Obstertric Emergencies Flashcards
Whats the mean time of delivery of the head to delivery of the shoulders in lethal cases?
5 mins
What are the risks for shoulder dystocia?
Large baby ; main risk Previous shoulder dystocia ⬆️ maternal BMI Labour induction Low height Maternal diabetes Imstrumental delivery Most cases are considered unprecentable.
How would you manage shoulder dystocia?
Rapid and skilled intervention.
Obstr at pelvic inlet- Xs traction- Erbs palsy
↪️gentle downward traction.
Legs are hyperextended onto abdomen (McRoberts manoeuvre + suprapubic pressure applied.
90% cases work.
What happens if gentle downward traction fails?
Internal manoeuvres are used; neccesiating episiotomy.
Posterior arm grasped and brought down, trunk will follow, or rorate trunk.
If fails; symphisiotomy- head replaced + C/S –> irriversible damage for fetus
Whats cord prolapse? Whats the Epidimiology?
Occurs when after membranes have ruptured, the umbilical cord descends below the presenting part.
Untreated, the cord will be compressed or go into spasm–> rapidly hypoxic baby
1 in 500 deliveries.
What are some RFs for cord prolapse?
Preterm labour, breech presentation, polyhydraminos
Abnormal lie, twin pregnancy
Artificial amniotomy - nore than half
How is the diagnosis of cord relapse made?
When fetal heart rate becomes abnormal or if cord palpable vaginally or visible at introitus.
What has reduced the incidence of cord prolapses?
The use of C/S when breech presentation.
How would u manage cord relapse?
1st- to avoid cord compression; cord pushed up by finger or tocolytics.
If still out of inroitus: kept warm & moist, not pushed back forcefully
2. Patient goes on “all fours” while preparation for safest delivery route is undertaken.
Immediate C/S is perforemed.
OR
Instrumental Vaginal delivery if head is low and cervix is fully dilated.
Prompt tx - fetal death rare.
What happens in amniotic fluid embolisms?
When liquor enters the matwrnal circulation,
anaphylaxis, sudden dyspnoea, hypoxia and hypotension
Often: seizures and cardiac arrest.
Acute heart failure !
Rare, but deadly.
If she survives- 30mims- disseminated intravascular coagulopathy (DIC) + pulm oedema and adult resp distress syndrom (ARDS) .
Few: 1st presentation: DIC
What are the risk Factors and tx of amniotic fluid embolus?
When membranes rupture, during labour, at C/S, even at termination of pregn.
Presence of polyhydraminos.
Prevention is impossible.
Diagnosis: confused with eclampsia, postmoterm- certainty.
Resuscitation + supportive tx key.
Oxygen, fluid Under central venous
Bloods: clotting, FBC, electrolytes and cross match.
ICU
What hapoens in uterine rupture?
Uterus tears de novo, or an old scar e.g from c/s can open. 10% neonatal mortality
Fetus is extruded, causing acute fetal hypoxia and massive internal haemorrhage.
Rupture of lower C/S is less serious than a 1o rupture or the classic caesarean one. Since the lower segment is not as heavily vascularised so heavy bleed and fetus extrusion and bleeding into the abdo is less likely.
How often does the uterine cavity ruprture?
How is the diagnosis made?
I in 1500 pregnancies and 0.7% of women who attempt vag delivery after single previous lower C/S (LSCS)
Diagnosis suspected from abnorm fetal heart rate or constant lower abdo pain, bajj bleed, cessation of contractions and maternal collapse may occur.
What is a C/S?
Lower segment Caesarean section; abdo wall opened with suprapubic transvere incision and the lower segment of the uterus is also incised for fetus delivery
What is a classical Caesarean secrion?
In extreme prematurity, multiple fibroids or where fetus is transvesrse, the uterus is incised vertically. After delivery, uterus and abdomen are sutured.
