Obs and Gynae Emergencies Flashcards
What is an ectopic pregnancy?
Pregnancy that occurs when the fertilised egg implants outside of the uterus
Where is the most common location of an ectopic pregnancy?
Fallopian tubes
What investigations might you do for a suspected ectopic pregnancy?
UPT (urine pregnancy test)
BHCG (Human chorionic gonadotropin)
USS
What is the medical management for ectopic pregnancy?
IM methotrexate to stop pregnancy growing.
1 in_ pregnancies end in loss during pregnancy or birth
4
1 in _ pregnancies end in miscarriage
5
Miscarriage in the s_____ loss of foetus under __ weeks
spontaneous
24
What happens to bHCG to indicate early pregnancy loss?
bHCG levels decrease by over 50% in 48 hours
What is a molar pregnancy?
Gestational trophoblastic disease
What does complete mole refer to?
Single sperm or 2 sperm fertilize an egg that has lost its DNA
What does a partial molar refer to?
Two sperm fertilizing one egg that has it’s DNA
What is the colloquial term for molar pregnancy sign on USS
Bunch of grapes
What does an USS of molar pregnancy show?
Irregular echobright area containing multiple cysts
What is the management of molar pregnancy?
Surgical only
Send POC (products of conception) for histology
What is a complication of molar pregnancy?
Developing into choriocarcinoma (rare cancer)
What is ovarian torsion?
When the ovary (and sometimes fallopian tubes) twists on the vascular and ligamentous supports
Ovarian torsion can cause blockage of blood flow to the ____
ovary
How does ovarian torsion present itself?
Severe abdo pain
N&V
What imaging is used for suspected ovarian torsion?
USS, enlarged ovary
How is ovarian torsion managed?
Surgical emergency - detorsion or oophrectomy (removal of ovary)
What does PID stand for?
Pelvic Inflammatory Disease
What is PID?
Infection within the female reproductive system (uterus, fallopian tubes, ovaries)
What are risk factors for PID?
Multiple sexual partners
Unprotected sex
IUD use
What causes PID?
Bacterial infection
Often chlamydia or gonorrhoea
How is PID managed?
Swabs
14 days antibiotics (stat IM ceftriaxone single dose plus PO metronidazole and doxycycline)
What is antepartum haemorrhage?
Bleeding from anywhere within the genital tract AFTER 24th week of pregnancy
What are some causes of antepartum haemorrhage?
Low lying placenta
Vasa Praevia (foetal vessels run close to cervical Os)
Minor/major abruption
Infection
What is low lying placenta
Also called placenta praevia
Part of the placenta has implanted into the lower segment
Can cover the Cervical Os
How is low lying placenta diagnosed?
20 week anomaly USS
Repeat at 32 weeks
How is low lying placenta managed?
Safety netting for pain/bleeding
Avoid sex
If recurrent bleeding then admit until delivery
Elective C-section at around 37 weeks
What is Vasa Praevia?
Where the foetal vessels are coursing through the membranes over the internal cervical os and below the foetal presenting part, unprotected by placental tissue or the umbilical cord.
True or false: Vasa Praevia carries a major risk to the mother
False
But major foetal risk
What is the risk of vasa praevia?
If the membrane ruptures then there is risk of major foetal haemorrhage with mortality of 60%
How is Vasa praevia managed?
Steroids (help foetus lungs to develop for C-section)
C-section at 34-37 weeks (earlier if bleeding and indicated)
What is placental abruption?
Premature separation of the placenta from the uterine wall
What are the 2 types of placental abruption?
Concealed
Revealed haemorrhage
How does placental abruption present itself?
Woody-hard
Tense uterus
Foetal distress
Maternal shock, out of proportion bleeding
How is placental abruption managed if after 37 weeks?
Emergency c-section and steroids
What is Cord prolapse?
The presenting part is the cord following rupture of the membrane
Why does cord prolapse pose a risk?
Leads to vasospasm and can cause increased risk of foetal morbidity and mortality from hypoxia
What are risk factors for cord prolapse?
Premature rupture of membranes
Polyhydramnios (increased levels of amniotic fluid)
Long umbilical cord
Foetal malpresentation
Multiparity (more than one baby)
How is cord prolapse managed?
Trendelenburg position (feet above head)
Constant foetal monitoring
Alleviate pressure on cord
Transfer to theatre and prepare for delivery
What is pre-eclampsia?
Hypertension in pregnancy with proteinuria
How does pre-eclampsia present?
Severe headache
Visual disturbances
Clonus
Liver tenderness
Abnormal liver enzymes
Platelet count falls to under 100
How is pre-eclampsia managed?
Stabilise blood pressure to under 140/90
What is 1st line med for pre-eclampsia
Labetalol
What is the 2nd line med for pre-eclampsia?
Nifedipine
What investigations are needed to diagnose pre-eclampsia?
Bloods (platelets, renal and liver function)
Urine dip (proteinuria)
What is eclampsia?
Onset of seizure in a women with pre-eclampsia
True of false: seizure in pregnancy is epilepsy until proven otherwise
False
Seizure in pregnancy is eclampsia until proven otherwise
How is eclampsia managed?
IV MgSO4, 4mgs given over 5 minutes
Followed by infusion of 1g/hour for 24 hours
Then treat cause of htn
What is the leading cause of maternal death in the UK?
Sepsis
What are steps taken to prevent sepsis in pregnancy?
Seasonal flu and Covid immunisations
What does BUFALO stand for in management of sepsis?
Blood cultures
Urine output monitoring and catheter insertion
Fluid resus (IV)
Antibiotics (IV)
Lactate (take VBG/ABG)
Oxygen
What is shoulder dystocia?
Failure for the anterior shoulder to pass under the symphysis pubis after delivery of the foetal head
Shoulder dystocia is an i_______ e______
intrapartum emergency
High risk of maternal morbidity and foetal mortality and morbidity.
What are some risk factors for shoulder dystocia
Macrosomia (large baby)
Maternal DM (again, larger baby)
Previous shoulder dystocia
Post maturity
Prolonged 1st and 2nd stage of labour
Instrumental delivery
What does HELPERRR stand for in shoulder dystocia?
Help (call for help)
Elevate for episiotomy
Legs into McRoberts
Pressure (suprapubic pressure)
Enter pelvis
Rotational manoeuvres
Remove posterior arm
Replace head and delivery by C-section if required
What is an episiotomy?
vaginal wall cut to create more space
What is the McRoberts position?
Legs flexed onto abdomen to rotate pelvis, align sacrum and open birth canal
What are the maternal complications of shoulder dystocia?
PPH
3rd/4th degree tear
Pyschological distress
What are the foetal complications of shoulder dystocia?
Hypoxia
Fits
Cerebral palsy
Injury to brachial plexus
What is the definition of post-partum haemorrhage?
Blood loss of over 500mls following delivery
How does Sytocinon work in PPH management?
Activation of receptors by oxytocin triggers release of calcium from intracellular stores, leading to myometrial contraction
