Monica’s Part 2 > Postpartum Problems > Flashcards

Postpartum Problems Flashcards

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1
Q

What is Erb’s palsy

A

C5-C6

Loss of sensation on the arm and paralysis and atrophy of the deltoid, biceps and brachialis muscles

The arm hangs by the side and is rotated medialy, the forearm is extended and pronated. The arm cannot be raised from the side, all power of flexion of the elbow is lost as is also supination of the forearm
Waiter tip

Can resolve on its own in months or need therapy or surgery

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2
Q

What can you consider during neonatal resuscitation if ongoing bradycardia when delivered

A

Adrenaline
Blood transfusion 10ml per kg
Glucose 250mg per kg 10 % glucose
Sodium bicarbonate 2-4ml per kg 4.2% to reverse intracardiac acidosis

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3
Q

Baby born with poor resp effort and HR90 what is the next step In resuscitation

A

Give 5 inflation breaths initially in air at 30cm h20 pressure with PEEP 5-6cm h2o

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4
Q

What does the blood spot test test for

A

Done on day 5 of life

Tests for 9 conditions:
Sickle cell disease
CF
Congenital hypothyroidism
Inherited metabolic disease: PKU
Medium chain actual coA dehydrogenase deficiency
Maple syrup urine disease
Isovaleric acidaemia
Gluctaric acidaemia
Homocystinuria

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5
Q

What is the correct ratio of chest compressions to ventilations during neonatal resuscitation

A

3:1

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6
Q

Klumpke’s paralysis symptoms

A

C8-T1

The nerves injured affects the intrinsic muscles of the hand , the interossei, thenar and hypothenar muscles and flexors of the wrist and fingers

Classic presentation if Claw hand where the forearm is supinated , the wrist extended and the fingers flexed

If Horners syndrome is present there is meiosis (constriction of the pupils in the affected eye

Klumpke is lower plexus erbs is higher plexus

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7
Q

How does RDS show on an x ray

A

Air bronchograms with reticulogranular pattern

Usu occurs right after birth due to deficiency of surfactant due to either inadequate surfactant production or surfactant inactivation in the context of immature lungs- prematurity affects both of these things

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8
Q

What is staging used to classify intraventricular hemorrhage in neonates

A

Papile grading

intraventricular haemorhage is most at risk in babies born pre 33w at the time the germinal matrix involutes
Can cause CP

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9
Q

What decreases the risk of intraventricular haemrrhage

A

Antenatal steroids but also delayed cord clamping

MgSO decreases the risk of CP

Hypothermia is used in HIE not for preventing IVH

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10
Q

How to diagnose a intraventricular haemorrhage in baby

A

Cranial USS at 7-14 days of life don’t I all babies born less than 30 w of life

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11
Q

How to diagnose necrotizing enterocolitis in baby

A

Abdominal x ray

NEC is the MC disease affecting neonates and is the mist common like threatening emergency affecting the GI tract in infants

NEC usually occurs in the 2nd or 3rd week of life.
Several RF have been identified but prematurity, low birth weight and formula feeding have been identified as the primary risks . Especially high osmotic strength formula
70% of cases are in premature babies
Mortality is from 10-50%
Most severe cases involve perforation, peritonitis, sepsis, mortality approaches 100%

Most important test is abdominal plain film series with AP and left lateral views
Findings of dilated loops of bowel , pneumatosis intestinalis and portal venous air is diagnostic for necrotizing enterocolitis.
Pneumatosis intestinalis is the visualization of small amounts of air within the bowel wall and is athognomic for nectrotizing enterocolitis. Portal nervous air is not universally present but is a poor prognostic sign when found .

Free air in the abdomen may be seen when perforation has occurred. An abdominal radiograph is a valuable tool for tracking the progression of the disease as well.
Sometimes even needs to be repeated every 6 hours until definitive treatment has occurred.

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12
Q

What is the fist line med to close a patent ductus arteriosus?

A

Ibuprofen

The PDA closes by 12 to 24 hours of age in healthy full term newborn with permanent anatomical closure occurring within 2-3 weeks. In premature infants the ductus arteriosus may not close rapidly and may require pharmacological or surgical closure.

The patency of the ductus is kept open by prostaglandin E2. If the ductus remains patent after birth it is associated with pulmonary oedema and pulmonary haemorrhage, NEC, intraventricular haemorrhage, congestive heart failure and renal failure and bronchi pulmonary dysplasia
A PDA and also result in a left to right shunt , the steal from the aorta during diastole required increased cardiac output to compensate. Decreased blood flow to the lower body results in increased risk for NEC and renal failure.

Tx is with indomethacin, ibuprofen or paracetamol. Should be considered for preterm infants with a symptomatic PDA. Infants who are born weighting greater than 1000 grams are unlikely to require pharmacological therapy to close the ductus.

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13
Q

What is the prevelance of jaundice in the 1st week of life

A

60%

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14
Q

What is the prevelance of jaundice in the 1st weeks of like for preterm babies

A

80%

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15
Q

What is the prevelance of jaudince in the 1st week of life in preterm babies

A

80%

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16
Q

What is the initial treatment for NEC

A

Complete bowel rest and parenteral nutrition
An NG tube for decompression of the dilated bowels
IV antibiotics - amipillin, gent, and either clindamycin or metro

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17
Q

Babies overal survival rate born at 24 and 25 weeks

A

40% and 60%

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18
Q

When is neonatal jaudice pathological

A

When its on day 1

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19
Q

What is the rate of survival of babies born at 25w without disability

A

43% from the onset of labour

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20
Q

Baby born in poor condition with NO resp effort , fist step, if over 28w

A

Give 5 inflation breaths with 25% oxygen at 25cm H20 pressure

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21
Q

What is the most common cause of conjugated hyperbilirubinemia in a neonate

A

Biliary atresia

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22
Q

How to treat bilirubin that is >450 micromol/litre in a neonate that is jaundiced at 48 hours

A

Exchange transfusion

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23
Q

Survival rate of babies born without disability at 23w

A

8% from the onset of labour

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24
Q

If baby born at 27w with no resp effort and HR 90 how what to do first

A

Give 5 inflation breaths with 30% oxygen at 25cm H2O pressure
If baby is less than 28w!

This is for poor or absent resp effort

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25
What is the BAPM framework for?
Criteria to fulfill if needs therapeutic hypothermia Criteria A,B,C
26
Imaging post therapeutic hypothermia which would be the best predictor of neurological outcome in infants treated with therapeutic hypothermia which
Cranial USS within 12H MRI 5-15 days post del ideally between 5-7days after birth
27
Apgar criteria
Skin color Pulse rate Reflex irritability Activity/muscle tone Respiratory effort
28
What is the definition of a secondary PPH
Excessive bleeding from the birth canal between 24h and 12 weeks postnatally
29
What contraception is allowed for epileptic women using AEDs - enzyme inducing anti-epileptic drugs
Allowed - UK MEC 1 LNG IUS and COpper IUD Depot injection - UKMEC 1 COCP, POP, Implant Prog. All UKMEC 3
30
What tests to do if mom is RH neg
-Cord flood for ANO and RHD typing of the baby -maternal blood for ABO RhD typing and feta maternal haemorrhage . These should ideally be taken after 30-45 min have elapsed since delivery but within 2 hours. This allows sufficient time for any fetomaternal haemorrhage to be dispersed into the maternal circulation and to allow for timely anit-D Ig administration prior to discharge,
31
When to start chest compressions on baby
3 to 1 breath If neonatal heart rate is not detectable or is less than 60bpm after 30 second of ventilation Oxygen should also be increased to 00% and intubation should be so diverted if not already don’t
32
What proportion of women infected with chlamydia at delivery will develop a peurperal infection
30% - up to 34% of women with untreated chlamydia that deliver vaginally will develop a peurpeural infection Need to treat asap to prevent - ophthalmia neonatorum and chlamydia pneumonitis
33
What % of neonates are at risk of developing Opthalmia neonatorum when born vagninally to moms with current chlamydia infection
50% Another 15% will develop chlamydia pneumonitis
34
When does postpartum psychosis usually start
Onset within 2 weeks of delivery with over 50% of symptoms onset occurring on day 1-3
35
What is a pre ductal oxygen saturation that is acceptable in a newborn of 2 min old
2 min - 65% 5 min- 85% 10 min - 90%
36
How to administer adrenaline during neonatal resuscitation
Intravenous 0.2ml per kg of 1:10 000 adrenaline
37
How much pressure should anti-embolism stocking be
14-15 mmHg
38
What to start postnatal women who is black and was hypertension
Nifedipine if black - can also consider amlodipine if women has used it previously Enalapril for white women - monitor renal and K+ levels
39
Can you transmit GAS through breastfeeding
Yes, if one or both infected , both always need antibiotics
40
What to do with family members / partners if mom is being treated for GAS infection
Treat partner with prophylactic antibiotics if mom treated for group A streptococcus and neisseia meningitidis Also treat household contacts and healthcare staff who are exposed to resp secretions
41
Does and woman who is rhesus negative and has anti D antibodies need more anti D if preggo again
No she is already sensitized and has immune anti D antibodies This is GTG … not sure this is correct
42
If IUD and mom is RH neg, does she need anti D? And when to give
Yes give 72h from when diagnosis of IUD - 500 IM UNITS The IUD is the sensitizing event not the delivery! Also take blood for fetomaternal haemorrhage at the time of diagnosis prior to administration of the prophylactic anti-D
43
When should IV anti D be considered after discussion with the transfusion lab?
If fetomaternal haemorrhage of >100ml
44
What to do if Kleihauer shows a fetomaternal haemorrhage of 6ml post delivery for a Rh neg mom with baby Rh pos, she already got 500 units IM post delivery
Give another 250 units I’m 1ml of fetomaternal haemorrhage requires : 125units of anti D ** maternal blood should be taken 72h after the IM dose of anti D to check for clearance of the fetal red cells **
45
How much anti D to give if post delivery mom with Rh negative blood get cell salvage
Give 1500 units IM. Then take maternal blood samples for fetomaternal haemorrhage 30-45min after the re infusion of salvaged red cell for fetomaternal haemorrhage . Further anti D should be given accordingly if required
46
What to do baby blood group unknown, mom is Rh negative and CS with MOH given cell salvage blood
Take cord blood for RH typing and maternal blood for FMH 30-45 min post cell salvage reinfused ** only give anti D when the Baby is confirmed as RH POS** You would give 1500units IM
47
How much many mls of FMH does 500 units of anti D cover
4ml Give anti D within 72h of birth If further anti D needed if FMH then maternal blood should be taken 72 hour after the IM dose of acid IG to check for clearance of cells I think check for clearance of cells even if no extra antiD given
48
If IV anti D given for massive FMH >100ml - when do you do a FU testing for FMH
Do after 48H another keliuhour , 46h post IV anti D given to check for clearance of fetal red cells
49
Risk of hypertensive disorder in future pregnancy of had severe PET with CS at 37w for breech
1 in 5
50
How long to do obs for baby that mom got antibiotics for GBS in labour
12 h
51
Risk of PET in a future pregnancy if PET in this one and delivered at 40w
1 in 6
52
Risk of gestation HTN at next deliver if Gestation HTN at this del
1 in 7
53
Had sever PET in fist preg- what is her risk of chronic HTN in the future
1 in 50
54
PET at 36w and has IOL- need antihypertensives post del , what is her risk of PET in the future
1 in 4
55
Sever PET with HELLP at 29w , what is her risk of gestational HTN in next preg?
1 in 8
56
EMCS at 29w for HELLP and PET- what’s her risk of PET at next preg
1 in 3
57
How to treat exotoxic shock secondary to group A streptococcal infection
Symptoms of: sore throat, fever, body aches, tonisllar exudate, cervical lymphadenopathy gets antibiotics and rapidly deteriorates and is admitted to ITU for inotripes where she develops a widespread macular rash evolved into blister and skin peeling Meds IVIG
58
IV treatment for sepsis from mastitis
Clindamycin
59
When can give LMWH after removal of a spinal or epidural
After 4 hours
60
What is the most common organism that causes sepsis from endometritis
is GBS Most commonly in the first 24 h, later on in 3-7 days it’s usually mixed anaerobic bacteria
61
When to start LMWH if no regional anaesthesia and no PPH
Right after delivery
62
What is E coi, type of bacteria
A gram negative rob
63
If prolonged srom and baby has normal obs, how long to monitor baby post birth?
12h of baby obs
64
What are signs of Group A Streptococcus pharyngitis
Fever , tonsillitis exudate , no cough, tender cervical lymphadenopathy Treat with antibiotics
65
Baby born preterm with no antibiotics given what to do
If signs of resp distress ie 2 or more non red flags - investigations for neonatal infection should be be undertaken and antibiotic treatment should be started without waiting Give IV Ben Pen!
66
Which bacteria usually causes mastitis ? And which atypical one as well
Staph Aureus If not responding to flucloxacillin consider MRSA
67
Cause of Nec Fasc, necrotising fasciitis
Group A Strep
68
Uterine necrosis caused by which bacteria
Clostridium perfrigens Is rare- toxins produced by clostridia during septicaemia can lead to serious illness with mortality rates ranging from 27% to 58% and 30-day mortality up to 73%
69
Urosepsis that does not respond to normal antibiotics but is caused by gram negative rod , how to treat?
Might need to use carbapenem ie meropenem
70
When to do regional anesthesia after LMWH
12 h Same for a blood patch
71
Rates of babies born without disability from the onset of labour 23w 24 25 26
23w- 8% 24w- 22% 25w - 43% 25- 59%
72
Rates of general survival from the onset of labour 23w 24 25 26
23w- 15% 24w- 36 25w- 62% 26w- 75%
73
what is the inspired oxygen O2 for 28-31w
21-30%
74
what is the inspired oxygen O2 <28 w
30%
75
acceptable pre ductal SpO2
2 min- 65% 5 min- 85% 10min- 90%
76
when to given adrenaline
if Non-shockable rhythm (PEA / asystole )when defib pads put on give adrenaline 1mg IV or IO right away or when VF or pulseless VT , so a shockable rhythm give after the 3rd shock repeat every 3-5 min during ALS
77
when to give amioderone in adult CPR
after the 3rd shock who are in VF or pVT - 300mg IV or IO give a further dose of 150mg IV after 5 shocks
78
at how many weeks gestation do you perform a perimorten CS /hysterotomy
if 20w or more to improve maternal outcome perform by 5 min if no ROS
79
when does puerperal physcosis ussually start
50% by day 7 post del, 75% by day 16 95% by day 90 women can break show and release early in labour
80
risk of recurrence of peurpeural psychosis is
50% propylaxis with lithium or olanzapine may reduce recurrence in studies
81
what is the % of women who develop bipolar disorder after an episode of Postpartum psychosis
35-64%
82
what is the MC time for presentation of Post partum depression
2-4 weeks and 10-14 weeks
83
when are women most likely to commit suicide Post part rum
1st 12 weeks, usually violent suicide
84
medication associated consequence sodium valproate
persistent low IQ
85
medication associated consequence risperidone
hyperprolactinaemia
86
medication associated consequence olanzapine
metabolic syndrome
87
medication associated consequence lorazepam
drug withdrawal
88
medication associated consequence lithium
drug toxicity
89
medication associated consequence fluoxetine
poor neonatal adaptation syndrome
90
when do baby blues occur
day 3-5 affect 50-80% of moms , last 48hours but it can recur periodically over 6-8 weeks particularly the the mom is very tiered
91
what is the most common day to develop PP psychosis
day 5
92
risk of puerperal psychosis if fam history of bipolar
1:3
93
definition on anemia per trimester
1st- <110 2nd- <105 3rd- <105 post partum <100
94
what is therapeutic goal of the MOH
maintain Hb above 80 platetes above 50 PT greater than 1.5 the norm APTT less than 1.5 the norm fibrinogen greater than 2
95
when does ACPO usually present how
early within 48H or as early as 6 hours mostly affects the LARGE bowel. marked distention in pain minimal poos, some poo on PR ACPO can **perforate**
96
How and when does Ileus present
late after 28h - mostly affects the small bowel mild distention minimal pain no poos and nil on PR
97
what sign is there for ACPO on an X-ray
the cut off sign on the large transverse colon
98
AF air-fluid fluid levels in and x ray
are traditionally associated with mechanical obstruction or ileus
99
normal air fluid levels
stomach - one small bowel 3-5 or less than 2.5 cm large bowel- none
100
CT normal caecal diamètres
greater than 6cm is diagnostic for ACPO >9cm is significant - surgical intervention >12 - 14cm has been associated with greater risk of perforation and mortality (impending perforation).
101
treatment for ACPO and ileus
other than conservative and IV fluid neostigmine epistigmin endoscopy /colonic decompression
102
what is Laplace's law
that most perforations occur int he caecum but perforations proximal and distal to the caecum have been reported post CS
103
what is the most common neuropathy in obs, which nerve affected
lateral cutaneous nerve of the thigh L2 L3 Compression of nerve as it exits the perneum under the inguinal ligament results in neuralgia paraesthetica Numbness, pain, paraesthesia, hyperalgesia, hypersensitivity to heat ** no motor symptoms** don't cross midline of the thigh , tinels test on later inguinal ligament
104
Lumbosacral nerve injury
L4, L5 done when compressed between the sacrum and the fiddlehead, or obstetric forceps, the nerve damaged, usually contributes to the **common peroneal nerve**. Therefore, Lumbo sacral trunk injuries, caused foot drop and per seizure or loss of sensation along the lateral calf and foot.
105
Femoral nerve
L2, 3, 4 The course it takes means that the moral nerve injuries are caused by stretching or compression at the inguinal ligament other than compression between the head and the pelvis Weakness of knee extension, with or without hip flexion and pain, paresthesia, or loss of sensation in the anterior thigh and medial calf, can be my lateral and up to 25% of cases knee giving away - can use physio
106
obturator nerve
L3,4,5 Because it into the true pelvis, it can also be damaged by compression of the foetal head The lithotomy position stretches the nerve as it exits the obturator foreman The patient cannot do hip adduction and affects sensory nerves to the medial portion of the thigh, it can be bilateral 25% of the case, can also be presented with isolated weakness of the hip adduction. has excellent prognosis.
107
common perineal nerve
Arises from the sciatic nerve in the posterior thigh Is vulnerable to compression and lithotomy position as it runs around the head of the fibula How's his foot drop and impaired sensation over the lateral and anterior calf and foot Pure common peroneal nerve injuries must be distinguished from Lumbo sacral trunk injuries by examination, and possibly by nerve conduction studies
108
sciatic nerve, how does damage to it present
Causes hamstring weakness and sensory/motor symptoms in the anterior lateral and posterior lower leg. Present with weakness of hip extension and right knee flexion , sensory impairment below the right knee Patients usually develop a high Steppin gate to come and take her for a drop, but remain vulnerable to falling Can be from lithotomy
109
when can you offer a perineal repair of a perineal repair with dehiscence
if less than 50% of the perineum is involved but has deep muscle involved and if predicted length of the perineal body is less than 2.5cm offer repair
110
indications for surgical management of a perineal would breakdown post initial repair
complete wouldn't dehiscence dehiscence within 48hr of primary repair Dehis of a 3rd or 4th trap necrotic tissue if severe perineal discomfort
Monica’s Part 2
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