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Year Three - Reproductive System > Obstetric Emergencies > Flashcards

Obstetric Emergencies Flashcards

1
Q

What is shoulder dystocia?

A

It occurs when, after delivery of the head, the anterior shoulder of the fetus becomes impacted on the maternal pubic symphysis

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2
Q

Describe the pathophysiology of shoulder dystocia

A

In normal labour, the fetal head is delivered via extension out of the pelvic outlet

This is followed by restitution of the fetal head, so it lies in a neutral position in relation to its spine

This means that the fetal shoulders now lie in an anterior-posterior position

Shoulder dystocia occurs when there is impaction of the anterior fetal shoulder behind the maternal pubic symphysis

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3
Q

Between which two cardinal movements does shoulder dystocia occur?

A

Extension and restitution

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4
Q

What are the three risk factors of shoulder dystocia?

A

Macrosomia

Gestational Diabetes

Previous Shoulder Dystocia

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5
Q

What is macrosomia?

A

It is defined a as a fetal weight larger than average

This is generally a fetal weight above 4.5kg

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6
Q

Why does gestational diabetes increase the risk of shoulder dystocia?

A

This is due to the fact that the baby’s weight distribution is disproportionately bigger in the abdomen region compared to the head

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7
Q

What are the three clinical features of shoulder dystocia?

A

Fetal Head Delivery Difficulty

Restitution Failure

Turtleneck Sign

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8
Q

What is restitution failure?

A

It occurs when the fetal head remains in the occipital anterior position after delivery by extension and therefore doesn’t turn sideways as expected

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9
Q

What is the turtleneck sign?

A

It is is when the fetal head retracts slightly back into the pelvis, so that the neck is no longer visible

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10
Q

What are the six management options for shoulder dystocia?

A

Episiotomy

McRoberts Manoeuvre

Suprapubic Pressure

Posterior Arm

Corkscrew Manoeuvre

Zavenelli Manoeuvre

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11
Q

What is an episiotomy?

A

It is a surgical cut made at the opening of the vagina during childbirth

This can enlarge the vaginal opening and can make access easier for manoeuvres

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12
Q

What is a McRoberts manouevre? How is it used to manage shoulder dystocia?

A

It involves the mother lying supine with both hips fully flexed and abducted

This widens the pelvic outlet by lifting the pubic symphysis up and out of the way and increasing the lumbosacral angle

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13
Q

What is the first line management option?

A

McRoberts manouevre

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14
Q

What is suprapubic pressure? How is it used to manage shoulder dystocia?

A

It involves pressing on the suprapubic region of the abdomen

This puts press pressure on the posterior aspect of the baby’s anterior shoulder, to encourage it down and under the pubic symphysis

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15
Q

What is the posterior arm manoeuvre?

A

It involves inserting a hand posteriorly and grasping the posterior arm to deliver

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16
Q

What is the corkscrew manoeuvre?

A

It involves reaching into the vagina to put pressure in the posterior aspect of the baby’s anterior shoulder

The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder

This is used to move the baby into an oblique position

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17
Q

What is the Zavenelli manoeuvre?

A

It involves pushing the baby’s head back into the vagina so that the baby can be delivered by an emergency c-section

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18
Q

What do we do if all the manoeuvres fail?

A

We roll the patient onto all fours and repeat

This may widen the pelvic outlet as the legs are abducted and flexed

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19
Q

What are the four complications of shoulder dystocia?

A

Fetal Brachial Plexus Injury

Fetal Hypoxic Brain Injury

Perineal Tears

Postpartum Haemorrhage

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20
Q

What postpartum haemorrhage (PPH)?

A

It refers to bleeding after delivery of the baby and placenta

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21
Q

What blood loss after a vaginal delivery is classified as postpartum haemorrhage?

A

500ml

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22
Q

What blood loss after a c-section is classified as postpartum haemorrhage?

A

1000ml

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23
Q

What are the two classifications of postpartum haemorrhage?

A

Primary Postpartum Haemorrhage

Secondary Postpartum Haemorrhage

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24
Q

What is primary postpartum haemorrhage?

A

It is defined as bleeding within 24 hours of delivery

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25
Q

What is secondary postpartum haemorrhage?

A

It is defined as bleeding from 24 hours to 6 weeks after delivery

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26
Q

What are the four categories of postpartum causes?

A

Thrombin

Tissue

Tone

Trauma

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27
Q

What are the four thrombin causes of postpartum haemorrhage?

A

Pre-Eclampsia

Placenta Abruption

Bleeding Disorders

Endometritis

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28
Q

What are the two tissue causes of postpartum haemorrhage?

A

Retained Placenta

Retained Products of Conception

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29
Q

What are the four tone causes of postpartum haemorrhage?

A

Uterine Atony

Multiple Pregnancy

Placenta Praevia

Previous PPH

30
Q

What is the most common cause of PPH?

A

Uterine atony

31
Q

What are the four trauma causes of postpartum haemorrhage?

A

Perineal Tear

C-Section

Macrosomia

Episiotomy

32
Q

What are the seven immediate management options for postpartum haemorrhage?

A

Call for help

ABCDE

Check uterine tone, trauma and tissue

O2 therapy

Further IV access

Fluid replacement

Bloods

33
Q

What six blood tests do we conduct in postpartum haemorrhage patients?

A

FBC

U&Es

LFTs

Group & cross match

Clotting tests

Lactate

34
Q

What are the two conservative management options for postpartum haemorrhage? Describe how

A

Uterus Massage - By massaging the uterus through the abdomen, a uterine contraction is stimulated. This can help stop the bleeding.

Catheterisation - A catheter can be placed into the bladder to empty it. This can help stop bleeding as bladder distention prevents uterus contractions.

35
Q

What five pharmacological treatments for postpartum haemorrhage?

A

Oxytocin

Ergometrine

Carboprost

Misoprostol

Tranexamic Acid

36
Q

What is the function of oxytocin?

A

It stimulates uterine contraction

37
Q

What is the function of ergometrine?

A

It stimulates smooth muscle contraction

38
Q

When is ergometrine contraindicated?

A

Hypertension

39
Q

What class of drug is carboprost? What is its functions?

A

A prostaglandin analogue

It stimulates uterine contraction

40
Q

When should we take caution when prescribing carboprost to patients?

A

If they have asthma

41
Q

What class of drug is misoprostol? What is its functions?

A

Prostaglandin analogue

It stimulates uterine contraction

42
Q

What class of drug is tranexamic acid? What is its functions?

A

Antifibrinolytic

It reduces bleeding

43
Q

What are the four surgical treatments for PPH?

A

Intrauterine Balloon Tamponade

B-Lynch Suture

Uterine Artery Ligation

Hysterectomy

44
Q

What is intrauterine balloon tamponade?

A

It is a surgical procedure that involves inserting an inflatable balloon into the uterus to press against the bleeding

45
Q

What is B-lynch suture?

A

It involves placing a suture around the uterus to compress it

46
Q

What is uterine artery ligation?

A

It involves ligation of one or more of the arteries supplying the uterus to reduce the blood flow

47
Q

What is hysterectomy?

A

It is a surgical procedure to remove the uterus

48
Q

What is lochia?

A

It is vaginal discharge for three to four weeks after birth, however it should be like a period or less with the absence of large clots

49
Q

In what five ways can we prevent postpartum haemorrhage?

A

Optimise antenatal haemoblogin levels

IV access

Active management of the 3rd labour stage

Tranexamic acid

Oxytocin infusion in high risk patients

50
Q

What is umbilical cord prolapse?

A

It is when the cord descends through the cervix, with or before the presenting part of the fetus

51
Q

What are the two classifications of umbilical cord prolapse?

A

Occult Cord Prolapse

Overt Cord Prolapse

52
Q

What is another name for occult cord prolapse?

A

Incomplete cord prolapse

53
Q

What is occult cord prolapse?

A

It occurs when the umbilical cord descends alongside the presenting part, but not beyond it

54
Q

What is another name for overt cord prolapse?

A

Complete cord prolapse

55
Q

What is overt cord prolapse?

A

It occurs when the umbilical cord descends past the presenting part and is lower than the presenting part in the pelvis

56
Q

What are the four risk factors of umbilical cord prolapse?

A

Breech Presentation

Unstable Lie

Polyhydramnios

Amniotomy

57
Q

How is a breech presentation a risk factor for umbilical cord prolapse?

A

It means that the cord can easily slip between and past the fetal feet and into the pelvis.

58
Q

What is the an unstable lie?

A

It is when the presentation of the fetus changes between transverse, oblique and breech

59
Q

What is the most significant risk factor for umbilical cord prolapse?

A

Unstable lie, especially after 37 weeks’ gestation

60
Q

What is polyhydraminos?

A

Excessive amniotic fluid around the fetus

61
Q

What is amniotomy?

A

The artificial rupture of membranes

62
Q

What two investigations are used to diagnose umbilical cord prolapse?

A

CTG

Vaginal examination

63
Q

What is the sign of umbilical cord prolapse on a CTG?

A

There are signs of fetal distress

Subtle signs = decelerations with contractions

Obvious signs = fetal bradycardia

64
Q

What is the main complication of umbilical cord prolapse?

A

Fetal hyopxia

65
Q

What are the two mechanisms in which umbilical cord prolapse can result in hypoxia?

A

Occlusion of the umbilical cord can occur when the presenting part of the fetus presses upon it. This occludes blood flow to the fetus.

Arterial vasospasm occurs when the exposure of the umbilical cord to the cold atmosphere results in a spasm, thus reducing blood flow to the fetus.

66
Q

What are the two conservative managements for umbilical cord prolapse?

A

We manually push the presenting part of the foetus back into the vagina. This is to prevent compression of the umbilical cord and therefore hypoxia.

We ask the mother to go on all fours, on knees and elbows

67
Q

What is the pharmacological management for umbilical cord prolapse?

A

Terbutaline

68
Q

How does terbutaline treat umbilical cord prolapse?

A

It used to relax the uterus, minimise contractions and relieve pressure off the cord

69
Q

When is terbutaline used to treat umbilical cord prolapse?

A

It is prescribed to patients whilst waiting for delivery by c-section

70
Q

What is the surgical management for umbilical cord prolapse?

A

Emergency c-section

71
Q

What category c-section does umbilical cord prolapse require?

A

Category one

Year Three - Reproductive System (52 decks)

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