2017/2018

Obstetrics Phase 3A Revision Session Jennifer McMurran 08/10/2018 The Peer Teaching Society is not liable for false or misleading information…

Overview Normal Pregnancy and Labour Pregnancy Labour Complications Pre-eclampsia Bleeding Infection Premature labour Prolonged labour Maternal Medical Conditions Diabetes Post-natal depression Chronic infections From the UoS Women’s Health Handbook The Peer Teaching Society is not liable for false or misleading information…

Normal Pregnancy Timeline: <12 weeks – 1st visit 11-13 weeks – Scan >14 weeks – CXR if TB risk 18-20 weeks – Scan 36 weeks – Check lie and presentation 37 weeks – Head engaged What do you do at the first visit? 1st visit: MSU, Hb, group, serology (syphilis & rubella), HIV test What is the 11-13 week scan for? dates, multiple pregnancies, nuchal translucency What is the 18-20 week scan for? Anomaly scan The Peer Teaching Society is not liable for false or misleading information…

Normal Labour 1st stage 2nd Stage - Latent – cervix effaces and dilates <4cm - Established – contractions, dilatation > 4cm 2nd Stage - Passive – complete dilatation, no pushing - Active – pushing How many weeks? 37 – 42 weeks, spontaneous delivery within 24hrs What is the ‘show’? cervical mucus plug and blood What is the ‘waters breaking? Membranes rupture Which position for 2nd stage? encourage comfortable not supine. How long do the stages of labour take? 1st stage: 8-18hrs primip, 5-12hs multip. 2nd stage: 3hrs primip, 2 hrs multip. The Peer Teaching Society is not liable for false or misleading information…

Pre-eclampsia Pregnancy-induced hypertension with proteinuria Flu-like symptoms, visual changes, shaking, hyperreflexia, may be asymptomatic Only cure = delivery (usually resolves within 10 days of delivery) What is the Pathophysiology? in placenta: spiral arteries don’t properly invade trophoblast => BP increases to compensate What week does pre-eclampsia start from? after 20 weeks How is pre-eclamspia prevented (e.g. HTN, CKD, DM, SLE)? aspirin from 12th week until delivery When to admit? BP 30/20 over booking, 160/100, or 140/90 with proteinuria or growth restriction How is eclampsia risk decreased in pre-eclampsia? MgSO4 (can be toxic to fetus in too high doses) The Peer Teaching Society is not liable for false or misleading information…

Bleeding in Pregnancy Abruption – part of placenta detaches. Disproportionate shock for blood seen, pain, ‘woody’ uterus. Placenta Praevia – placenta in lower uterine segment. Painless, lie/presentation may be abnormal. Why avoid vaginal examination? Can get catastrophic bleeding from placenta praevia Management: admit, emergency management- if bleeding severe, deliver, otherwise establish diagnosis, keep PP in until delivery, abruption depends on severity and other factors. Risk of PPH in both abruption and placenta praevia. The Peer Teaching Society is not liable for false or misleading information…

Infection in Pregnancy Rubella – Cataracts, deafness, cardiac lesions. CMV – Cognitive effects Toxoplasmosis – Intracranial calcification, hydrocephalus HIV – transmission risk Syphilis – rhinitis, rash, hepatosplenomegaly Listeria – fetal distress, respiratory distress, convulsions How is rubella picked up? Routine antenatal screening What are the TORCH infections? Toxoplasmosis, Other (syphilis, varicella-zoster, parovirus B19), Rubella, CMV, Herpes What is the treatment for syphilis? Procaine penicillin IM 3 weeks What should pregnant women avoid eating to reduce listeria risk? Soft cheeses The Peer Teaching Society is not liable for false or misleading information…

Premature Labour Born before 37 +6 weeks Delivery <28 weeks: Room temp 36’, wrapped in plastic without drying, placed under heat >28 weeks: dry towels 3-min delay cutting cord The Peer Teaching Society is not liable for false or misleading information…

Prolonged Labour Delay in 1st stage: <2cm/hr dilatation in 4hrs, continuous fetal heart monitoring, consider oxytocin Delay in 2nd stage: Delivery not imminent within 1hr of active 2nd stage (multip) or 2hrs (primip) => call relevant obstetrician, Amniotomy, Consider instrumental/c-section The Peer Teaching Society is not liable for false or misleading information…

Maternal Diabetes 5mg Folic acid preconception Tight diabetes control around conception Compensatory fetal hyperinsulinaemia => fetal growth Elective delivery at 38 weeks Avoid acidosis in labour Encourage breastfeeding Give a risk of macrosomia during labour- Shoulder dystocia. The Peer Teaching Society is not liable for false or misleading information…

Post-natal Depression Usually resolves in about 6 months – however important to manage as risks for patient and baby. Pre-empt - antenatal clinic MDT The Peer Teaching Society is not liable for false or misleading information…

Maternal Chronic Infections HIV Offer testing Maternal antiretrovirals Avoid fetal blood sampling/ scalp elctrodes Can have vaginal delivery if low viral load otherwise elective c-section The Peer Teaching Society is not liable for false or misleading information…

Reference Oxford Handbook of Clinical Specialities 9th Edition The Peer Teaching Society is not liable for false or misleading information…