressure and protein in your urine. It can make you unwell and can affect your baby’s growth and wellbeing.

40
Q

prolonged first stage of labour management

A
  • As membranes are not ruptured, offer ARM
  • Consider augmentation with oxytocin
  • Ongoing obstetric review every 15-30 mins
  • Consider instrumental delivery (if criteria for instrumental delivery are met)
  • Diligent observation of the CTG trace in case emergency C-section is ne
41
Q

causes of prolonged labour

A

Malposition
Epidural analgesia
Obstructed labour (e.g. CPD)

42
Q

propess vs prostin

A

Propess (24 hours)

Prostin (can be given 6 hourly)

Cross reference - year 5 (22 decks)

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