Obstetrics

• Amniotic Fluid Embolism → tachypnoea, tachycardia, hypotension and hypoxia during/shortly after labour.
• Prolonged 2nd Stage of Labour (≥3 hrs from full dilatation) → instrumental delivery is main intervention. If not possible, caesarean section may be done.
• HIV during Pregnancy → start mother on combination antiretroviral therapy. If viral load <50, vaginal delivery is okay. If >50, elective caesarean is recommended.
• Miscarriage → loss of pregnancy <24 weeks gestation. Antepartum Haemorrhage → bleeding >24 weeks gestation.
• Epilepsy in Pregnancy → all need to take 5mg folic acid daily. Monotherapy should be encouraged (levetiracetam and lamotrigine are the safest).
• Management of 3rd Stage of Labour → controlled cord traction. Oxytocin may be administered to expedite process.
• Ectopic Pregnancy → medical management with methotrexate if patient is experiencing symptoms. Indications for surgery are if patient is in significant pain, adnexal mass >35mm, b-hCH level >5000, or foetal heartbeat present on ultrasound.
• Tocolytics → drugs that suppress contractions during pregnancy to delay labour, typically used in pre-term labour. Main agents are nifedipine (CCB) and atosiban (oxytocin receptor antagonist).
• Shoulder Dystocia → following the delivery of the foetal head the anterior shoulder becomes impacted behind the maternal pubic symphysis. Initial management involves McRoberts manouevere (hyperflexion and abduction of the mother's legs tightly to the abdomen) and applying suprapubic pressure. This is successful in 90% of cases. May lead to erb’s palsy (affects C5-C6).
• Puerperal Psychosis → admission to mother & baby unit.
• Glucosuria during Pregnancy → may be normal finding during pregnancy due to increased GFR and reduction in tubular reabsorption of filtered glucose.
• Layers of Skin during Caesarean Section → skin > subcutaneous fat > rectus sheath > rectus abdominus muscle > peritoneum > uterine myometrium > amniotic sac.
• HELLP Syndrome → haemolysis, elevated liver enzymes, low platelets. Associated with severe pre-eclampsia. Causes RUQ pain and N+V.
• Obstetric Analgesia → non-pharmacological methods (exercise, heat therapy, TENs stimulation), nitrous oxide (enotox), simple analgesia (paracetamol), opiate analgesia (codeine or diamorphine), epidural analgesia, pudendal nerve block (regional anaesthesa). Avoid NSAIDs due to risks to mother and fetus.
• Post-Partum Contraception → not required for first 21 days post-partum. IUS can be inserted up to 48 hrs after delivery (if after this point should wait until 28 days). POP can be started at any point. COCP should not be used within first 28 days due to VTE risk + is contraindicated if breastfeeding (can reduce breast milk production).
• Vasa Praevia → foetal blood vessels run through free placental membranes and are at risk of rupture causing haemorrhage when membranes rupture. Triad of membrane rupture, PV bleeding and foetal tachycardia.
• Antepartum Haemorrhage → admit for observation even if bleeding has stopped.
• Vaginal Birth After Caesarean Section (VBAC) → delivery method for women ≥37/40 who have previously had a single caesarean delivery. Increased risk of uterine rupture and also requiring a caesarean section. Previous classical/vertical caesarean section is an absolute contraindication.
• Down’s Syndrome Screening → combined screening test can only be done between 10 and 13 weeks gestation. If between 15 and 22 weeks, quadruple test should be done.