Obs and Gynae Emergencies

Question 1

Pelvic pain is unilateral, HCG positive?

Answer 1

ectopic pregnancy

Question 2

Pelvic pain is unilateral, HCG negative, signs of infection?

Answer 2

appendicitis

Question 3

Pelvic pain is unilateral, HCG negative, no signs of infection?

Answer 3

ovarian torsion
cyst accident
fibroid degeneration
renal calculi

Question 4

Pelvic pain is generalised, HCG positive?

Answer 4

miscarriage

Question 5

Pelvic pain is generalised, HCG negative, signs of infection?

Answer 5

Diverticulitis
PID
UTI

Question 6

Pelvic pain is generalised, HCG negative, no signs of infection?

Answer 6

endometriosis
constipation
IBS
urinary retention

Question 7

Describe ovarian torsion?

Answer 7

more likely in cysts > 5cm, may be functional cysts from cycle or dermoid cysts, in periomenopausal likely benign, post menopausal is more likely malignant

Question 8

Describe cyst accident?

Answer 8

haemorrhage etc, rupture can be spontaneous or after trauma (sex or contact sport)

Question 9

List some maternal causes of collapse using head, heart, hypoxia, haemorrhage, whole body and hazards?

Answer 9

Head- eclampsia, epilespy, cerebrovascular accident, vasovagal response
Heart- MI, arrythmias, peripartum cardiomyopathy
Hypoxia- asthma, PE, pulmonary oedema, ananphylaxis
Haemorrage- abruption, atony, trauma, uterine rupture, uterine inversion, ruptured aneurysm
wHole body and Hazards- hypoglycaemia, amniotic fluid embolism, septicaemia, trauma, anaesthetic complications, drug overdose

Question 10

For cardiac arrest there are 4HTs and 4Hs but what do you add on if someone is pregnant?

Answer 10

2Cs

eclampsia and intracerebral bleed

Question 11

Describe the difficulties of resuscitation in a pregnant woman?

Answer 11

The gravid uterus causes aortocaval compression which reduces venous return to the heart. This means that cardiac compressions will be less effective at creating a circulation.

Ventilation is more difficult due to the pressure on the diaphragm from the uterus.

The feto-placental unit effectively ‘steals’ oxygen and circulating volume from the mother – reducing the effectiveness of CPR.

The pregnant women is more likely to aspirate due to the hormonal relaxation of the oesophageal sphincter and delayed gastric emptying – this makes intubation during a maternal cardiac arrest a priority; however, because of oedema and the larger tongue and breasts of pregnancy, pregnant women can be more difficult to intubate.

Question 12

Describe what needs to be done to a pregnant woman from 20 weeks onwards if doing CPR?

Answer 12

if woman looks obviously pregnant they are probs 20 weeks or over
need to do manual uterine displacement when performing CPR

Question 13

When is a perimortem C section done in maternal cardiac arrest?

Answer 13

if no response to CPR at 4 mins a perimortem C section should be undertaken to assist maternal resus, limited equipment is needed and mother is only moved to theatre if she stablises

Question 14

What is cord prolapse associated with?

Answer 14

malpresentation, preterm labour, 2nd twin, artificial membrane rupture

Question 15

What can cord prolapse cause?

Answer 15

direct compression and cord spasm, decreased blood flow, hypoxia and death

Question 16

Management of cord prolapse?

Answer 16

Should scan for fetal cardiac activity, usually the fetus becomes dramatically bradycardiac
need immediate delivery by C section or forceps, whatever is faster

Question 17

What is shoulder dystocia?

Answer 17

condition where the fetal head has delivered but the shoulders fail to deliver spontaneously or with normal amount of downward traction
it is a bony impaction of fetal anterior shoulder on the maternal symphysis

Question 18

Risk factors for shoulder dystocia?

Answer 18

hard to predict because 25% women wont have any risk factors
some known risk factors are obesity, macrosomnia, prolonged 1st and 2nd stage of labour, instrumental delivery

Question 19

Signs of shoulder dystocia?

Answer 19

slow delivery of the head, head bobbing (head consistently retracts back between contractions), turtling of head against perineum (head tightly pulled back against perineum so there is difficulty delivering the chin)

Question 20

Risks of shoulder dystocia?

Answer 20

hypoxic brain injury, brachial plexus injury, fractures, PPH, 3rd/ 4th degree distress

Question 21

Treatment of shoulder dystocia?

Answer 21

first line treatment is McRoberts manouvre (abducted hips, flexed knees to chest) and suprapubic pressure is applied, this is successful in majority of cases
if this is unsuccessful may need to do internal manuvres