Obstetrics

Question 1

where should pregnant patients with minor trauma be transported to?

Answer 1

Patients should be transported to the nearest major trauma center but not the RWH

Question 2

what destination should a >36wk gestation pt be transported to during labor? METRO

Answer 2

• If at term (>36 weeks gestation) and an
  uncomplicated labour is anticipated, then the
  default destination should be the hospital the
  patient is booked into whether public or private.

Question 3

where should you take a patient that is 32 - 36 wks pregnant and giving birth? METRO

Answer 3

• If preterm and - between 32 - 36 weeks gestation consult with PIPER for advice regarding destination.

Question 4

where should you take a patient that is < 32 weeks gestation and giving birth? METRO

Answer 4

• < 32 weeks gestation the receiving
  hospital should be the closest of the Royal
  Women’s Hospital, Mercy Hospital for Women
  Heidelberg or Monash Clayton. These
  hospitals have appropriate NICU facilities.

Question 5

BP required for fluid admin in PPH?

Answer 5

< 90

Question 6

If the fundus is firm and the BP is < ? What is the mx?

Answer 6

90:
Titrate normal saline IV max 40ml/kg consult for further 20ml/kg further (60ml kg)

Provide analgesia

Mx any visible laceration

Question 7

What is the fluid intervention point for APH? What is the regime

Answer 7

< adequate perfusion

Titrate normal saline to 40ml/kg consult for 20ml/kg more (max 60)

Question 8

BP changes during pregnancy

Answer 8

Minimal change – initial decrease in 1st and 2nd trimesters, normal in 3rd trimester

SBP > 170 mmHg and DBP > 110 mmHg is significant

Question 9

SS of pre-eclampsia (VAHHHANA)

Answer 9

Visual disturbances
Agitation
Hyper-reflexia
Heartburn/epigastric pain
Headache
Abdominal pain
N/V
An elevation of 20mmhg above normal can indicate pre-eclampsia.

Question 10

pre-eclampsia significant hypertension range SBP/DBP

Answer 10

SBP - 140-170

DBP 90-110

Question 11

Severe hypertension range pre-eclampsia + mx

Answer 11

SBP > 170
DBP >110
S+S pre-eclampsia

consult with PIPER