gestation and present
Pregnant
6 weeks
wo m e n
with Vaginal bleeding
+ no pain = can be managed
Chorioamnionitis
expectantly
• Intra-amniotic infection affecting membranes
surrounding fetus and placenta
• Can lead to foetal and maternal sepsis
• Most common organisms = GBS, E.coli,
Streptococcus agalactiae
• Symptoms = fever, abdominal pain, cervical
tenderness, malodorous vaginal discharge,
PROM, tachycardia
• Indication for hospital admission and
delivery - IV broad spectrum antibiotics
• Gentamicin and ampicillin = 1ST LINE
• Clindamycin or metronidazole may be
considered if CS is performed
• IV vancomycin + gentamicin + metronidazole
- penicillin allergy
Obstetrics
The thyrotoxicosis phase of
Skin
↓ post-partum thyroiditis
=
propanotol
subcutaneous fat
↓
rectus sheath
I
↓
rectus abdominis musche
↓
peritoneum
↓
uterine myometrium
↓
amniotic sa
, ANTENATAL CARE
Nutritional Supplements &polyethylene glysed xatives or
• 400mcg folic acid from before conception until 12 weeks Avoid -
Senna
↳ induces contractions which
I rists
of
• If high risk = 5mg folic acid
preterm labour miscarriage or
- NTD history, antileptics, coeliac disease, diabetes, obese > 30, sickle cell
• 10mcg of vitamin D/day > develop
-
dark stool-harmless
• Screen for anaemia at booking visit - PO ferrous fumarate or sulphate (3 months)
Air Travel During Pregnancy - avoid if:
• > 37 weeks with singleton pregnancy
• Multiple pregnancies once > 32 weeks
• Increased risk of VTE
> smoking-protective
-
Nausea and Vomiting
• Natural remedies - ginger, acupuncture ↓
• 1st line = antihistamines - promethazine > Risk factorets-multiple pregnancies trophoblastic
case
S
,
·
• If weight loss, ketones in urine = admit hospital = IV saline + K+ (severe) · FH or PMH of New
Antenatal Care Timeline Referral
~antihistamManagement
me promettaa
n Hyperemes
nge
Criteria (admit
a
-ContinuedNutunablekeepdown
• 10 pregnancy visits = uncomplicated 1st pregnancy
t
* CND LINE
• 7 pregnancy visits = uncomplicated subsequent pregnancies ↳ PO ondansetron -> avoid in 1st trimester =
deft lip /
palate
↳ po metoclopramide , domperidone
↳ don't for morethan EPS
use 5
days +
Down syndrome - Antenatal testing
3 5
• Combined test - done between 11 - 13+6 weeks If NT .
mm
- Nuchal translucency measurement, serum B-HCG, pregnancy-associated plasma protein A (PAPP-A)
- Down's syndrome = ↑ HCG, ↓ PAPP-A, thickened nuchal translucency + low AFP + oestriol
- Trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower
• Quadruple test - offered between 15 - 20 weeks
- Alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
• If 'higher chance' results - offered a second screening test
- NIPT or a diagnostic test (e.g. amniocentesis or chorionic villus sampling)
- week 15 onwards > 11th-13th week
, NORMAL PREGNANCY
Physiological Changes in Pregnancy
• Trace glycosuria is common - increased GFR and reduction in tubular reabsorption of filtered glucose
• Diastolic BP is reduced in 1st & 2nd trimester, returning to non-pregnant levels by term
• Enlarged uterus may interfere with venous return - ankle oedema, supine hypotension and varicose veins
• Reduced urea, reduced creatinine, increased urinary protein, reduced platelets
• Pregnant women with previous VTE history = LMWH throughout pregnancy until 6 weeks postnatal
Rhesus well-explained
>
-
on
passmed
• All babies born to Rh -ve mother - at delivery FBC, blood group & direct Coombs test
• Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
• Kleihauer test: add acid to maternal blood, fetal cells are resistant
• Advise giving anti-D to non-sensitised Rh -ve mothers at 28 and 34 weeks
Rubella
• Pregnant woman not immune to rubella - offer MMR vaccination in post-natal period
• MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant
HIV
• All pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously
• Vaginal delivery is recommended if viral load is LESS than 50 copies/ml at 36 weeks
• Zidovudine infusion should be started four hours before beginning the caesarean section
• Zidovudine is usually administered orally to neonate if maternal viral load is <50 copies/ml
- Otherwise triple ART should be used-> continue for 4-6 weeks.
Hep B
• Babies born to hep B mothers with surface antigen positive, or are high risk of hep B = receive 1st dose of hep B vaccine soon after birth
• If mother is surface antigen positive = also receive 0.5ml hep B within 12 hours of birth
• Baby should receive a 2nd dose of hep B vaccine at 1-2 months and at 6 months
• Lochia = vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth
- US is indicated if lochia persists beyond 6 weeks
Pregnant
6 weeks
wo m e n
with Vaginal bleeding
+ no pain = can be managed
Chorioamnionitis
expectantly
• Intra-amniotic infection affecting membranes
surrounding fetus and placenta
• Can lead to foetal and maternal sepsis
• Most common organisms = GBS, E.coli,
Streptococcus agalactiae
• Symptoms = fever, abdominal pain, cervical
tenderness, malodorous vaginal discharge,
PROM, tachycardia
• Indication for hospital admission and
delivery - IV broad spectrum antibiotics
• Gentamicin and ampicillin = 1ST LINE
• Clindamycin or metronidazole may be
considered if CS is performed
• IV vancomycin + gentamicin + metronidazole
- penicillin allergy
Obstetrics
The thyrotoxicosis phase of
Skin
↓ post-partum thyroiditis
=
propanotol
subcutaneous fat
↓
rectus sheath
I
↓
rectus abdominis musche
↓
peritoneum
↓
uterine myometrium
↓
amniotic sa
, ANTENATAL CARE
Nutritional Supplements &polyethylene glysed xatives or
• 400mcg folic acid from before conception until 12 weeks Avoid -
Senna
↳ induces contractions which
I rists
of
• If high risk = 5mg folic acid
preterm labour miscarriage or
- NTD history, antileptics, coeliac disease, diabetes, obese > 30, sickle cell
• 10mcg of vitamin D/day > develop
-
dark stool-harmless
• Screen for anaemia at booking visit - PO ferrous fumarate or sulphate (3 months)
Air Travel During Pregnancy - avoid if:
• > 37 weeks with singleton pregnancy
• Multiple pregnancies once > 32 weeks
• Increased risk of VTE
> smoking-protective
-
Nausea and Vomiting
• Natural remedies - ginger, acupuncture ↓
• 1st line = antihistamines - promethazine > Risk factorets-multiple pregnancies trophoblastic
case
S
,
·
• If weight loss, ketones in urine = admit hospital = IV saline + K+ (severe) · FH or PMH of New
Antenatal Care Timeline Referral
~antihistamManagement
me promettaa
n Hyperemes
nge
Criteria (admit
a
-ContinuedNutunablekeepdown
• 10 pregnancy visits = uncomplicated 1st pregnancy
t
* CND LINE
• 7 pregnancy visits = uncomplicated subsequent pregnancies ↳ PO ondansetron -> avoid in 1st trimester =
deft lip /
palate
↳ po metoclopramide , domperidone
↳ don't for morethan EPS
use 5
days +
Down syndrome - Antenatal testing
3 5
• Combined test - done between 11 - 13+6 weeks If NT .
mm
- Nuchal translucency measurement, serum B-HCG, pregnancy-associated plasma protein A (PAPP-A)
- Down's syndrome = ↑ HCG, ↓ PAPP-A, thickened nuchal translucency + low AFP + oestriol
- Trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower
• Quadruple test - offered between 15 - 20 weeks
- Alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
• If 'higher chance' results - offered a second screening test
- NIPT or a diagnostic test (e.g. amniocentesis or chorionic villus sampling)
- week 15 onwards > 11th-13th week
, NORMAL PREGNANCY
Physiological Changes in Pregnancy
• Trace glycosuria is common - increased GFR and reduction in tubular reabsorption of filtered glucose
• Diastolic BP is reduced in 1st & 2nd trimester, returning to non-pregnant levels by term
• Enlarged uterus may interfere with venous return - ankle oedema, supine hypotension and varicose veins
• Reduced urea, reduced creatinine, increased urinary protein, reduced platelets
• Pregnant women with previous VTE history = LMWH throughout pregnancy until 6 weeks postnatal
Rhesus well-explained
>
-
on
passmed
• All babies born to Rh -ve mother - at delivery FBC, blood group & direct Coombs test
• Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
• Kleihauer test: add acid to maternal blood, fetal cells are resistant
• Advise giving anti-D to non-sensitised Rh -ve mothers at 28 and 34 weeks
Rubella
• Pregnant woman not immune to rubella - offer MMR vaccination in post-natal period
• MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant
HIV
• All pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously
• Vaginal delivery is recommended if viral load is LESS than 50 copies/ml at 36 weeks
• Zidovudine infusion should be started four hours before beginning the caesarean section
• Zidovudine is usually administered orally to neonate if maternal viral load is <50 copies/ml
- Otherwise triple ART should be used-> continue for 4-6 weeks.
Hep B
• Babies born to hep B mothers with surface antigen positive, or are high risk of hep B = receive 1st dose of hep B vaccine soon after birth
• If mother is surface antigen positive = also receive 0.5ml hep B within 12 hours of birth
• Baby should receive a 2nd dose of hep B vaccine at 1-2 months and at 6 months
• Lochia = vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth
- US is indicated if lochia persists beyond 6 weeks
