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Obstetrics > Obstetric Complications + Emergencies > Flashcards

Obstetric Complications + Emergencies Flashcards

1
Q

Name some causes of maternal collapse.

A

Can be broadly divided into head, heart, lungs, and uterus.
Head: eclampsia, intracranial bleed, trauma
Heart: MI, aortic dissection, arrhythmia
Lungs: PE, amniotic fluid embolism
Uterus: abruption, sepsis, haemorrhage
+drugs, anaphylaxis, hypoglycaemia

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2
Q

How would you manage maternal collapse?

A
  • Call for help, 2222 call
  • A to E approach, with CPR as needed. Ensure left lateral tilt (eg. with Cardiff Wedge) to prevent aortocaval compression in >20 weeks
  • Insert 2 wide bore cannulae, take bloods (FBC, clotting, CM 6 units, U+Es, cardiac enzymes)
  • CTG to assess fetal wellbeing, USS
  • Ix and manage the cause
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3
Q

Name some risk factors for maternal sepsis.

A

ROM, immunocompromise, obesity, DM, UTI, GBS +ve, procedures (amniocentesis, cervical cerclage)

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4
Q

Describe features that may be seen with maternal sepsis.

A
  • Obs: increased Temp, HR and RR, decreased BP, reduced urine output
  • Rigors, rashes, mottling/pallor, cold peripheries, reduced LOC, D+V, abdo pain
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5
Q

How would you manage maternal sepsis?

A
  • A to E approach
  • Initiate sepsis 6 protocol:
  • Gain peripheral venous access, take bloods including blood cultures, lactate. Also FBC, U+Es, CRP, ABG
  • Further Ix to identify source of infection eg. urine dip, urine MC+S, vaginal swab, etc.
  • Monitor urine output +/- catheter
  • Start high flow O2, give broad spectrum antibiotics and IV fluids
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6
Q

What are some common bacteria that can cause maternal sepsis? Which antibiotics can be effective?

A

Group A strep (Strep pyogenes)
E coli
-Good broad spectrum eg. Tazocin/Carbapenem + clindamycin

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7
Q

Define antepartum haemorrhage. Name some causes

A

Vaginal bleeding >20 weeks. Divided into minor (<50 ml), major (50-1000ml), massive (>1000mls).
Causes can be divided into maternal, fetal, and placental
Placental: abruption, praevia
Maternal: ectropion, carcinoma, infection
Fetal: vasa praevia

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8
Q

What features are important to ask about in a history of PV bleeding at 24 weeks?

A

Blood: quantity, colour, any material/clots
Pain: pain vs contractions
Triggers: sex, trauma
Other features: discharge/fluids, fetal movements, fever
Smear
-Obs history

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9
Q

What is placental abruption?

A

Premature separation of the placenta from the uterine wall

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10
Q

Name some risk factors for placental abruption.

A
  • Hypertension
  • Smoking, cocaine
  • Trauma
  • Polyhydramnios
  • Multiples
  • FGR
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11
Q

Describe how placental abruption presents.

A

Painful bleeding with a tense rigid abdomen (unless concealed). Sweating, hypotension, tachycardia, tachypnoea, decreased fetal movements

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12
Q

What is placenta praevia?

A

Placental covering/encroaching on the cervical os

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13
Q

Name some risk factors for placenta praevia?

A
  • Multiples
  • Previous C section
  • Uterine structural anomaly
  • ART
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14
Q

Describe how placenta praevia presents

A

Presents as painless PV bleeding (though can then cause contractions). Collapse, hypothermia, dizziness, distress.

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15
Q

How would you manage antepartum haemorrhage?

A

-A-E approach, triage patient
If severe:
-Gain peripheral venous access, take bloods (ABG, FBC, clotting, G+S, CM 4 units if significant loss, U+Es, LFTs)
-IV fluids/transfusion
-USS, CTG
-Consider need for immediate delivery, corticosteroids if likely and 24-35 weeks.
-If mum Rh-ve, send Kleihauer test

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16
Q

A woman comes in at 30 weeks with moderate PV bleeding. Will you admit? If yes, when can she go home?

A
  • Yes. Women with more than minor spotting should be admitted at least until the bleeding stops.
  • She should not be discharged until bleeding stops + if there is not a clinical need to monitor closely (eg. abruption)
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17
Q

What is vasa praevia? What can happen as a result?

A

A condition where fetal vessels traverse the membranes that lie over the internal os. When there is SROM/ARM, these vessels bleed and there can be catastrophic consequences eg. fetal death

18
Q

What is postpartum haemorrhage? What are the causes?

A

Bleeding >+ 500 mls that occurs after delivery.
Minor: 500-1000ml
Major: >1000ml
Causes: 4 T’s (Trauma, Tone, Tissue, Thrombin)
Uterine atony is most common!

19
Q

Name some risk factors for uterine atony

A
  • Macrosomia
  • Multiples
  • Prolonged labour
  • Oxytocin use
  • IOL
20
Q

How can we prevent postpartum haemorrhage?

A
  • Manage any antenatal anaemia well

- Give oxytocin to high-risk women (10IU IM in 3rd stage)

21
Q

How would you manage PPH?

A

-Based on the amount of blood loss.
Minor without shock: IV access, send bloods urgently, give fluids, monitor
Major: initiate protocol for major obs haemorrhage.
-A-E approach
-High flow O2. Insert 2 large bore cannulae, take bloods (FBC, CM 6 units, etc)
-Give fluid challenge, blood transfusion
-Uterine compression/massage. Catheterise.
-Uterotonic drugs: 5-10 IU IV oxytocin/0.5mg IM ergometrine/combined eg. Syntometrine (0.5 mg ergo, 5 IU oxytocin)
-If no success, try 2nd uterotonic. Consider rectal misoprostol/carbaprost IM
-Transfer to theatre for surgical management eg. balloon tamponade, hysterectomy

22
Q

Define eclampsia

A

1+ generalised convulsions or coma in the presence of pre-eclampsia

23
Q

How do you prevent against eclampsia?

A
  • Manage pre-eclampsia effectively with antihypertensives

- Mg sulphate if already had a fit/severe pre-eclampsia.

24
Q

Name several risk factors for eclampsia.

A

Poorly controlled BP, obesity, DM, age <20 years

25
Q

Describe the warning signs and symptoms of eclampsia

A

Epigastric pain, headache, hypertension (though not always), distress, hyper-reflexia and clonus, facial oedema, oliguria, papilloedema

26
Q

How would you manage eclampsia?

A 
Call for senior help (obs, anaesthetics)
A-E approach
Mg sulphate (4g loading dose followed by 1g/hr)
Consider the need for immediate delivery
Refer to critical care as needed
27
Q

Define umbilical cord prolapse

A

Descent of the umbilical cord through the cervix with/ahead of the presenting part

28
Q

Name for risk factors for umbilical cord prolapse

A

Multiples, polyhydramnios, unstable/transverse/oblique lie, LBW

29
Q

A woman is seen at antenatal clinic at 36+3. On examination, the fetus is in an oblique lie. What would you discuss with this woman?

A
  • Discuss risk of cord prolapse during labour
  • Discuss admission from 37+0
  • Inform her to call immediately if there is ROM or signs of labour
  • Need for fetal monitoring during labour
30
Q

How would you manage cord prolapse?

A
  • Call for senior help
  • Prep for Cat 1/2
  • DO NOT touch the cord/push back in
  • Elevate the uterus (mothers position, fill bladder)
  • Deliver baby
31
Q

What is shoulder dystocia?

A

Difficulty delivering the shoulders after traction, following vaginal cephalic delivery

32
Q

Name some complications of shoulder dystocia.

A

Maternal: perineal injury, PPH, psychological trauma
Fetal: brachial plexus injury, fractured clavicle/humerus, hypoxia/death

33
Q

Name some risk factors for shoulder dystocia.

A

Macrosomia, GDM/DM, obesity, previous dystocia

34
Q

How would you manage shoulder dystocia?

A

Call for senior help

  • Drop bed flat, position mum (flex + adduct hips)
  • Apply suprapubic pressure
  • Rubin II/Woods screw manouvres (Rubin II: push ant shoulder towards chest, Woods screw: same + push post shoulder to turn)
  • Episiotomy
  • Consider further action such as symphysiotomy, Zavanelli
35
Q

Name some risk factors for VTE during pregnancy

A

Pre-existing: obesity, older age, underlying medical conditions, smoking, thrombophilia, previous VTE
Maternal: pre-eclampsia, multiples, C section
New onset/transient: immobility/hospitalisation, hyperemesis, OHSS, infection, surgery

36
Q

How is VTE managed in pregnancy?

A

LMWH is 1st line (safe in breastfeeding)

37
Q

Describe the types of uterine inversion

A

Uterine inversion occurs when the uterus turns inside out. 4 degrees:

1: Inside cervix
2: Inside vagina
3: Outside vagina
4: Uterus and vagina are outside the introitus

38
Q

What can cause uterine inversion?

A

Prolonged second stage, Syntocinon

39
Q

How is uterine inversion managed?

A
  • Manual replacement +/- GA
  • Hydrostatic replacement
  • Hysterectomy
40
Q

What are some risk factors for uterine rupture?

A
  • Previous C section! Myomectomy

- Multiple pregnancy, IOL/augmentation

41
Q

What are the signs and symptoms of uterine rupture?

A
  • Maternal shock (Low BP, high HR, cold + clammy + pale)
  • Severe sudden onset abdo pain
  • Absent contractions
  • Unable to auscultate fetal heartbeat

Obstetrics (4 decks)

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