Random Flashcards
(24 cards)
What opioids can you use as pain relief in pregnancy and what are the SE and guidelines of it?
pethidine, diamorphine
SE: dizziness, nausea, vomiting
If given IV/IM = give an anti-emetic
Do not enter the pool within two hours
What stage of labour does epidural analgesia prolong?
second stage of labour
When should you offer a continuous CTG?
maternal pulse >120beats/min on two occasions epidural analgesia (offer for 30mins) temperature 38 or above suspected chorioamnitis/sepsis presence of significant meconium fresh vaginal bleeding in labour
In a low risk labour, what foetal monitoring should you do?
intermittent auscultation of FHR after contraction for one minute every 15 minutes
palpate maternal pulse hourly
If a rising baseline/decelerations are suspected, what foetal monitoring should you do?
If a rising baseline/decelerations are confirmed, what foetal monitoring should you do?
intermittent auscultation more frequently
summon help/advise continuous CTG
Outline first, second, third and fourth degree perineal tears
1) fourchette, vaginal mucosa are damaged. underlying muscles are exposed, not torn
2) posterior vaginal walls and perineal muscles torn but anal sphincter intact
3) tear extends to anal sphincter but the rectal mucosa is intact
4) anal canal opened, rectum may be opened
what are the indications for episiotomy?
rigid perineum
a tear seems imminent
instrumental delivery
mediolateral method is used
what are the consequences of perineal trauma?
interfere with breast feeding and bonding of the baby
aggravate postpartum depression
incontinence
what are risk factors for perineal tears?
primagravida
large babies
shoulder dystocia
forceps delivery
What is the management of shoulder dystocia?
Stop mother pushing
McRoberts manouvre (patient hyperflexes and abducts hips against abdomen)
Rubin’s manouvre (reverse woods screw, post to ant)
Woods screw (ant to post)
How does Erb’s palsy present?
Due to shoulder dystocia. brachial plexus palsy
‘waiter tip’ arm, slightly rotated
What are the risk factors for stillbirth?
Fetal growth restriction Preterm birth Afro-Caribbeans Nulliparity Age <25 or >40 BMI >30
List some possible causes of stillbirth
Congenital abnormality Premature labour P-PROM IUGR Cord prolapse
What is the management of stillbirth?
When death is diagnosed antenatally = prostaglandins (2-3 days)
BP, urinalysis, temperature
FBC, clotting screen, Kleihaeur test HbA1c
What is the initial management of a suspected antepartum haemorrhage?
Estimate amount of blood loss Fetal distress = urgent delivery Fetal monitoring USS (exclude praevia) FBC (group and save), clotting studies, Kleihauer test,
What are the indications for instrumental delivery?
Failure to progress Spinal cord injury Myasthenia gravis Cardiovascular disease Hypertensive crisis Presumed fetal compromise
What are the requirements for an instrumental delivery?
'FORCEPS' Fully dilated cervix Occipito-anterior position Ruptured membranes Cephalic presentation Engaged Pain relief adequate Sphincter (bladder) empty
What are common problems that occur in early puerperium?
Stress incontinence
Mastitis
Backache
Mental health problems
When do you treat mastitis and how?
Treat if systemically unwell, if nipple fissure is present, or already been 12-24 hours
PO flucloxacillin 10-14 days
Continue breast feeding
What score do you use to assess postpartum depression?
Edinburgh Postnatal Depression Scale
How does ‘baby blues’ present?
3-7 days after birth
Anxious, tearful, irritable
Explanation and reassurance
How does postnatal depression present?
Starts within a month, peaks at three months
Explanation and reassurance, CBT, sertraline/paroxetine can be used
How does puerperal psychosis present?
Within 2-3 weeks following birth
Severe swings in mood and disordered perception
Admit to hospital
How does puerperal pyrexia present? What are the causes? What is the management?
Temperature >38 in first 14 days after childbirth
Endometritis is the most common cause. Also caused by UTI/VTE/mastitis
If endometritis is suspected, refer to hospital: IV clindamycin and gentamicin
