Obstetric Emergencies Flashcards
What are examples of obstetric emergencies?
Shoulder dystocia
Postpartum haemorrhage
Cord prolapse
What is Shoulder dystocia?
Foetal shoulder becomes impacted behind maternal pubic symphysis after delivery of the foetal head.
Occurs between extension and restitution.
Foetal O2 can drop.
What are the main causes of concern for obstetric emergencies?
- Umbilical cord entrapment
- Brachial plexus damage
- Inability of chest to expand properly
- Severe brain damage or death due to hypoxia/acidosis if delivery is delayed
What is the acronym for management of shoulder dystocia?
HELPERR
What is the management of shoulder dystocia?
H - call for help E - episiotomy (evaluate) L - legs into McRobert's position P - pressure (suprapubic) E - Enter manouvers (internal rotation) R - remove posterior arm R - roll patient onto all 4s
What are the main causes of PPH?
Thrombin Tissue Tone Trauma Other
Examples of thrombin causes of PPH?
- Bleeding disorders
- Pre-eclampsia
- Placental abruption
- Pyrexia
Examples of tissue causes of PPH?
- Retained placenta
- Placenta accreta (placenta grows too deep into uterine wall)
- Retained products of conception (RPOC)
Examples of tone causes of PPH?
- Previous PPH
- Placenta praevia
- Over distension of the uterus eg multiples, polyhydramnios, macrosomia
- Uterine relaxants
Examples of trauma causes of PPH?
- C-section
- Episiotomy
- Macrosomia
Examples of other causes of PPH?
- Age
- BMI>35
- Asian ethnicity
- Anaemia
- Induction
- Prolonged labour
What is primary PPH?
- First 24 hours after birth
- > 500ml blood
- Severe >2000ml
What is secondary PPH?
- > 24 hours – 6 weeks PP
* Often caused by RPOC
What is the management of PPH?
- ABCDE
- Empty bladder
- Rub uterine fundus
- Medications
- Surgical intervention
What is the medical management of PPH?
- Oxytocin IV/injection
- Ergometrine
- Tranexamic acid
- Carboprost
- Misoprostol
What is the surgical management of PPH?
- Intrauterine balloon tamponade
- B-Lynch suture
- Hysterectomy
- Manage on clinical signs, not just estimated blood loss (EBL)
- Fluid replacement +/- blood products
What is Cord prolapse?
Descent of umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of a ruptured membrane.
What are the risk factors for cord prolapse?
- Arrangement of things in the womb: Polyhydramnios, Low-lying placenta
- Presentation of: Breech presentation, transverse/oblique/unstable lie
- More than one coming out: Multiparity, 2nd twin
- Room for the cord to fall out: Preterm labour, Low birthweight, Unengaged presenting part, Fetal congenital abnormalities
What is the management for cord prolapse?
- Call for help
- Replace cord into vagina (reduce chances of compression, vessels spasming due to cold temperature)
- Digital elevation of the presenting part
- Catheterise and fill bladder to elevate presenting part
- Encourage mother the adopt knee-chest or left lateral position with raised hips
- Consider tocolysis (suppress labour)
- Arrange a Cat 1 C section
