Obstetrics

Front

What is the conservative management of placenta previa?

Back

Mcafee regimen

1. Bed rest along with pad charting to monitor bleeding

2. 2. Vitals monitoring

3. 3. USG monitoring every 2 weeks for placental migration

4. 4. IM dexamethasone 12mg 12hrly BD

5. 5. Prolong the pregnancy until term usually 38weeks for elective LSCS

Front

Risk factors of placenta previa

Back

1. 1. Previous cesarean section

2. 2. Multiple gestation/ multiparity

3. 3. Multiparity

4. 4. Previous D&C/ intrauterine surgery

5. 5. Previous placenta previa

6. 6. Smoking, cocaine use

Front

Prophylactic treatment of DVT after LSCS

Back

Choose any one of:

1. 1. LMWH SC, e.g. Enoxaparin 40mg daily

2. 2. Fondaparinux SC - starting dose at 2.5mg (6hours after surgery) followed by 2.5mg daily

3. 3. Unfractionated heparin SC - 5000units BD

Front

Management of PPH

Back

1. 1. Start two large-bore IVs and infuse isotonic crystalloids, blood grouping and cross-matching, coagulation profile

2. 2. Manually compress and massage the uterus, remove blood clots from the uterus

3. 3. Empty the bladder with continuous bladder drainage

4. 4. Carefully inspect the placenta to ensure it is intact

5. 5. Inspect the cervix and vagina for trauma/ lacerations

6. 6. If the uterus is flabby and boggy, suspect atony:

7. - IV Oxytocin 40units in 500mL normal saline in rapid infusion within 45s

8. - IV ergometrine 0.5mg

9. - IM carboprost 250mcg

10. - PR misoprostol 800mcg

11. - IV tranexaminc acid 1g

12. If not responding, send patient to OT

13. 1. Uterine artery embolisation

14. 2. Surgical exploration

15. 3. Hysterectomy

Front

Placenta accreta vs Placenta increta vs Placenta percreta

Back

Front

Complications of placenta previa

Back

1. 1. Placenta accreta

2. 2. PPH

3. 3. Fetal hypoxia, IUD

4. 4. Need for Cesarean section

Front

Active management of third stage of labor

Back

1. 1. Prophylactic oxytocin - IV Pitocin 5-10units

2. 2. Early clamping of the cord

3. 3. Controlled cord traction

4. 4. Check uterine level whether it's well-contracted if not start fundal massage

5. 5. Empty the bladder, check whether the placenta is intact/ complete

Front

Types of prostaglandin analogues used in obg

Back

1. 1. PGE1 - Misoprostol (Abortion, PPH)

2. 2. PGF2a - Carboprost IM (PPH)

3. 3. PGE2 - Dinoprostone/ prostin intravaginal (IOL)

Front

Management of arrest active phase

Back

1. 1. Abdominal and vaginal examination - to exclude malposition, large fetus and CPD

2. 2. Continuous CTG

3. 3. If absence of the above factors, augmentation with oxytocin should be achieve vaginal delivery

4. 4. If presence of above factors -> Emergency LSCS

Front

Management of prolonged second stage

Back

1. 1. Exclude CPD and malposition

2. 2. Augment with oxytocin if no CPD

3. 3. Encourage maternal expulsive powers

4. 4. Continuous CTG

5. 5. Instrumental delivery - should be considered if the head is below the level of ischial spines

6. 6. Cesarean delivery - evidence of CPD or no response to oxytocin