Obstetric Emergencies (1) Flashcards
Post-Partum Haemorrhage:
What is its diagnosis criteria?
What are its risk factors?
What causes it?
How can it be prevented?
➊ • 500ml loss after vaginal delivery
• 1000ml loss after c-section
➋ Previous PPH, Multiple pregnancy, Macrosomia, Prolonged 3rd stage, Induced/Augmented/Instrumental delivery, Polyhydramnios
➌ 4 T’s:
• Tone - Uterine atony – Most common cause
‣ Contraction of uterus after delivery helps compress the vessels and slow down blood loss
• Trauma e.g. perineal tear
• Tissue - Retained placenta
• Thrombin - Coagulopathy
➍ • Emptying bladder before delivery – full bladder can reduce uterine contraction
• Active management of 3rd stage with IM Syntometrine
What are the mechanical management options?
What are the medical management options?
What are the surgical management options?
What is Secondary PPH?
→ What are the most common causes of it?
→ What do investigations include?
➊ * Rubbing uterus through abdomen stimulates a contraction
* Catheterisation – A distended bladder prevents uterine contractions
➋ * Oxytocin
* Ergometrine – Stimulates smooth muscle contraction
‣ CI in hypertension
* Carboprost or Misoprostol – Prostaglandin analogue
‣ Caution in asthmatics
* Tranexamic acid – Antifibrinolytic for high-risk patients
➌ * Intrauterine balloon tamponade – Inflatable balloon into uterus to press against the bleeding
* B-Lynch suture around uterus to compress it
* Uterine artery ligation to reduce blood flow
* Hysterectomy – LAST RESORT - Will stop bleeding and may save the mother’s life
➍ Bleeding 24hrs – 12 wks post-partum
→ * Retained Products of Contraception (RPOC)
* Endometritis (infection)
→ * TVUS for retained products
* Endocervical/high vaginal swabs for infection
Maternal Sepsis:
What is the most common cause?
→ How does this present?
What’s another key cause?
How is it managed?
➊ Chorioamnionitis – Infection of membranes in uterus and amniotic fluid
→ Abdo pain, Uterine tenderness, Vaginal discharge, Fever, Maternal and foetal tachycardia
➋ UTI
➌ • Sepsis 6 (Take – Lactate, Blood culture, Urine output; Give – O2, Abx, IVF)
• Emergency c-section if signs of foetal distress
Cord Prolapse:
What occurs here?
What are its risk factors?
When should it be suspected?
→ What should you NOT do after diagnosing a prolapse? Why?
What can be done to relieve pressure on the cord?
How else is it managed?
➊ Umbilical cord descends below presenting part of the foetus, therefore causing cord compression → foetal hypoxia
➋ Abnormal foetal lie, Multiple pregnancy, Polyhydramnios
➌ When signs of foetal distress on CTG, and diagnosed O/E
→ Don’t try and push the cord back as it can cause vasospasm!
➍ • Women to lie in left lateral position (with pillow under hip) or knee-chest position (on all fours) to draw foetus away from pelvis
• Fill the bladder with fluid to push the foetal head away
➎ • Emergency instrumental delivery or C-section
• Tocolytics to stop uterine contractions
Shoulder Dystocia:
What occurs here?
What are its risk factors?
→ What is Anticipation?
How can it present?
What are the complications that can occur here?
What are the 2 Brachial plexus injuries that can occur?
➊ Anterior shoulder becomes stuck behind pubic symphysis
➋ Macrosomia, GDM, Anticipation, Maternal birth weight, Maternal obesity
→ Big baby, Prolonged 1st/2nd stage, Instrumental delivery
➌ * Difficult delivery of the face and head
* Failed descent of the shoulders following delivery of the head
* Failure of restitution where the head remains face downwards and doesn’t turn back sideways as expected after delivery of it
* Turtle-neck sign – Head is delivered but then retracts back into the vagina
➍ * Foetal hypoxia (and subsequent cerebral palsy)
* Brachial plexus injury (Erb’s palsy)
* Perineal tears
* PPH
➎ Erb’s palsy (C5/C6) and Klumpke’s palsy (C8/T1)
N.B. Erb’s palsy - C5 + C6 = 11 erbs and spices.