Round-up Yeehah! Flashcards
(24 cards)
What questions need to be asked for PV bleeding?
How heavy is the bleeding - how does it compare to a period
Any unusual discharge
Have you had a pregnancy test?
Any pain - where is it? what is it like? pain during sex?
What percentage of pregnancies are ectopic?
1%
RF for ectopic?
Previous surgery - tubal. sterilisation? Uterine contraceptives PID Chlamydia Smoking IVF Previous ectopic pregnancy
What is PV bleeding before 24 weeks gestation? after?
Before = threatened miscarriage After = Antepartum haemorrhage
Plan for suspected ectopic?
Pregnancy test and urine dip
Ultrasound
Serum HCG (>1500)
What do you need to have done to make a diagnosis of PUL (pregnancy of unknown location)?
Ultrasound
In PUL what would a HCG rise of <66% every 48hrs indicate?
Ectopic pregnancy between 6-10 weeks
Also consider filed pregnancy
How can you tell the ectopic pregnancy is threatening?
Signs of peritonitis
/ shock
Management of ectopic pregnancy?
Salpingectomy
Salipingotomy if only 1 tube
Methotrexate
When would the mothers and babies blood mix?
Delivery Amniocentesis External cephalic version Trauma Ruptured ectopic antepartum haemorrhage
What week gestation do foetal movements start to be felt?
20 weeks
Symptoms of pre-eclampsia?
Headache Visual disturbance Epigastric pain Swelling Vomiting
Signs = clonus, brisk reflexes, oedema, high BP, low SFH, proteinuria (PCR - urinary to creatine ration = >30 for proteinuria)
Management of pre-eclampsia?
To prevent eclampsia = delivery (NB. 40% eclampsia occurs post-partum)
Do examination to see mode of delivery e.g. if fully dilated do instrumental delivery
Monitor bloods - will indicate HELLP syndrome (heamolysis, elevated liver enzymes, low platelet count)
BP control - labetalol/nifedipine
Magnesium sulphate as prophylaxis
Questions for PB bleeding at 35 weeks?
Pain? (placental preavia = painless, placental abruption = painful)
How much blood? Post coital?
Contractions? - could be a bloody show
Foetal movements?
Last smear
Antenatal notes - specifically placental position (scan at 20 weeks)
What is vasa praevia?
Foetal blood loss
Who is placental more dangerous for, the mother or the foetus?
Foetus
Results in a hard ‘woody’ uterus on palpation (spasms) - can be hidden abruption so this is an important sign
Most common cause of post-menopausal bleeding?
Atrophic vaginitis
But worry about endometrial cancer
RF for endometrial cancer?
Diabetes Obesity Late menopause Early menarche PCOS Nulliparity Tamoxifen
Why is PCOS a state of unopposed oestrogen?
Follicles –> FSH –> ovaries –> estrogen
Investigations of PMB?
USS (thickened endometrium - should be <4mm)
Hysteroscopy and endometrial biopsy
Management of atrophic vaginitis?
Give oestrogen - look up how
Causes of PPH?
Retained products of conception
Endometritis (give co-amoxilav postnatally, cefuroxime + metronidazole antenatally)
Fluid loss from vagina in pregnant women?
PROM/PPROM Threatened preterm labour UTI PV bleeding Vaginal infection physiological discharge
Plan for PPROM?
Steroids +/- tocolytics
