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