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42 Cards in this Set
- Front
- Back
Pre Eclampsia BP severity
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Mild = 140-150 / 90-100
Moderate = 150-160 / 100-110 Severe = 160+ / 110 + |
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Pre Eclampsia drug treatment
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Lobetalol, Nifedipine, Methyldopa for control
Hyrdralazine, Magnesium Sulphate and Diazepam when eclamptic |
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Liver changes during normal pregnancy
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Increased metabolism, ALK PHOS and Fibrinogen
Decreased transaminases and protein concentration Normal Bilirubin |
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HELLP Syndrome
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Haemolysis, Elevated Liver enzymes, Low Platelets
Liver enzymes are transaminases, LDH and unconjugated bilirubin. Give steroids post partum due to worsening. |
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Triple Test (Down's)
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15-20 weeks
Beta hCG, Oestriol, Alpha Feto Protein, (BOA) |
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Combined Test (Down's)
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Nuchal translucency, nasal bone presence on USS
hCG and PAPP-A (pregnancy associated plasma protein A) |
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Obstetric Cholestasis
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Generalised severe pruritis
NO RASH Bile acids and ALT raised Dark urine, pale stools |
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Acute Fatty Liver
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Very rare, potentially lethal
N+V, Malaise, abdo pain, hypertension, proteinuria Jaundice, FULMINANT LIVER FAILURE HEPATIC ENCEPHALOPATHY DIC Decreased glucose, increased uric acid |
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Booking Bloods
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FBC, LFT, U + E
Glucose if risk Blood group and RHESUS Blood disorders if risk (ethnicity) INFECTIONS: UTI, chlamydia, syphilis, HIV, Hep B, rubella |
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Management of Obstetric Cholestasis
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Counsel about risks (IUD 2%)
Weekly monitoring Piriton, UDCA, Vit. K Elective delivery after 37 weeks |
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Pre-eclampsia, protein above..
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0.3g in 24h
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Risk factors for pre-eclampsia
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Primiparity
Previous/Family history Older age Chronic hypertension Diabetes/Autoimmune disease Twins Obesity Renal disease (SMOKING IS PROTECTIVE) |
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Maternal complications of pre-eclampsia
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HELLP
DIC Liver failure Renale failure Eclamptic fits Pulmonary oedema CVA (all can lead to death) |
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Fetal complications of pre-eclampsia
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IUGR
Preterm labour Placental ABRUPTION Hypoxia |
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Antepartum Haemorrhage definition
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Bleeding from the vagina after 24 weeks gestation, but before labour
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Causes of Antepartum Haemorrhage
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Uterine: Placenta praevia, placental abruption, vasa praevia, circumvallate placenta
Cervical: Ectropion, polyp, cancer, cervicitis Vaginal: Vaginitis |
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Differential diagnosis of Antepartum Haemorrhage
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Vulval varices
Rectal bleeding Haematuria Bleeding diatheses |
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Complications of Antepartum Haemorrhage
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Maternal:
Anaemia Infection Shock Renal tubular necrosis Consumptive coagulopathy PPH Foetal: Hypoxia IUGR Preterm IUD |
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Clinical assessment of Antepartum Haemorrhage
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(ABC)
Pulse, BP Abdo palpation - tense woody uterus --> significant abruption Contractions Speculum exam: cervical dilatation, other causes Bimanual: NEVER if placenta praevia is suspected |
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Management of Antepartum Haemorrhage
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Mother is priority
FBC, Group and Save, Coag screen U+E, LFT RhD management (Kleihauer test to gauge the dose of anti-D Ig required) USS to exclude placentra praevia Fetal CTG |
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Tocolysis
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Anti-contraction medication
Indicated in: preterm situations to buy time for steroid administration Contraindicated in placenta praeviae or abruption. |
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Preterm Prelabour Rupture of Membranes epidemoiology
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Occurs between 24-37 weeks gestation in 2% of pregnancies. 40% of preterm deliveries.
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Complications of PPROM
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Prematurity (and Pulmonary Hypoplasia)
Sepsis (4x mortality than non-septic) Maternal risks with choriamnionitis (infection of fetal membranes) |
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Diagnosis of PPROM
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History of waters breaking <37 weeks
Sterile speculum examination to visualise pool of fluid in posterior fornix Test pH of fluid (neutral --> PPROM) Avoid bimanual USS Observe for infections: VItal signs, temperature, offensive discharge, foetal vitals. |
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Management of PPROM
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Erythromycin prophylaxis for 10 days.
This also delays delivery, allowing time for steroids. Do not use tocolytics. Delivery considered at 34 weeks. Insufficient evidence for use of fibrin glue. |
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Gynaecology presenting complaint empiricals
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LMP
Cycle (k=a/b) Sexually active? Dysmenorrhoea/menorrhagia Dyspareunia (deep/superficial) Discharge Urinary + Bowel symptoms |
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Gynaecology Past History empiricals
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Menarche
Smears Contraception use STIs Pregnancies - outcomes and weights Previous gynae problems/surgeries |
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Parity definition
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Pregnancies after 24 weeks
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Obstetric history empiricals
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LMP
Gestation from LMP Gestation from scan Gravidity and Parity Pregnancy problems Test and Scan results Foetal movements (>20 weeks) Contractions/abdo pain Fluid/blood Urinary/Bowel |
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Types of speculum
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Simms (for prolapse)
Cusco (cervix visualisation) |
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Presentations of uterus on bimanual
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Anteverted (tipped forwards) - normal
Anteflexed (anterior or uterus is concave) Retroverted (tipped backwards) - less common, some dyspareunia/dysmenorrhoea. Retroflexed (anterior of uterus is convex) |
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Group B Strep
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Most common cause of severe neonate infection
Offer Intrapartum Antibiotic Prophylaxis during identified pregnancy Pyrexial in labour --> give broad specs. Previous baby with GBS disease --> offer broad specs in new pregnancy Benzylpenicillin is best, then clindamycin |
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Stages of foetal descent
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Engagement
Descent Flexion Internal rotation Extension External rotation Expulsion |
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Naegele's rule
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+ 1 year
- 3 months + 1 week |
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Stages of labour
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1. Dilation of cervix to 10cm
2.baby 3. Placenta |
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Managed third stage of labour
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If over 1 hour unmanaged, treat for retained placenta.
If over 30 minutes after syntometrine or oxytocin, treat for retained. Can also breastfeed or stimulate nipples to encourage contractions. Retained placental product can be removed by hand under anaesthetic in operating theatre |
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Causes of retained placenta
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1. Uterine atony
2. Adherent placenta 3. Trapped placenta, behind closing cervix |
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Primary post partum haemorrhage
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Before 24 hours after delivery
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Secondary post partum haemorrhage
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Between 24 hours and 6
May need ultrasound to rule out retained product |
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Rhesus status
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Kleihauer test shows dose of anti D needed.
If maternal mixing of blood with foetal, give anti D |
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Tocolytic agents
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Nifedipine and atosiban
Also betamimetics such as terbutaline and salbutamol Contraindicated in placenta praeviae and abruption |
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Prostaglandins
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Used to ripen the cervix and induce abortion, or for preparation for surgical abortion
Misoprostol or gemeprost |