Causes

🔹Cardiac arrhythmias

🔹Infection (e.g. UTI, chorioamnionitis, pneumonia)

• Fever, leaking liquor, abdominal pain, dysuria, urinary frequency
• Cough
• UFEME (leukocyte, nitrite), Urine C&S, HVS C&S

🔹Dehydration / Electrolyte imbalance (e.g. caused by excessive vomiting)

• UFEME (urine ketone), RP, Ca, Mg, PO4, albumin
  (abnornal/normal calcium level is MEANINGLESS without being corrected according to albumin level)

🔹Hyperthyroidism

• Signs & symptoms of hyperthyroidism e.g. heat intolerance, increased appetite, palmar erythema, anterior neck swelling, palpitation
• TFT

🔹Anaemia in pregnancy

• Palpitation, reduced effort tolerance / fatigue, clinical pallor, vegetarian/ malnutrition, or parasitic infection
• FBC

🔹Pulmonary embolism

• SOB, SpO2 drops, not uncommon in clinical setting, but it depends on risk factors & clinical situation of the patient (e.g. persistent tachycardia + low grade fever), high VTE scoring
• ECG: S1Q3T3
• Might need to send ABG if indicated
• If indicated, specialist will also order for CTPA to diagnose pulmonary embolism

Management

Whatever causes of maternal tachycardia, ECG is a must.

• Refer Medical for Holter / Echo if indicated (for suspected cardiac problem)

Miscellaneous

Anti-Hypertensive in Pregnancy

STOP methyldopa post delivery in patients with PIH on T. Methyldopa because it is associated with postpartum depression

AVOID Nifedipine if uncontrolled HTN with tachycardia, as nifedipine is also associated with reflex tachycardia

DO NOT GIVE Labetalol in patients with history of asthma / underlying asthma as it can trigger bronchoconstriction

HELPERR

H – Call for Help
E – Evaluate for Episiotomy
L – Legs: McRoberts manoeuvre
P – Pressure at suprapubic area
E – Enter: Rotational mamoeuvre
R – Remove posterior arm
R – Roll the patient to her hands and knees

Post LSCS Plan

Here is a general plan for post Caesarean section. Different centers would have slightly different details of management plan.

• Allow transfer out to ward once stable
• Monitor vital sign 1/4 hourly for 1H, 1/2 hourly for 1H, hourly for 4H, then 4 hourly
• Keep rest in bed for 6 hours
• Keep CBD 12H post op
• IVD Pitocin 40 units in 1 pint NS over 6 hours
• IVD 5 pints (3 pints NS and 2 pints D5) over 24 hours until tolerating orally well
• Strict I/O charting
• Strict pad charting, inform if increase in PV bleeding
• SC Clexane 40mg OD for 10 days (booking weight _ kg), to commence 6 hours post op, if no contraindication (counsel patient in ward)
• Analgesia as per anaesth plan
• Wound inspection Day 2, no need STO
• Encourage orally, breastfeeding and ambulation
• Allow trial of scar in next pregnancy if no contraindication
• Advise on long-acting reversible contraceptives

Miscellaneous

Neuraxial opioid-induced pruritus — Patient post LSCS under spinal anaesthesia complains of pruritus

CTG Description for Newbie

Features (baseline fetal heart rate, acceleration, deceleration, beat-to-beat variability). For each feature, use the description below:

• Reassuring
• Non-reassuring
• Abnormal

Then, Categorization / Overall assessment based on the features above:

• Normal
• Suspicious (one non-reassuring feature)
• Pathological (two suspicious features // one abnormal feature)

AVOID USING THESE INAPPROPRIATE TERMS (especially when referring cases): CTG tak cantik, CTG reactive / not reactive, longkang besar etc.

Miscellaneous

DM is one of the HIGH risk factors for pre-eclampsia. Therefore, DM pregnant women should be started with Aspirin 150 mg OD once fetus is viable, about 12 weeks or before 16 weeks of gestation. This is for pre-eclampsia prophylaxis. At 20 weeks, pregnant women should also be started with calcium carbonate 1g BD + Vitamin D