Abnormal CTG Interpretation in Pregnancy
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Questions and Answers

What is the recommended initial dose of Nifedipine for the suppression of preterm labor at greater than 34 weeks of gestation?

  • 20mg (correct)
  • 30mg
  • 10mg
  • 15mg
  • Which maternal condition is a contraindication for using Indomethacin as a tocolytic?

  • Anemia
  • Hypertension
  • Poor control of Diabetes Mellitus (correct)
  • Maternal tachycardia
  • Which fetal heart rate range is considered as bradycardia and indicates a potential acute hypoxic event?

  • 160-170 bpm
  • 120-130 bpm
  • 100-109 bpm (correct)
  • 140-150 bpm
  • What is the main advantage of using Nifedipine over betamimetics for the suppression of preterm labor?

    <p>Oral administration</p> Signup and view all the answers

    At what gestational age should a 200mg pessary be recommended for women with a cervix less than 20mm?

    <p>34 weeks</p> Signup and view all the answers

    What is the loading dose of Ampicillin for suspected chorioamnionitis?

    <p>3g</p> Signup and view all the answers

    Which fetal heart rate pattern is characterized by a transient rise in heart rate above baseline?

    <p>Accelerations</p> Signup and view all the answers

    'Chorioamnionitis' is suspected during prenatal care. Which antibiotic regimen is typically recommended for treatment?

    <p>(Ampicillin or Amoxicillin) and Gentamicin and Metronidazole</p> Signup and view all the answers

    Which medication combines the rapid action of syntocinon with the sustained tonic effect of ergometrine?

    <p>Syntometrine</p> Signup and view all the answers

    What is the main side effect of Syntometrine?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which condition is a contraindication for the use of Syntometrine?

    <p>Pre-eclampsia</p> Signup and view all the answers

    What is the main purpose of Uterine massage in postpartum hemorrhage management?

    <p>Encourage uterine contraction</p> Signup and view all the answers

    In case of postpartum hemorrhage related to trauma, what is the recommended action?

    <p>Repair any trauma</p> Signup and view all the answers

    What may follow a massive hemorrhage and is characterized by clotting factors being consumed faster than they can be produced?

    <p>Disseminated Intravascular Coagulation (DIC)</p> Signup and view all the answers

    Which condition is NOT a risk factor for developing Disseminated Intravascular Coagulation (DIC)?

    <p>Premature rupture of membranes</p> Signup and view all the answers

    Which type of placental insertion has a higher chance of cord avulsion at birth due to its position?

    <p>Velamentous Insertion</p> Signup and view all the answers

    What are the signs of low blood pressure in pregnant women?

    <p>Light-headedness, fatigue, and fainting</p> Signup and view all the answers

    Which hormone is involved in water retention and vasoconstriction in pregnant women with hypertensive disorders?

    <p>Antidiuretic hormone</p> Signup and view all the answers

    What is the primary function of adrenaline (Epinephrine) and noradrenaline (Norepinephrine) in pregnant women with hypertensive disorders?

    <p>Increasing blood pressure</p> Signup and view all the answers

    Which condition is characterized by sudden onset of tonic-clonic seizures in pregnant women?

    <p>Eclampsia</p> Signup and view all the answers

    What is the main cause of HELLP syndrome in pregnancy?

    <p>Abnormal placental formation</p> Signup and view all the answers

    Which hormone impair insulin function during pregnancy, leading to insulin resistance?

    <p>Human placental lactogen (HPL)</p> Signup and view all the answers

    What is the diagnostic criteria for Gestational Diabetes Mellitus (GDM) based on the Oral Glucose Tolerance Test (OGTT)?

    <p>&gt; 8.5 mmol/L at 2 hours post load</p> Signup and view all the answers

    What is the recommended action for pregnant women with hyperthyroidism who require insulin treatment?

    <p>Start short-acting insulin like aspart or lispro</p> Signup and view all the answers

    Study Notes

    CTG Tracing

    • Baseline: 140, variability normal, accelerations present: no concerns
    • Baseline: 140, variability reduced, early decelerations persist for 30 seconds: escalate findings
    • On oxytocin, no accelerations, and reduced variability with persistent variable decelerations: change maternal position, escalate and continue tracing until CTG returns to normal

    Hypertension

    • Causes of hypertension:
      • Reduced variability
      • Pethidine
      • Betablockers
      • Preterm hypoxia
      • Prior neurological damage
      • Infection
      • Anaemia
      • CNS malformations
      • Cardiac malformations/arrhythmia
      • Chromosomal abnormalities

    Blood Pressure Regulation

    • Cardiac output (CO) = stroke volume (SV) x heart rate (HR)
    • Blood pressure (BP) = CO x peripheral resistance
    • Factors affecting blood pressure:
      • Blood volume
      • Dietary salt intake
      • Vessel radius
      • Blood viscosity
      • Autoregulation
    • Baroreceptor reflex and renin-angiotensin system (RAS) regulate blood pressure

    Pre-Eclampsia

    • Definition: hypertension after 20 weeks with one or more of the following:
      • Renal involvement
      • Liver disease
      • Neurological problems
      • Haematological disturbances
      • Pulmonary oedema
      • Fetal growth restriction
      • Placental abruption
    • Signs and symptoms:
      • Headaches
      • Visual disturbances
      • Oliguria
      • +1 on dipstick on two or more occasions, 6 hours apart
    • Complications:
      • Maternal: eclampsia, HELLP syndrome, placental abruption, fetal growth restriction
      • Fetal: hypoxia, acidosis, birth asphyxia, stillbirth

    Diabetes

    • Insulin:
      • Secreted by beta cells in pancreas
      • Lowers blood glucose levels
      • Facilitates uptake of glucose by cells
    • Glucagon:
      • Secreted by alpha cells in pancreas
      • Raises blood glucose levels
    • Carbohydrate metabolism during pregnancy:
      • Diabetogenic state
      • Increased need for nutrients
      • Fat deposition

    Gestational Diabetes Mellitus (GDM)

    • Screening: OGTT at 24-28 weeks
    • Diagnosis: one or more of the following:
      • Fasting venous glucose ≥ 5.1 mmol/L
      • 1-hour venous glucose ≥ 10.0 mmol/L
      • 2-hour venous glucose ≥ 8.5 mmol/L
    • Risk factors:
      • Obesity
      • Family history
      • Previous GDM
      • Ethnicity
    • Complications:
      • Pre-eclampsia
      • Polyhydramnios
      • Macrosomia
      • Neonatal complications

    PPH Management

    • Identify cause of PPH
    • Rub: fundal massage to encourage uterine contraction
    • Repair: repair trauma to perineum, vagina, cervix, etc.
    • Remove: remove retained products, clots, membranes
    • Replace: replace blood lost by fluid resuscitation
    • Anticoagulation: may be necessary in some cases

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    Description

    Learn to interpret abnormal cardiotocography (CTG) findings in pregnancy, including reduced variability, early decelerations, and the significance of oxytocin use. Understand the potential implications for the baby's well-being.

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