delivery emergencies

Question 1

what is maternal collapse ?

Answer 1

acute event involving the cardiorespiratory system or nervous system resulting in reduced or absent conscious levels at any stage in pregnancy and up to 6 weeks after birth

Question 2

what are the causes of maternal collapse ?

Answer 2

4 Hs 
hypoxia 
hypovolemia 
hypo/hyperkalemia and hyponatraemia 
hypothermia 

4 Ts 
Thromboembolism 
Toxicity 
tension pneumothorax 
Tamponade 
Eclampsia and pre-eclampsia

Question 3

what is the presentation of amniotic fluid embolus ?

Answer 3

( amniotic fluid enters the blood stream of the mother)
presents as collapse during labour or birth in the form of:
acute hypotension
respiratory distress
acute hypoxia
seizure and cardiac arrest may occur

Question 4

if the mother survives long enough after a maternal collapse what is most likely to develop ?

Answer 4

coagulopathy

Question 5

what is the best initial management of maternal collapse ?

Answer 5

ABCDE approach to the patient

relieve aortocaval compression by moving the uterus to the left in women above 20 weeks of gestation

Question 6

what is aortocaval compression ?

Answer 6

when na pregnant uterus compresses on the abdominal aorta and the IVC

Question 7

what is the management in the case of maternal collapse secondary to antepartum haemorrhage

Answer 7

the fetus and the placenta should be delivered to allow control of the haemorrhage
along with the administration of tranexamic acid

Question 8

what is the management for amniotic fluid embolus ?

Answer 8

supportive rather than specific :
Oxygen + ventilate
Deliver the baby as soon as
possible

Question 9

what is expected to happen after amniotic fluid embolism ?

Answer 9

vaginal bleeding due to coagulopathy/DIC

Question 10

what is the antidote for magnesium sulphate toxicity ?

Answer 10

10% calcium gluconate
or
10% calcium chloride

Question 11

if local anesthetic toxicity is suspected what is the best step inn management ?

Answer 11

stop injecting

lipid rescue should be used

Question 12

what is cord prolapse ?

Answer 12

umbilical cord drops through the cervix and out into the vagina before the baby moves into the birth canal

Question 13

what is cord presentation ?

Answer 13

the cord lies below the presenting part with an intact membrane

Question 14

what is the preferred method of delivery in cases of cord prolapse ?

Answer 14

CS is usually indicated inn order to prevent hypoxic acidosis

Question 15

when should cord prolapse be suspected ?

Answer 15

when there is an abnormal fetal heart rate pattern especially if these changes start soon after rupture of membranes