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Obstetric management

Management of obstetric conditions

Reduced foetal movements Assess risk. USS for growth. CTG for ?distress.
?SROM Ask about contractions. If Hx suggestive, admit.
BP 150/90, no proteinuria in commnity Recheck BP and urinalysis twice a week. USS. Baseline investigations.
BP 170/110, no proteinuria in commnity Admit to hospital, manage as pre-eclampsia.
BP 130/85, ++ proteinuria in commnity Admit to hospital to investigate ?pre-eclampsia.
Symphysis-fundal height >2cm below dates USS for growth.
Antepartum haemorrhage Admit to hospital. CTG.
Transverse lie at 28 weeks Re-check at 37 weeks.
Oblique lie at 38 weeks Admit to hospital. USS.
Breech presentation at 37 weeks Refer for USS. Consider ECV.
Gestation at 42 weeks Offer sweep or induction. CTG daily if declines.
?polyhydramnios USS. ?anomalies and glucose if confirmed.
<10th centile at 32 weeks, UA doppler normal resistance Repeat USS and UA doppler fornightly.
<10th centile at 32 weeks, UA doppler severe resistance fetal Doppler, steroids and daily CTG.
<10th centile at 38 weeks, UA doppler normal resistance CTG and induce labour.
Admitted with BP 170/110, no proteinuria, 36 weeks Control BP with nifedipine and start methyldopa.
Admitted with BP 170/110, + proteinuria, 36 weeks Control BP with nifedipine and start methyldopa. Induce labour.
Admitted with BP 150/90 and seizures IV MgSO4. Test patellar reflexes to assess Mg toxicity.
Unsuccessful ECV at term USS to check presentation. LSCS.
Antepartum haemorrhage secondary to placenta praevia with shock Resuscitate mother. Activate major haemorrhage protocol. LSCS.
Antepartum haemorrhage ABCs. CTG. USS (exclude placenta praevia).
Painless antepartum haemorrhage Suspect placenta praevia. ABCs, investigations etc.
Pelvic pain and inconsistent PV bleeding Suspect placental abruption. ABCs, investigations etc.
Pre-term SROM Rule out infection. Prophylactic erythromycin. Steroids if <34 weeks. Induce at 36 weeks.
Pre-term SROM with fever and tachycardia Antibiotics, blood cultures. Deliver regardless of gestation.
Induction PGE2 if needed, then ARM. CTG.
CTG abnormality FBS, urgent LSCS if indicated.
pH 7.18 on FBS Urgent LSCS.
pH 7.23 on FBS Repeat in 30 minutes.
Collapse 2222 Obstetrics and anaesthesia on call. ABCs etc.
Postpartum haemorrhage ABCs, involve seniors. Deliver placenta if necessary. Oxytocics. EUA then laparotomy if necessary.
Pre-term delivery USS and CTG. Tocolysis. ABx. Phone neonatology.
Created by: s0911751