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 A) Post term B) previous macrosmic baby C) large size of parents D) advanced maternal age E) GDM T2DM F) multiparity G) obesity
F) 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
