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Obs & Gyn > Emergencies in O&G > Flashcards

Emergencies in O&G Flashcards

1
Q

main obstetric causes of emergencies 3

A

PPH

APH

eclampsia

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2
Q

main incidental cuases of emregnecies in obsteics 4

A

massive VTE

ruptured aneuryms

ruptured spleen/liver

MI

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3
Q

emergenceis in gynaecologyy 3

A

ectopic pregnacy

miscarriage

post-op/intra-abdominal bleeding

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4
Q

define postpartum haemorrhage

A

any bleeding from or in to the genital tract following delivery of the infant

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5
Q

define primary post-partum haemorrhage

A

occuring within 24hours of delivery

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6
Q

define secondary postpartum haemorrhage

A

occuring betweeen 24hrs and 12 weeks postnatally

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7
Q

define the values assocateid with quantiy of blood loss in types of post partum haemorrhage

A

Postpartum haemorrhage (PPH) is defined as blood loss of > 500 ml after a vaginal delivery and may be primary or secondary.

minor- loss of 500-1000ml

moderate loss of 1000-2000ml
severe- loss of >2000ml
(BOTH DEFINED AS MAJOR BLEEDS)

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8
Q

define acute blood loss in postpartum haemorrhage

A

500ml/min
-acute loss of large blood volume

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9
Q

causes of primary postpartum haemorrhage 4

A

thrombin

tissue

tone

trauma

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10
Q

types of thrombin disorders causing primary postpartum haemorrhage 3

A

pre-exisitng

pregnancy induced

iatrogenic

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11
Q

antenatal risk factors for postpartum haemorrhage 8

A

suspected or proven placental abruption

known placenta praevia

multiple pregnancy

pre-eampsia/ HT

previous PPH

asian

BMI >35

anaemia

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12
Q

intrapartum risks associated with postpartum haemorrhage 7

A

C section

induced labour

retained placenta

episiotomy

prolonged labour

big baby

age >40

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13
Q

4 components of immediate postpartum haemorrhage managemnt

A

communcation

resusciation

monitoring and investigations

arresting the bleeding

ALL SIMULTANEOUSLY

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14
Q

aspcts of immediate postpartum haemorrhage immediate action and resus 5

A

blood loss>1000ml

call for help- senior midwife, obesterician, aneathetics, blood transfusion

resus
-ABC
-O2
-fluid
-blood products
-keep patient warm

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15
Q

aspects of minitoring and investgiaons in postpartum haemorrhage management 6

A

2 cannula

FBC, coag, U&Es, LFTs

cross match

ECG

foley ceehte

weigh all swabs and estimate blood loss

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16
Q

medical treatment of postpartum haemorrhage managemnt 2
-what drugs can be used

A

bimanual uterine compression

empty bladder

-oxytocin
-ergometrine
-carboprost
-misoprostol

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17
Q

define bimanual uterine compression compression

A

the clinician places one hand on the abdomen and the other hand inside the vagina then compresses the uterus between the two hands. These techniques cause the uterus to contract, which treats atony and assists with expulsion of retained placenta or clots.

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18
Q

what medications can be used to promote uterine contractility 4

A

syntocinon- injection and infusion

ergometrine- injection

carboprost IM

misoprostol

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19
Q

what immediate tecniqures can be considered in theatre for postpartum haemorrhage 2

A

intrauterine balloon tamponade

brace suture

?interventional radiology

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20
Q

what surgery can be used for postpartum haemorrhage 4

A

bilateral uterine artery ligation

bilateral internal iliac ligation

hysterectomy

uterine artery embolisation

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21
Q

steps in manual removal of placenta (just pictures)

A

[25,26,27]

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22
Q

balloon tamponate for postpartum haemorrhage (picture)

A

[28]

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23
Q

b-lynch suture for tamponade for postpartum haemorrhage (picture)

A

[29]

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24
Q

importance of uterine inversion (picture)

A

[30]

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25
Q

what is secondary postpartum haemorrhage usually associated with

A

infection (endometritis) ± retained tissue

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26
Q

managemnt of secodnary postpartum haemorrhage

A

treat infection

consider removal of tissue
-postnatal surgical evacuation risks

consider balloon tamponade

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27
Q

how does bleeding in ectopic vs miscarriage differ

A

ectopic- most likely concealed

miscarriage- most likely visulaised vaginally

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28
Q

important point with ectopic

A

can become unstable very quickly

29
Q

important point with miscarriage

A

remeber cervical shock if products of conception or clot in cervical os

30
Q

immediate Managemnt of miscarriage and ecotpic

A

if haemodynamically unstable- EMERGENCY
-ABC resus
-early senior involvement

prepare for theatre

31
Q

define maternal collapse

A

acute event involving cardiorespiraroty systeem ± brain

resulting in reduced or absent conscious level (and potentially death)

32
Q

when can maternal collapse happen

A

any stage of prengnacy and up to six weeks after delivery

33
Q

incidence of maternal collapse

A

estimate between 0.14-6/1000 births

34
Q

how does preganncy impact on resusication procedure

A

have reduced oxygen carrying capcacity therefore:
-increasd CPR circulation demands

potential rapid massive haemorage

blood can sequester during CPR

decreased BP reserve

35
Q

how can prengnacy impact respiratory system if in maternal collapse

A

decreased buffering capacity- acidosis more likely

-hypoxia may develop more quickly
-can have difficult intubation

36
Q

other resuscitaion considerations for pregant woemn

A

increased risk of aspriation

large nbreasts may interfere w intubation and make ventilation more difficult

37
Q

when is a premortem C section performed

A

if no response to CPR after 4 minutes and uterus appox 20 week size

-aim for delivery by 5 minutes

38
Q

aim of premortem C section

A

save mothers life
-increase venous return
-imrpove ease of ventilation
allow CPR in supine posiotn
reduced O2 requirements

39
Q

causes of collapse (resus collapse) in all patients (including O&G)

A

4 Hs , 4 Ts

Hypoxia
hypovolaemia
hypo/hyperkalaemia
Hypothermia

Thromboembolism
Toxic
Tamponade
Tension pneumothorax

40
Q

pregnancy specific resusitation collapse causes 4

A

eclampsia (incld magneussim toxicitiy)

amniotic fluid embolism

splecic artery ruptue

antepartum/post partum haemorrhae

41
Q

incidence of preeclampsia in pregnancy

A

affects approx 3% of pregnnacies

42
Q

largest cause of death from pre-eclampsia

A

intracranial haemorrage secodnary to uncontrolled hypertension indicating a failure in antihypertensive therapy

43
Q

what blood pressure value should be treated as a medical emergency in pre-eclampsia

A

> 160mmHG

44
Q

maternal complications of pre-eclampsia 7

A

intracranial haemorrhage

placental abruption and DIC

eclampsia

HELLP syndrome

renal failure

pulmonary oedema

acute respiratory arrest

45
Q

define HELLP syndrome

A

severe form of eclampsia

Haemolysis, elevated liver enzymes, low platelets

46
Q

fetal complicatiosn fo pre-eclampsia 5

A

intrauterine growth restriction

oligohydramnios

hypoxia from placental insufficiency

placental abruption

premature delivery

47
Q

managemnt of moderatee pre-eclapmsia

A

oral labetaol if systolic BP reaches 150-160mmHg

48
Q

how is severe pre-eclampsia defined

A

systolic BP >180mmHg

49
Q

manamegant of severe preeclampsia (>180mmHg) 3

A

oral/IV labetalol

oral nifedipine

IV hydralazine

usually oral labetolor or nifedipine
-repeat oral if unsuccessful
-maintenance oral ehrapy or IV therapy ± infusion of labetoalol or hydrazline

50
Q

what is the aim of antihypertensivee meds in pre-eclapmisa 1

A

lower systolic BP to <150mmHG

51
Q

observations for motheres with severe pre-eclampsia

A

IV access, urine output

BP check
-15 mins if on treatemtn
-30 mins when stabilised

reviewed 4hrly by obstetrician

if not delivered-> continuous CTG

52
Q

fluid balance managemnt in preeclampsia

A

input 1ml/kg/hr or 80ml/hr
-unless ongoing fluid loss (haemorrhage)

hourly urine output measurements
->100ml/4hr

if oral intake is adequate do not need IV

do not preload w IV fluids if epidural neeeded

53
Q

define eclampsia

A

one or more convulsions in assocation with pre-eclampsia

-HOWEVER- MOST women in UK will not have established hypertension or proteinuria prior to seizure

54
Q

when does eclampsia happen in pregnacy by percentage

A

44% postpartum

38% antepartum

18% intrapartum

5-30% recurrent seizure

55
Q

management of pre-eclapmisa seizures

A

drug of choice magneisum sulphate
-fewer recurrent seziures than diazepam or phenytoin

DO NOT use diazepam, phenytoin or lytic cocktails as alternative to MgSO4

56
Q

management of pre-eclapmisa seizures

A

drug of choice magneisum sulphate
-fewer recurrent seziures than diazepam or phenytoin

DO NOT use diazepam, phenytoin or lytic cocktails as alternative to MgSO4i

57
Q

how does MgSo4 work for eclampsia

A

acts primarl by reducing cerebral vasospasm

can also prevent eclampsia

58
Q

when should MgSO4 be considered for eclampsia management 2

*how long should it be used for

A

primary prophylaics
-women with severe-preeclampsia where birht is planned within next 24 hours

secondary prophylaxis
-after eclamptic fit

*-given for 24hours form time of commencement or for 24 hours after delivery

59
Q

immediate managemnt of elampsia

A

call for help-> ABC

control seizures-> MgSO4 loading dose-> maintenance dose_> recurrent seziures?->MgSO4 bolus

then follow severe pre-eclpamisa guidelines

60
Q

magnesium sulphate observations 3

A

hourly urine measurements
-MgSO4 exreted by kidnyes therefore risk of toxicity is higher with oliguria

hourly deep tendon reflexes

hourly RR

61
Q

signs of MgSO4 toxicity 4

A

loss of deep tendon reflexes

respriaoty depression

respriaitoy arrest

cardiac arrest

62
Q

what can cuase MgSO4 toxicitiy 2

A

if oliguria or renal impairment

63
Q

emergency managemnt of MgSO4 toxicity 5

A

call for help

stop MgSO4

start BLS

give IV calcium gluconate (1g (10ml of10%)

intubate early and ventilate until respiration resumes

64
Q

long term implciations of pre-eclampsia/eclampisa 2

A

increased risk of preeclampsia in future prectnacies

increased risk of hypertension adn its complications later in life

65
Q

which syxs antenatallly is pre-eclampsia until otherrwise

A

Headache of sufficient severity to seek medical advice is pre-eclampsia until proven otherwise

Epigastric pain ≥ 20/40 is pre-eclampsia until proven otherwise

66
Q

what should be measured to check for preeclampsia 2

A

BP

urinalysis

67
Q

what should be used in the third stage of labour if concerns over BP

A

syntocinon

68
Q

what additional maneuver cna be required for resuscitaiton of a pregnant women

A

manual left lateral uterine displacemtn [31]

69
Q

define amniotic fludi embolus

A

catastophic complcation of pregnancy
-amniotic fluid, fetal cells, hair or other debris enters maternal pulmonary circulation and causes cardiovascular collapse

Obs & Gyn (23 decks)

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