5.2. Intra-Partum and Post-Partum Care - Emergencies

Question 1

What are the Major Pregnancy Emergencies?

Answer 1

1. Shoulder Dystocia
2. Post-Partum Haemorrhage
3. Cord Prolapse

Question 2

What are the stages of Normal Delivery?

Answer 2

1. Head floating, before Engagement
2. Engagement - Flexion + Descent
3. Further Descent + Internal Rotation
4. Complete Froation + Beginning Extension
5. Complete Extension
6. Restitution (External Rotation
7. Delivery of Anterior Shoulder
8. Delivery of Posterior Shoulder

Question 3

What happens in Shoulder Dystocia?

Answer 3

The Anterior Shoulder is Impactedon the Pubic Symphysis

Question 4

What are the Dangers of Shoulder Dystocia?

Answer 4

1. Umbilical Cord Entrapment
2. Inability of Child’s Chest to Expand Properly
3. Severe Brain Damage / Death due to Hypoxia / Acidosis if Delays in Delivery
4. Brachial Plexus Damage

Question 5

What is the management of Shoulder Dystocia?

Answer 5

HELPERR:
H - Call for Help
E - Evaluate for Episiotomy
L - Legs (McRoberts Position)
P - Suprapubic Pressure
E - Enter Manouvers (Internal Rotation)
R - Remove the Posterior Arm
R - Roll the Patient (onto all Fours)

Question 6

What are the 4 T’s associated with the causes Post-Partum Haemorrhage?

Answer 6

1. Thrombin
2. Tissue
3. Tone
4. Trauma

Question 7

In relation to the 4 T’s associated with the causes of Post-Partum Haemorrhage, what falls under Thrombin?

Answer 7

1. Pre-Eclampsia
2. Placental Abruption
3. Pyrexia in Labour
4. Bleeding Disorders - Haemophilia / Anticoagulation / Von Wileband Disease

Question 8

In relation to the 4 T’s associated with the causes of Post-Partum Haemorrhage, what falls under Tissue?

Answer 8

1. Retained Placenta
2. Placenta Accreta
3. Retained Products of Conception (RPOC)

Question 9

In relation to the 4 T’s associated with the causes of Post-Partum Haemorrhage, what falls under Tone?

Answer 9

1. Placenta Praevia
2. Over-Distension of the Uterus
3. Uterine Relaxants
4. Previous Post-Partum Haemorrhage

Question 10

In relation to the 4 T’s associated with the causes of Post-Partum Haemorrhage, what falls under Trauma?

Answer 10

1. Caesarean Section
2. Episiotomy
3. Macrosomia (>4Kg Baby)

Question 11

What are the 2 types of Post-Partum Haemorrhage?

Answer 11

1. Primary - >500ml blood lost in 24 hours

2. Secondary >500ml blood lost after 24 hours - 6 weeks

Question 12

What is the management of a Primary Post-Partum Haemorrhage?

Answer 12

1. ABCDE approach
2. Empty Bladder
3. Rub up Fundus
4. Drugs
5. Surgical

Question 13

What Drugs are used in the Management of Primary Post-Partum Haemorrhage?

Answer 13

1. Oxytocin
2. Ergometrine
3. Carboprost
4. Misoprostol

Question 14

What are the Surgical Managements of a Primary Post-Partum Haemorrhage?

Answer 14

1. Intrauterine Baloon Tamponade
2. Interventional Radiology
3. B-Lynch Suture
4. Hysterectomy

Question 15

What is a Cord Prolapse?

Answer 15

The Descent of the Umbilical Cord through the Cervix alongside (Occult) or Past (Overt) the presenting Part in the Presence of Ruptured Membrane

Question 16

What are the Risk Factors of Cord Prolapse?

Answer 16

General:

1. Multiparity / Twin
2. Low Birthweight / Preterm Labour
3. Foetal Congenital Abnormalities
4. Breech / Transverse / Oblique Lie
5. Artificial Rupture of Membranes
6. Vaginal Manipulation of the Fetus

Question 17

What is the management of a Cord Prolapse?

Answer 17

1. Call for Help
2. Perform Digital Elevation of the Presenting Part - Replace Cord into Vagina (Not Uterus)
3. Catheterise and Fill Bladder to elevate presenting part
4. Encourage mother to adopt Knee - Chest / Left Lateral Position with Raised Hips
5. Consider Tocolysis
6. C-Section