-
Causes of abnormal bleeding in early pregnancy?
- implantation bleeding
- spontaneous abortion
- ectopic pregnancy
- molar pregnancy
-
Differentiate between an ectopic and IUP
TV scan to locate gestation sac in uterus. Sac usually visible after 5-6 weeks, if uncertain perform laparoscopy.
-
What are the causes of PPH?
4 T's
- Tone (70%)
- -placenta previa
- -overs distention of the uterus (polyhydramnios, macrosomia, multiple pregnancy)
- -uterine relaxants
- -previous PPH
- Trauma (20%)
- -c section
- -episiotomy
- Tissue (10%)
- -retain POC
- -placenta accreta
- -retained placenta
- Thrombin (1%)
- -bleeding disorders
- -placental abruption
- -pre-eclampsia
-
Manoeuvres for shoulder distocia?
-
Assessment of amenorrhoea
-
-
Risk factors for abnormal lie
- multiparous lax uterus
- inc or dec fetal activity
- inc or dec liqour
- fetal malformation
- placenta previa
- uterine malformation
- prematurity
-
Clinical Signs of placenta previa
- Painless bleeding
- abnormal liw/high presenting fetal part
- soft non tender uterus
- normal FHR
- depening on bleeding > tachycardia + hypotension
-
Risk factors for placenta previa
- multiparity
- previous c-sections
- submucosal fibroid
- previous placenta previa
- increasing age
- smoking
- previous D+C
- multiparous
-
define preterm labour/name a tocolytic/when should steroid therapy be commenced? (gestation)
- Labour prior to 37 completed weeks
- nifedipine, terbutaline
- 24-34 wk gestation
- previous preterm is r/f
-
Should CTG be done routinely?
No proven benefit and may increase the intervention rate in low risk patients
- indications:
- Abnormal antenatal scans/doppler/CTG
- suspected IUGR
- any hydramnios
- prolonged pregnancy
- multiple pregnancy
- breech
- antepartum haemorrhage
- prior uterine scar/c-section
- meconium or blood stained liqour
-
PPH immediate management
- assess need for resuscitation
- call for help
- lie woman slat and reassure
- massage fundus
- administer O2 via FM
- insert large bore cannulas + take bloods crossmatch
- check placenta > ensure 3rd stage oxytocin
- check 4T's
-
increased nuchal translucency is associated with:
- chromosomal abnormalities
- cardiac abnormalities
- diaphragmatic hernias
- skeletal dysplasias
- noonans syndrome
- CAD
-
signs of shoulder dystocia
- turtling
- protracted late active stage of labour
- prolonged second stage
- delay in decent of the head in second stage
-
which is not associated with macrosomia
obesity
GDM T2DM
Post term
multiparity
large size of parents
advanced maternal age
previous macrosmic baby
multiparity
-
Risk factors for preeclampsia
- Nulliparity
- Preeclampsia in a previous pregnancy
- Age >40 years or <18 years
- Family history of preeclampsia
- Chronic hypertension
- Chronic renal disease
- Autoimmune disease (eg, antiphospholipid syndrome, systemic lupus erythematosus)
- Vascular disease
- Diabetes mellitus (pregestational and gestational)
- Multifetal gestation
- Obesity
- Black race
- Hydrops fetalis
- Woman herself was small for gestational age
- Fetal growth restriction, abruptio placentae, or fetal demise in a previous pregnancy
- Prolonged interpregnancy interval if the previous pregnancy was normotensive. If the previous pregnancy was preeclamptic, a short interpregnancy interval increases the risk of recurrence.
- Partner-related factors (new partner, limited sperm exposure [eg, previous use of barrier contraception])
- In vitro fertilization
|
|
