OB/GYN

Question 1

ED Approach to precipitous delivery

Answer 1

1.Call for help (Peds, OB), 2. delivery kit, neonatal wamer 3. brief history - gestation, parity, ultrasound for position; 4. clean and drape 5. place 1 hand on head to minimize uncontrolled movements, other hand gentle pressure on the perineum 6. push during contractions, count to 10 x 3 until you see head 7. stop pushing when the head is seen, and have mom breathe through contractions 8. deliver head 9. check for nuchal cord 10. if unable to pass, clamp and cut 11. gentle downwad traction to deliver anterior shoulder, then upward 12. clamp cord 3 cm from abdomen x 2 and cut 13. oxytocin 20 U in 1L at 250 cc/h; stimulate bab,

Question 2

approach to shoulder dystocia

Answer 2

“ALARMER” - ask for help, leg yperflexion (McRoberts), anterior shoulder disimpaction (suprapubic pressure), rotate (hand on superior head above shoulder to disimpact, 2 fingers on scapula of inferior shoulder to turn baby, deliver posterior arm, episiotomy, roll on all fours

Question 3

approach to umbilical cord presentation

Answer 3

elevate presenting part, reduce compression, hand remains in vagina, emergent C-section, medications if delay in C/S (Terbutaline, NTG, MgSO4)

Question 4

approach to PPH

Answer 4

call OB, MTP protocol, palpate uterus for atony, uterine fundal massage, bimanual compression, oxytocin 40U iL open util uterus firm then 200 cc/hr, misprostol 800 mcg rectally, methylergonovine 0.2 mg IM, carboprost 250 mcg IM q15mins max of 8 doses, TXA, FFP, platelets or cryo for DIC