| Problem | Management |
| Reduced foetal movements | Assess risk.
USS for growth.
CTG for ?distress. |
| ?SROM | Ask about contractions.
If Hx suggestive, admit. |
| BP 150/90, no proteinuria in commnity | Recheck BP and urinalysis twice a week.
USS.
Baseline investigations. |
| BP 170/110, no proteinuria in commnity | Admit to hospital, manage as pre-eclampsia. |
| BP 130/85, ++ proteinuria in commnity | Admit to hospital to investigate ?pre-eclampsia. |
| Symphysis-fundal height >2cm below dates | USS for growth. |
| Antepartum haemorrhage | Admit to hospital.
CTG. |
| Transverse lie at 28 weeks | Re-check at 37 weeks. |
| Oblique lie at 38 weeks | Admit to hospital.
USS. |
| Breech presentation at 37 weeks | Refer for USS.
Consider ECV. |
| Gestation at 42 weeks | Offer sweep or induction.
CTG daily if declines. |
| ?polyhydramnios | USS.
?anomalies and glucose if confirmed. |
| <10th centile at 32 weeks, UA doppler normal resistance | Repeat USS and UA doppler fornightly. |
| <10th centile at 32 weeks, UA doppler severe resistance | fetal Doppler, steroids and daily CTG. |
| <10th centile at 38 weeks, UA doppler normal resistance | CTG and induce labour. |
| Admitted with BP 170/110, no proteinuria, 36 weeks | Control BP with nifedipine and start methyldopa. |
| Admitted with BP 170/110, + proteinuria, 36 weeks | Control BP with nifedipine and start methyldopa.
Induce labour. |
| Admitted with BP 150/90 and seizures | IV MgSO4.
Test patellar reflexes to assess Mg toxicity. |
| Unsuccessful ECV at term | USS to check presentation.
LSCS. |
| Antepartum haemorrhage secondary to placenta praevia with shock | Resuscitate mother.
Activate major haemorrhage protocol.
LSCS. |
| Antepartum haemorrhage | ABCs.
CTG.
USS (exclude placenta praevia). |
| Painless antepartum haemorrhage | Suspect placenta praevia.
ABCs, investigations etc. |
| Pelvic pain and inconsistent PV bleeding | Suspect placental abruption.
ABCs, investigations etc. |
| Pre-term SROM | Rule out infection.
Prophylactic erythromycin.
Steroids if <34 weeks.
Induce at 36 weeks. |
| Pre-term SROM with fever and tachycardia | Antibiotics, blood cultures.
Deliver regardless of gestation. |
| Induction | PGE2 if needed, then ARM.
CTG. |
| CTG abnormality | FBS, urgent LSCS if indicated. |
| pH 7.18 on FBS | Urgent LSCS. |
| pH 7.23 on FBS | Repeat in 30 minutes. |
| Collapse | 2222 Obstetrics and anaesthesia on call.
ABCs etc. |
| Postpartum haemorrhage | ABCs, involve seniors.
Deliver placenta if necessary.
Oxytocics.
EUA then laparotomy if necessary. |
| Pre-term delivery | USS and CTG.
Tocolysis.
ABx.
Phone neonatology. |
