Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing?Read more
Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:
- Abdominal pathology
- Urinary pathology
- Drug History
- Chronic H.Pylori
Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway
1. Investigation – of suspected PE
- Clinical assessment – its all on the history and exam scoring doesn’t work
- Perform the following tests:
- CXR – sheilding can protect the baby and may avoid further radiation
- Bloods: FBC, U&E, LFTs
- Commence Dalteparin (unless treatment is contraindicated) – BNF
- Arrange admission to AAU/AMU (>20/40 AMU @CRH and inform Obstetrics)
On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This process has been agreed with transfusion so this can be done safely and responsibly. Read more
When giving blood products you need to use the transfusion care pathway.
It can be found on intranet > Policies & Documents Library >Other Systems [green button] > Clinical records repository > Search [title And transfusion] – its only 9 clicks away (and some writing)
Rhesus (Rh)-D negative women, pregnant with Rh-D positive foetus are at risk of developing antibodies against future pregnancies if/when they suffer a sensitising event. (Remember, this should be considered a standard treatment for all Rh-D negative women, as we are never certain of the fathers Rh-D status) Read more
Bleeding in early pregnancy is a relatively common problem and in the many cases (esp. with spotting) the pregnancy remains viable. However, bleeding in early pregnancy should never be thought of as normal, and it is vital that we investigate this appropriately.
Communication is also vital at a very stressful time
- Who you are discussing this pregnancy in front of? – Does the patient want them to know
- Manage expectations – There is nothing we or mum can do to change the out come of the pregnancy apart from ensuring mum is well
- Ensure the patient has all the details they need – Return advice, clinic time, where to go, what is happening
- Be sensitive to the patients feelings – Patients respond very differently, be careful not to impose your emotions/assumptions on the situation
Anti-D immunoglobulin guide
Search: ectopic pregnancy, Ectopic Pregancy, pv bleed, MISCARRIAGE, vaginal bleed, EPAU
Preform intimate examinations on Sexual assault/Rape patients
- Unless life-threatening injuries are suspected e.g Haemorrhage.
- As our examination will inevitably destroy evidence that may aid this patients case
- Consider contamination injury (HIV, HepB, HepC) – Guide
- Consider emergency contraception
- Children must have police referral for safeguarding
- Refer to The Sexual Assault Referral Centre, either via Police or Self referral
- Do the Basics – don’t forget ABCD
- Inform Transfusion and get someone to run a G&S sample down
- If you no longer need the MTP – inform transfusion and return products ASAP
In recent incidents we have had significant delays in giving OCTAPLEX, So …..
- Activate EARLY in head injury patients on warfarin.
- Order on EPR & Paper [see below]
- Infuse over no more than 30 min
- Recheck INR at 30 min after finished infusion