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Obstetrics > Intrapartum care: tears, uterine rupture, amniotic fluid embolism > Flashcards

Intrapartum care: tears, uterine rupture, amniotic fluid embolism Flashcards

1
Q

What are perineal tears

A

tears in perineum caused by childbirth

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2
Q

What % of deliveries have perineal trauma

A

80

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3
Q

What are 5 RFs for perineal tear

A 
Episiotomy 
Macrosoma
Instrumental delivery 
Shoulder dystocia 
Nulliparous 
IOL
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4
Q

What is a first-degree tear

A

Tear in mucosa

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5
Q

How are first degree tears handled

A

Appose themselves

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6
Q

What is a second-degree tear

A

Tear in underlying perineal muscles

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7
Q

What is used to repair second-degree tears

A

Absorbable sutures

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8
Q

What is 3A degree tear

A

Tear in external anal sphincter <50%

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9
Q

What is 3B degree tear

A

Tear in external anal sphincter >50%

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10
Q

What is 3C degree tear

A

Tear in internal anal sphincter

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11
Q

How is third-degree tear investigated

A

Rectal exam

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12
Q

How is third-degree tear managed immediately

A

Take to theatre - suture under GA

Antibiotics

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13
Q

What is used to manage third-degree tears long-term

A

Lactulose and high-fibre diet for 10d

Physiotherapy

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14
Q

How long is a high-fibre diet and lactulose given

A

10d

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15
Q

If pain or incontinence following a third degree tear where should the person be referred and why

A

Refer to colorectal surgeon for mamonetry or US

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16
Q

what is a fourth degree tear

A

tear in external anal sphincter, internal anal sphincter and rectal mucosa

17
Q

explain management for fourth-degree tear

A
  • Theatre for suture under GA
  • Antibiotics
  • Physio
  • Lactulose and high–fibre diet
18
Q

what is a uterine rupture

A

break in muscle and overlying serosa of the uterus

19
Q

what is an incomplete uterine rupture

A

perineum remains intact - meaning uterine contents remain in uterus

20
Q

what is complete uterine rupture

A

perineum disrupted - remaining uterine contents enter peritoneal cavity

21
Q

what is the biggest risk factor for uterine rupture

A

c-section (especially classical scar)

22
Q

what are 5 risk factors for uterine rupture

A 
multiparous 
multiple pregnancy 
past C-section 
past uterine surgery 
induction w/prostaglandins
23
Q

what are the clinical features of uterine rupture

A

severe pain persistent between contractions

shoulder tip pain

24
Q

how may women with uterine rupture present

A

hypovolaemic shock

25
Q

if at risk of uterine rupture what should be ordered

A

CTG

26
Q

what can be used to diagnose uterine rupture

A

US

27
Q

how is uterine rupture approached

A 
A-E approach 
Airways -
Breathing - 15L oxygen 
Cardiac - 2 large bore cannula, cross-match, fluid 
D
E
28
Q

what is the definitive management for uterine rupture

A

Emergency C-section

Hysterectomy or repair

29
Q

how quickly should hysterectomy or repair be performed

A

Within 30-minutes

30
Q

what is an amniotic fluid embolism

A

foetal cells or amniotic fluid enters maternal circulation and stimulates an autoimmune reaction

31
Q

how common is amniotic fluid embolism

A

rare cause of maternal collapse

32
Q

what time frame does amniotic fluid embolism occur

A

30-minutes into labour

33
Q

what is the clinical presentation of amniotic fluid embolism

A

‘anaphylaxis-type’ picture

  • Hypoxia, Hypotension
  • Foetal distress
  • Shock
  • DIC
34
Q

what will patients with amniotic fluid embolism all develop within 4h

A

DIC

35
Q

how should amniotic fluid embolism be managed

A

A-E approach

- Contact anaesthetist for HDU admission

36
Q

what is the problem with diagnosis amniotic fluid embolism

A

No definitive diagnostic test (whilst alive) hence diagnosis of exclusion

37
Q

explain management of amniotic fluid embolism

A

If baby is not delivered and patient is stable initiate continuous foetal monitoring with aim of delivery.

If cardiac arrest or maternal compromise occur, perimortem section is indicated to facilitate CPR or mother.

38
Q

what is the only definitive way to diagnose amniotic fluid embolism

A

post-mortem: foetal squamous cells in pulmonary vasculature

39
Q

what is the mortality rate for amniotic fluid embolism

A

high (50%)

Obstetrics (27 decks)

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