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O&G > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Where is pain from an ectopic pregnancy referred?

A

Tip of the shoulder

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2
Q

What is the most common location for an ectopic pregnancy?

A

Ampulla of the fallopian tube

Fallopian tube 95%

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3
Q

How is an ectopic pregnancy surgically managed?

A

Laparoscopic salpingectomy

  • Salpingostomy (removal of the ectopic only) carries a risk of retained trophoblastic tissue and recurrent ectopic*
  • Does not increase risk of future infertility*
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4
Q

What is eclampsia?

A

New-onset generalised tonic-clonic seizure in women with pre-eclampsia

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5
Q

What’s the definition of an antepartum haemorrhage (APH)?

A

Any vaginal bleeding following 20/40

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6
Q

What’s the definition of a postpartum haemorrhage (PPH)?

A

Vaginal bleeding > 500 mL after delivery (1L for C-section)

Primary: within 24 hours

Secondary: after 24 hours

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7
Q

PROM

A

Prelabour rupture of membranes at term

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8
Q

PPROM

A

Preterm prelabour rupture of membranes

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9
Q

What is the most common cause of PPH?

A

Uterine atony

Failure of the uterus to effective contract and retract after delivery

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10
Q

What are the four Ts of PPH?

A
  1. Tone
  2. Tissue
  3. Thrombin
  4. Trauma
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11
Q

What is a placental abruption?

A

Partial or complete separation of the placental from the uterus prior to delivery

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12
Q

What is the most significant risk factor for placental abruption?

A

Maternal hypertension

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13
Q

What are the clinical features of placental abruption?

A
  • Dark, vaginal bleeding
  • Abdominal pain
  • Uterine tenderness
  • Hypertonic contractions, rigid uterus, premature labour
  • Foetal distress (decelerations + diminished/absent heart beat)
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14
Q

What are three complications of PROM?

A
  1. Umbilical cord prolapse or compression
  2. Placental abruption
  3. Chorioamnionitis
  4. Maternal/foetal sepsis
  5. Maternal DVT
  6. Foetal infection
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15
Q

What is placental previa?

A

The placenta obstructs the neck of the uterus

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16
Q

How is placenta previa classified?

A

Low-lying placenta (2cm from internal os)

Marginal (touches internal os)

Partial (partially covers internal os)

Complete (completely covers internal os)

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17
Q

What is vasa previa?

A

Foetal vessels are located in the membranes near the internal os of the cervix, putting them at risk of injury if the membranes rupture

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18
Q

How is vasa previa managed?

A

Emergency caesarean

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19
Q

Painless vaginal bleeding that occurs suddenly after rupture of membranes suggests what?

A

Vasa previa

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20
Q

What is the most common cause of umbilical cord prolapse?

A

Rupture of membranes when the presenting part is not engaged

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21
Q

What are 4 risk factors for umbilical cord prolapse?

A
  1. Presentation anomalies e.g. breech, transverse
  2. SROM
  3. PPROM
  4. Polyhydramnios
  5. Multiple pregnancy
  6. Long umbilical cord
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22
Q

What CTG abnormality is seen with umbilical cord prolapse?

A

Variable deceleration

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23
Q

What is uterine rupture?

A

A full thickness tear through the uterine myometrium and serosa

24
Q

What are 3 risk factors for a uterine rupture?

A
  1. Classical caesaream incision
  2. Myomectomy (removal of fibroids)
  3. Uterine anomalies
  4. Cocaine abuse
  5. Malpresentation
  6. Placenta increta/percreta (chorionic villi invade the myometrium and beyond)
25
Q

What is placenta accreta?

A

Chorionic villi attach to the myometrium rather than the decidua basalis

Vessels do not invade or penetrate the myometrium

26
Q

What is placenta increta?

A

Chorionic villi invade or penetrate into the myometrium

27
Q

What is placenta percreta?

A

Chorionic villi penetrate through the myometrium, penetrate the serosa, and in some cases, adjacent organs e.g. rectum or bladder

28
Q

Why is magnesium sulfate administered to women at imminent risk of preterm birth?

A

Neuroprotection

Decreases risk of cerebral palsy and motor dysfunction

29
Q

What are the steps in managing a PPH from uterine atony?

A
  1. General (IV access, monitor, fluid, oxygen)
  2. Uterine massage and external compression
  3. Tranexamic acid
  4. Uterotonic agents e.g. oxytocin
  5. Speculum to examine extrauterine bleeding
  6. Intracavitary prostaglandin
  7. Blood transfusion
  8. Hysterectomy
30
Q

How is PPH from abnormal placental separation treated?

A
  1. General (IV access, fluid, oxygen)
  2. Brandt-Andrews manoevre
  3. Uterotonic agents e.g. oxytocin
  4. Removal of RPOC under anaesthesia
  5. Hysterectomy
31
Q

What is the most significant risk factor for PROM?

A

Infection e.g. chorioamnionitis, STIs, UTIs

Also cigarette smoking

32
Q

Without intervention, when do mothers with PROM go into labour?

A

50% within 24 hours

75% within 48 hours

33
Q

Why are antibiotics given in PPROM?

A

GBS

Treat triggering infection

Prevent chorioamnionitis

Delays labour by up to a week

34
Q

What tests are performed on spectulum examination for PROM?

A
  1. Positive pool: amniotic fluid pooling in the vagina
  2. Litmus/nitralazine: strips turn blue
  3. Fern test: amniotic fluid reveals a fern-like pattern under microscopy
35
Q

What clinical features carry a high suspicion of chorioamnionitis?

A

Maternal fever

Maternal tachycardia

Uterine tenderness

Foetal tachycardia

36
Q

What are the steps in managing shoulder dystocia?

A
  1. Suprapubic pressure
  2. McRobert’s manoeuvre (knees to chest)
  3. Corkscrew manoeuvre
  4. Episiotomy
  5. Caesarean section
37
Q

Why does placental abruption confer a high risk of DIC?

A

The placenta is rich in thromboplastin which is released in abruption

38
Q

Following delivery, a woman has massive bleeding and fails to complete the third stage. What is the likely diagnosis?

A

Placenta accreta, in which the placenta is firmly attached to the myometrium and is not expelled after delivery of the foetus

39
Q

Name two risk factors for placenta previa

A
  1. Prior pregnancy
  2. Maternal age > 35
  3. Previous caesarean
  4. Previous placental previa
40
Q

What anticonvulsant is used to treat eclampsia?

A

Magnesium sulfate

41
Q

In an umbilical cord prolapse, if the cervix is fully dilated what is the management?

A

Vaginal delivery

42
Q

In an umbilical cord prolapse, if the cervix is NOT fully dilated what is the management?

A
  1. Cease syntocinon
  2. Consdier terbutaline
  3. Turn the woman into the left lateral, Trendelenberg or all fours
  4. Place Foley catheter and fill bladder with 500 mL normal saline
  5. Monitor CTG and if not improving
  6. Caesarean
    * If the cord is visibly outside of the vagina push it back in, minimising contact where possible*
43
Q

What is terbutaline?

A

A tocolytic

Beta-2 agonist → smooth muscle relaxant → inhibits contractions

44
Q

What is a Bakri balloon?

A

Balloon catheter used to treat PPH

45
Q

What are the most common causative agents in puerperal sepsis?

A

GAS (Streptococcus pyogenes)

  • Escherichia coli*
  • Staphylococcus aureus*
  • Streptococcus pneumoniae*

MRSA

46
Q

How is acute severe hypertension managed in pregnancy?

A

IV labetalol

47
Q

At what BP are patients with pre-eclampsia treated?

A

>160 SBP

>100 DBP

May prevent severe hypertension which is an indication for delivery

48
Q

What proportion of PPHs are caused by each of the 4 T’s?

A

Tone - 70%

Trauma - 20%

Tissue - 10%

Thrombin - 1%

49
Q

What is the mneumonic for shoulder dystocia management?

A

H - help

E - evaluate for episiotomy

L - legs to nipples

P - pubic pressure

E - enter: rotational manoeuvres

R - remove the posterior arm

R - roll the patient onto all fours

50
Q

Up to what gestational age are antenatal corticosteroids given?

A

34+6

51
Q

How long until labetalol IV exerts its maximal effect?

A

5 minutes

52
Q

How long until nifedipine exerts its maximal effect?

A

Oral tablet (no IV preparation)

30-45 minutes

53
Q

What are the most common adverse effects of nifedipine?

A

Headache

Flushing

54
Q

What is severe hypertension in pregnancy?

A

BP > 170 systolic or 110 diastolic

Acute blood pressure lowering therapy is required

Increased risk of maternal morbidity and mortality

55
Q

Which clinical features are most suggestive of uterine rupture over placental abruption?

A

Cessation of contractions

Recession of presenting part

56
Q

What are the risk factors for umbilical cord prolapse?

A

Presenting part high or ill-fitting

Malpresentation (breech or transverse)

Low lying placenta

Polyhydraminios

Prematurity, LBW, second twin

Use of cervical ripening balloon

Obstetric manipulation

O&G (13 decks)

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