Obstectric emergencies

Question 1

What is Shoulder Dystocia?

Answer 1

When the anterior shoulder gets stuck/impacted behind the maternal pubic symphysis.

Fetel oxygen can drop
Need MDT management

Question 2

What are the dangers/potential consequences of shoulder dystocia?

Answer 2

Umbilical cord entrapment
Inability of fetuses chest to properly expand
Severe brain damage or death due to hypoxia
Brachial plexus damage

Question 3

How is shoulder dystocia managed?

Answer 3

HELPERR
H- call fo Help
E-evaluate for Episiotomy
L-Legs (MAcRoberts position)- hips flexed to 60 degrees
P-Suprapubic Pressure
E-Enter Manouvers (internal rotation of baby)
R-Remove posterior arm
R-Roll the patient on to all fours

Question 4

How is PPH mananged?

Answer 4

ABCDE
Empty bladder
Rub uterine fundus (massage above umbilicus)

Oxytocin IV
Ergometrine
Tranexamic acid
Carboprost
Misoprostol (prostiglandin)

Surgical:
Intrauterine balloon tamponade
B-lynch suture
Hysterectomy

Fluid replacement
Blood product transfusion

Question 5

What is cord prolapse and how is it treated?

Answer 5

Descent of umbilical cord through cervical opening or past the presenting part of fetus.

This is high risk of being compressed and the fetus becoming hypoxic

Replace cord into vagina
Perfome digital evaluation of presenting part
Digital elevation of presenting part
Catheterise and fill bladder to raise presenting part
Mother adopt knee-chest position or left lateral postion with raised hips

Tocolysis- medications to suppress premature labour

C-section

Question 6

What is a category 1 C- section?

Answer 6

Immediate threat to life of mother or baby

Question 7

Category 2 c-section?

Answer 7

There are problems affecting health of the mother and/or baby but not immediatly life threatening

Question 8

What is a Category 3 c-section?

Answer 8

Baby needs to be born early but there is not immediate risk to mother or baby.