Obs emergencies Flashcards
6 important energencies
- antepartum hemm
- uterine rupture
- uterine inversion
- shoulder dystocia
- cord prolapse
- amniotic fluid embolism
5 causes of antepartum hemmorage
- placenta previa - PAINLESS vag. bleed
- abruptio placenta - premature separation or normally implanted placenta - bleed and PAIN
- Vasa previa - FETAL vessels that cross membranes located in lower uterine segment in advance of fetal part - not protected
- LUTS lesions
- unclassified
what to always give in hemmorage
Rh Ig if Rh neg.
findings in uterine rupture
- fetal brady
- severe abdo pain
- vaginal bleed
- loss of presenting part
- intraabdo hemmorage
- hypovolemic shock
causes of rupture
- uterine scar
- excessive contradindications
- trauma
- spontaneous
mgmt of rupture
- stabilize mom
- treat hypovolemia
- call for help
- emerg. laparotomy
def. uterine inversion
fundus below os
3 causes of inversion
- excessive cord traction
- fundal pressure
- placenta accreta
mgmt of inversion
- uterine punch
- stabilize mom
- call for help
def. shoulder dystocia
impaction of anterior shoulder above symphysis in the AP diameter to remainder of body cannot be delivered in normal manner
risks for shoulder dystocia
- port term
- mat. obesity
- fetal macrosomia
- previous dystocia
- operative vag. deliv.
- prolonged labor
- poorly controlled DM - fat shoulder
maternal and fetal complications of dystocia
maternal - hemmorhage fetal - - birth trauma - fractures - brachial plexus palsy - hypoxic ischemia - death
what to do in dystocia
(ALARMER) A-ask for help L - lift, hyperflex legs A - anterior shoulder disimpaction R -rotation of post. shoulder M -manual delivery of post. arm E- episiotimy R - roll over on all fours
3 options if nothing works
- fratcure clavicle
- symphysiotomy
- zavanelli - push head back in and CS
4 things NOT to do
- pull on head
- push on fundus
- panic
- pivot
how to assess viability in cord prolapse
feel for pulsations - if none- not viable
what to do for cord prolapse
push back into vagina and elevate pressure on it
risks for cord prolapse
- malpresentation
- premat.
- multipreg
- polyhydram
- premature membrane rupture
- placenta previa
- high presenting part
what is perinatal mortality assoc. with amnitoic fluid embolism
9-44%
def. AFE
presence of amniotic debris in maternal lungs
risks for AFE
- old mom
- CS
- assissted deliv.
- placenta previa
- placental abruptions
- eclampsia
- fetal distress
- polyhydramnio
- cervical laceration
impact of AFE in dev. counties
5-15% of all mat. deaths
what is patho of AFE
breach of the barrier between maternal and fetal compatments with a pressure gradient
3 most common presenting sign of AFE
- profound hypotension
- cyanosis, dyspnea, resp arrest
- hemm. /DIC
commonly reported Sx in women with AFE
- breathlessness
- chest pain
- coldness
- light headed
- panic
6/ N/V
3 basic directives of obs. emergencies
- rapid init. and continuation of o2
- circ. support
- correct coagulopathy
