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Flashcards in Week 235 - Pregnancy 2 Deck (52):
1

Week 235

 

What is Labetalol used for?

The treatment of high blood pressure.

2

Week 235

 

What are the foetal indications for operative vaginal delivery?

Foetal compromise. If it looks like baby is in crisis, call ghostbusters (AKA the guys with the suction cup and forceps)

3

Week 235

 

What are the Maternal indications for operative vaginal delivery?

Basically anything seriously bad with momma Bear

 

  • Spinal cord damage or injury
  • cardiac high risk or injury
  • Hypertensive crisis AKA eclampsia
  • Stuff like myasthenia gravis

(excuse the lack of my normal loquacity, just, it's 3am and I'm at the point where I think I will tear my eyes out soon).

4

Week 235

 

What are the "inadequate progress" indications for operative vaginal delivery?

Nulliparous women:

  • Lack of progress after 3 hours with regional anaesthesia
  • Lack of progress after 2 hours without regional anaesthesia

Multiparous women:

 

- As above, but one hour less for each.

5

Week 235

 

What are C.A.B requirements for instrumental vaginal delivery?

  • Cervix Fully dilated
  • Appropriate analgesia
  • Bladder empty

6

Week 235

 

What position is this? What is the best appropach for operative surgical delivery (method/tools used)?

Q image thumb

Direct Occiput anterior

 

Can use forceps of ventouse

7

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Direct Occiput posterior

 

Often accompanied by extension of the fetal head presenting part too large
Aim for rotation of 180º with the ventouse or with rotational forceps

8

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Left Occiput anterior

 

Forceps or ventouse

9

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Left occiput posterior

 

Often accompanied by extension of the fetal head presenting part too large
Aim for rotation of 180º with the ventouse or with rotational forceps

10

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Left Occiput Transverse

 

Usually due to insufficient descent of head to cause rotation
Ventouse to achieve descent, and hopefully rotation
Rotational forceps to achieve rotation in situ and then descent

11

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Right Occiput Anterior

 

Use Forceps or Ventouse

12

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Right Occiput Posterior

 

Often accompanied by extension of the fetal head  presenting part too large
Aim for rotation of 180º with the ventouse or with rotational forceps

13

Week 235

 

What position is this? What is the best approach for operative surgical delivery (method/tools used)?

Q image thumb

Right Occiput Transverse

 

Usually due to insufficient descent of head to cause rotation
Ventouse to achieve descent, and hopefully rotation
Rotational forceps to achieve rotation in situ and then descent

14

Week 235

 

Significant vaginal and perianal trauma for th mother occurs with which operative vaginal delivery intervention?

Forceps.

 

Are you surprised?

 

Have you SEEN how HUGE they are? !

15

Week 235

 

What is the name given to this particular incision site for C section?

Q image thumb

Pfannensteil

16

Week 235

What are the absolute indications for C section?

 

ABSOLUTE INDICATIONS

  • Placenta praevia
  • Severe antenatal fetal compromise
  • Uncorrectable abnormal lie
  • Previous classical caesarean section
  • Pelvic deformity

17

Week 235

 

What are the relative indications for C section?

RELATIVE INDICATIONS

  • Breech presentation
  • Diabetes mellitus and other medical diseases
  • Previous caesarean sections
  • Older nulliparous women

18

Week 235

 

What is a dichorionic-diamniotic (DCDA) twinning?


When each baby of the twin has its own
placenta
, there will be two chorions and two
amnions and it is known as dichorionic
-
diamniotic (DCDA) twinning.
 

19

Week 235

 

What is a monochorionic diamniotic (MCDA)
twinning?

When each baby of the twin pregnancy
has its own amniotic sac, but share a
single placenta
, there will be one chorion
and two amnions and it is known as
monochorionic diamniotic (MCDA)
twinning.
 

20

Week 235

 

What is a monochorionic-monoamniotic
(MCMA) twinning?

When the twin babies share both the
amniotic sac and the placenta
there will be
one chorion and one amniotic sac and it is
known as monochorionic
-
monoamniotic
(MCMA) twinning.
 

21

Week 235

 

What are the risks associated with multiple chorionicty (more than one placenta)?


Miscarriage,
Congenital abnormalities
Preterm,
IUGR,
Perinatal loss,
TTT

22

Week 235

 

Which clotting factors are increased in pregnancy?

  • I
  • VII
  • VIII
  • IX
  • X
  • XII

 

23

Week 235

 

What are the symptoms of threatened miscarriage?

Bleeding, foetus alive, OS closed.

24

Week 235

 

What are the symptoms of inevitable miscarriage?

Bleeding heavier, foetus may be alive, OS open

25

Week 235

 

What are the symptoms of incomplete miscarriage?

Bleeding, Some foetal parts passed, OS open

26

Week 235

 

What are the symptoms of complete miscarriage?

All pregnancy tissue passed, bleeding settling, OS closed

27

Week 235

 

What are the symptoms of missed miscarriage?


Foetus not developed or died in utero. OS closed. Often
asymptomatic
 

28

Week 235

 

What are the symptoms of septic misccariage?

Infected uterine contents. Offensive loss, tender uterus
.
 

29

Week 235

 

When should Anti-D prophylaxis be administered, and why?

Should be administered to all rhesus negative mothers after all surgical and medical intervention regardless of gestation, within
72hrs of bleed.

Spontaneous miscarriages after 12+0 weeks gestation should be administered anti-D. 250 IU should be given up to 19 +6 weeks.

500 IU after 20+0 weeks.
 

Why?

 

Mothers antibodies are against babies blood. Bad for baby.

30

Week 235

 

What is placental abruption?

Can be seen or be hidden.

Separation of the placenta from the wall of the womb during pregnancy, especially when it occurs prematurely.

31

Week 235

 

What are the clinical signs of placenta praevia?

  • Asymptomatic
  • Painless
  • bright red bleed
  • Malpresentation/highpresenting part


 

32

Week 235

 

What is Placenta Accreta?

This is a firmly adherent placenta.

33

Week 235

 

What is Placenta increta?

In this condition, the placenta invades the myometrium

34

Week 235

 

What is Placenta Percreta?

In this condition, the placenta invades through to the serosa and beyond.

35

Week 235

 

What is Vasa Praevia?

In this condition, the placental vessels overlie the cervix.

36

Week 235

 

What make up the HEELP syndrome?

  • Haemolysis,
  • Elevated Liver enzymes,
  • Low platelet

37

Week 235

 

What are the aetiologies of pre-existing (chronic) hypertension in pregnancy?

  • Essential hypertension - idiopathic
  • Chronic renal disease - present in 5% of hypertensive disorders of pregnancy

38

Week 235

 

What is gestational hypertension?

  • HTN arising after 20 weeks (2nd trimester), and resolving within 3 months of delivery
  • No symptoms of pre-eclampsia

39

Week 235

 

Pre-eclampsia is hypertension arising after how long?

20 weeks

40

Week 235

 

Severe pre-eclampsia is pre-eclampsia with one or more of (list):

  • SBP/DBP > 160/110
  • Pulmonary oedema
  • Cyanosis
  • Persistent headache
  • Thrombocytopaenia
  • Severe proteinuria (>5g/24hrs)
  • Oliguria (<400mls/24hrs)
  • Liver pain/impaired hepatic function
  • >foetal growth/placental abruption

41

Week 235

 

What is the Pathophysiology of HELLP syndrome?

Impaired trophoblastic invasion of maternal spiral arteries

  • Placenta pre-disposed to hypoxia
  • >vasodilator/anticoaglant production (i.e. prostacyclin)
  • Increased angiogenic and prothrombic factors produced (i.e. thromboxane)
  • Widespread coahulation causing systemic effects
  • Reduced GFR therefore renal injury

42

Week 235

 

How does pre-eclampsia present?

  • Usually after 34 weeks
  • often Asymptomatic
  • Neuro - headache, visual disturbance
  • Epigastric/RUQ pain
  • Oliguria, cloudy urine
  • High blood pressure

 

43

Week 235

 

What is Eclampsia?

This is convulsion associated with pre-eclampsia
.

May occur before OR AFTER delivery.

 

Prophylaxis = low dose aspirin from early pregnancy for those with risk factors.

44

Week 235

 

What is Labetalol?

This is an anti-hypertensive that can be used to treat eclampsia. It is a Beta-Blocker, which inhibits adrenergic receptors (these< peripheral vascular resistance)

45

Week 235

 

What is Methyldopa?

This is antihypertensive drug used in the treatment of pre-eclampsia. It reduces dopamine production.

46

Week 235

 

What is Nifedipine?

  • This is an anti-hypertensive medication used in the treatment of pre-eclampsia. It it a calcium channel blocker, which inhibits vascular muscle contraction.

47

Week 235

 

What is hydralazine?

This is an antihypertensive medication used in the treatment of pre-eclampsia. IT blocks Calcium channels, but isn't a calcium channel blocker!

48

Week 235

 

Are ACE inhibitors safe for use in pregnancy?

NO!

49

Week 235

 

What is Magnesium sulphate?

This is used for severe preeclampsia/eclampsia

 

Seizure prophylaxis (mechanism unknown!)

Given IV: 4mg Loading dose, followed by 1mg/hr, with 2mg after convulsions.

50

Week 235

 

When is phenytoin/Lorazepam used in pre-eclampsia/eclampsia?

May be used as 2nd line treatment if non responsive to MgSO4 (post 34 weeks if possible)

 

 

51

Week 235

 

What is Betamethasone? Why is it used in premature birth?

This steroid is used to stimulate foetal lung maturation and surfactant production

 

NB: Ergometrine is contraindicated - increase BP.

52