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What is the primary survey for a pregnant patient?
- <c> ABCDEFG
- Fundus / Go go go
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What should you look for or consider with a catastrophic haemorrhage in pregnancy?
- Any blood soaked clothes?
- Any blood soaked pads?
- Remember the uterus is a reservoir.
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How much blood is a red flag when assessing a pregnant patient?
One saturated sanitary pad - c 50ml.
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What AIRWAY considerations are there for the pregnant patient?
- Open (same as non-pregant pt).
- Protected.
- Maintained.
- Beware of aortocaval compression beyond 20weeks.
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What are the BREATHING red flags?
- RR of 0-10.
- RR >21
- SpO2 <94%
- Added respiratory sounds.
- Cyanosis.
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What CIRCULATORY red flag are there?
- Pulse <49.
- Pulse >100
- BP of <99 / <39
- BP of >150 / >91
- (Either a systolic or diastolic reading alone is a red flag).
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What should you check for CIRCULATION?
- Pulse (50-99)
- BP (100-149 / 40 - 90)
- Pallour
- Skin temp.
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What DISABILITY red flags are there?
- No response to voice, pain, or unresponsive.
- Fitting, twitching.
- Visual disturbance.
- Signs of pre-eclapmsia.
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What EXPOSE red flags are there?
- Temperature <35.9
- Temperature >38.
- > 50ml bleeding (soaked sanitary towel, blood on the floor).
- < 37 weeks any blood stained membranes.
- < 37 weeks any meconium or offensive smell.
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What FUNDUS red flags are there?
- Contractions < 37 weeks.
- Constant pain.
- Tender / woody.
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What FUNDUS checks ar there?
- Any contractions?
- Last fetal movements?
- Height of the fundus?
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How many red flags do you need to be considered time critical?
ONE
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Where do you take the time critical pregnant patient?
- <20 weeks ED (pre-alert).
- >20 weeks Obstetric Unit (pre-alert).
- Shoulder dystocia / cord prolapse / breech - Obstetrics Unit.
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What history should you include?
- P/C
- HxP/C
- PMHx
- DHx
- FHx
- SHx
- ROS (review of systems)
- IMP (impression)
- Current Obstetric Hx
- Past Obstetric Hx
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What obstetric history should you ask for?
- Mum's age, DOB.
- Hospital registration
- Lead clinician.
- History of this pregnancy.
- Estimated due date.
- Previous obstetric history.
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What questions should you ask re this current pregnancy?
- LMP (last menstrual period).
- Any problems / complications?
- Number of babies expected?
- Care plan?
- Any concerns?
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What questions should you ask re previous pregnancy?
- How many previous pregnancies?
- How many previous deliveries?
- What type of delivery (c-section or normal)
- Any complications?
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Define obstetrics
Branch of medicine concerned with care of women during pregnancy, childbirth and the period 6 weeks after birth when reproductive organs are recovering.
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Define gynaecology
The study of diseases of women and girls, particularly affecting the female reproductive organs.
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When is pregnancy measured from?
First day of LMP up to 42 weeks.
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When is the first trimester?
1-12 weeks +6 days
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When is the second trimester?
13-25 weeks + 6 days
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When is the third trimester?
26+ weeks.
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What changes occur in the respiratory system in a pregnant patient?
- Increased RR.
- Increased respiratory effort.
- Increased tidal volume.
- Decrease in vital capacity.
- Diaphragm is elevated.
- Lower ribs flare.
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How much does the average maternal heart rate increase by?
10-15 bpm
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What is the increase in cardiac output in a pregnant patient?
- 20-30% in the first 10 weeks.
- 50% at term.
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How does BP differ in a pregnant pt compared to normal?
- Decrease in systolic and diastolic of c 10-15 mmHg.
- Returns to normal at term.
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How much does circulating blood volume increase?
- By 45-50%.
- This means the pregnant women can tolerate a greater blood loss before showing signs and symptoms of shock.
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Does plasma volume and red blood cell volume increase at the same rate?
NO. RBC volume increases only a small amount, so pregnant patients can appear anaemic.
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What changes occur to the alimentary system?
Relaxation of cardiac sphincter - causes delay in gastric emptying, and increased heartburn and increased regurgitation.
Pressure on stomach from enlarged uterus.
Constipation. Reduced GI motility.
Gall stones.
Bleeding gums.
Odema of larynx.
Breast enlargement - can fall against neck!
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What changes occur to the urinary system?
Kidneys increase in weight.
Ureters dilate/lengthen to accommodate growing uterus.
Urinary stasis from the gravid uterus.
Increased urinary frequency.
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What changes occur to the genital tract?
Uterus - Increased blood flow.
Uterus - Increased size / muscle .
Cervix - mucus plug.
Cervix - increase in elastic tissue.
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What other changes to skin and breasts occur?
Skin - elastic tissues stretch. Stretch marks occur.
Breasts - enlarge, colostrum and milk production post birth.
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