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1 Obs & Gyn > Obstetric emergencies > Flashcards

Obstetric emergencies Flashcards

1
Q

List three differentials for antepartum bleeding

A

Placental abruption
Local trauma
Placenta praevia

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2
Q

What is the management of antenatal bleeding?

A

Senior escalation
IV access
Blood tests
X-match
IV fluids (whilst awaiting packed RBC)
Analgesia
CTG
Communication

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3
Q

Whilst awaiting blood, what interventions can you do in the meantime?

A

oxygen <04%
urinary catheter
tranexamic acid

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4
Q

What does activation of major haemorrhage protocol result in?

A

designated porter
packed RBCs
FFP
+- cryoprecipitate +- platelets (only once X-match has been sent off)

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5
Q

Where can you get O- blood from?

A

A&E
Theatres
Labour ward

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6
Q

Cryoprecipitate contains which clotting factors?

A

fibrinogen (essential for effective blood clotting)
Factor VIII (the protein missing in patients with haemophilia A)
Factor XIII (helps stabilise clots)
von Willebrand factor (helps the platelets stick together).

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7
Q

Patient has bleeding and ‘woody’ uterus. What is the likely diagnosis?

A

placental abruption

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8
Q

What is the best scoring system for sepsis

A

qSOFA

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9
Q

Why is SIRS not useful for diagnosing sepsis

A

Raised WCC and pyrexia- patient might feel completely with no worrying signs/symptoms

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10
Q

List two investigations in a patient presenting with likely ectopic pregnancy

A

bHCG
FBC
(no need for AXR or CT if there is no evidence of obstruction)

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11
Q

Which team should be phoned with ectopic pregnancy emergency?

A

gynae (NOT obstetrics)

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12
Q

How long does it take to wait for X-match?

A

up to 1 hour

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13
Q

Is free fluid on pelvic FAST scan concerning?

A

yes, indicates blood in abdomen

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14
Q

List three tasks you can do whilst awaiting transfer to theatre/gynae team arriving/once they have told you the patient needs to go to theatre?

A

oxygen
activate MHP
transfuse more blood products
contact anaesthetist
contact theatre coordinator
contact blood bank to increase X-match to 6 units and inform that location will change from ED to resus
Tranexamic acid
analgesia
getting equipment ready for transfer

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15
Q

List three signs of pre-eclapmsia

A

proteinuria
peripheral oedema
blurry vision
headache (signs of raised ICP)
brisk reflexes
clonus

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16
Q

How is significant proteinuria defined?

A

24 hour urine collection >300 mg protein
OR
urinary protein: creatinine ratio (PCR) > 300 mg/mmol

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17
Q

Is nulliparity of multiparity a risk factor for pre-eclampsia?

A

nulliparity

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18
Q

List four risk factors for pre-eclampsia

A

BMI >35
Age >40
pre-existing diabetes
chronic kidney disease
FH of pre-eclampsia
prev gestational hypertension

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19
Q

What is the initial pharmacological management of pre-eclampsia?

A

oral labetolol 200 mg (not IV!)

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20
Q

Why should you arrange LFTs in patient with pre-eclampsia?

A

HELLP!
haemolysis
elevated liver enzymes
low platelets

Hemolysis
Elevated
Liver enzymes
Low
Platelets

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21
Q

What is the management of pre-eclampsia?

A

Antihypertensive medication
Magnesium IV
Fluid restriction
CTG monitoring
Arterial line for blood pressure monitoring
NBM if operation
Early communication with paeds/neonates

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22
Q

Why is magnesium administered in pre-eclampsia?

A

to prevent progression to eclampsia. Monitor for magnesium toxicity

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23
Q

Why should steroids be administered in pre-eclampsia?

A

to improve fetal lung development

24
Q

List three maternal complications of pre-eclampsia

A

eclampsia
HELLP
pulmonary oedema
intra-cerebal haemorrhage
acute renal failure

25
Q

List two fetal complications of pre-eclampsia

A

placental abruption
intrauterine growth restriction
death
premature delivery

26
Q

Green smelly discharge, fever, abdo pain in pregnant lady. What are you worried about?

A

chorioamnionitis

27
Q

Differentials for fever and abdo pain in pregnant woman?

A

sepsis secondary to:
chorioamnionitis
urinary
intraperitoneal

28
Q

Which empirical antibiotics would you prescribe for sepsis?

A

amox, gent, met

29
Q

List three risk factors for placental abruption

A

previous placental abruption
smoking
cocaine or amphetamine user
pre-existing hypertension
pre-eclampsia
trauma; has she been involved in a car accident; has she fallen; has she been assaulted
fetal growth restriction
non-vertex presentations
polyhydramnios
advanced maternal age
multiparity
low body mass index (BMI)
pregnancy following assisted reproductive techniques
intrauterine infection
premature rupture of membranes
first trimester bleeding

30
Q

List two risk factors for ectopic pregnancy

A

smoking
pelvic inflammatory disease history
chlamydia infection
pelvic/abdo surgery e.g. c-section or lap appendicetomy

31
Q

What is the management of ectopic pregnancy?

A

conservative management
methotrexate
salpingectomy (in haemodynamically unstable patients)

32
Q

What is the criteria for methotrexate in ectopic pregnancy?

A

haemodynamically stable
no intrauterine pregnancy
no fetal cardiac activity
bHCG <1500

33
Q

Name two common organisms ID in pregnant women with sepsis

A

e.coli
beta-haemolytic strep

34
Q

What is the main risk factor for pre-eclampsia?

A

primiparity

35
Q

List three maternal emergencies

A
  1. Ante partum haemorrhage (APH)
  2. Post partum haemorrhage (PPH)
  3. Eclampsia
  4. Maternal collapse
  5. Uterine inversion
36
Q

List three fetal labour emergencies

A
  1. Shoulder dystocia
  2. Cord prolapsed
  3. Fetal distress (hypoxia/acidosis)
  4. Malpresentation
  5. Failed operative delivery
37
Q

List three differentials for antepartum haemorrhage

A

placental abruption
placental praevia
uterine rupture
cervical polyp
cervical cancer
vaginal infection
vasa previa

38
Q

List three differentials for post partum haemorrhage

A

aTony
Trauma
Tissue
Thrombin
uTerine inversion

39
Q

List three risk factors for PPH

A

big baby
multiple pregnancy
polyhydramnios
fibroids
prolonged labour/op
antepartum haemorrhage

40
Q

List two oxytocic medicines

A

syntocinon
ergometrine
carboprost
misoprostol

41
Q

Can oxytocic medicines be used in antepartum and postpartum haemorrhage?

A

ONLY in PPH!!

42
Q

List two surgical options for PPH management?

A

intra uterine balloon device
uterine artery embolisation
hysterectomy

43
Q

List two complications of the third stage of labour

A

PPH
uterine inversion
third/fourth degree tear
amniotic fluid embolisation

44
Q

List three indications for ELECTIVE c-section/lower uterine segment c section

A

previous c-section
breech/abnormal lie
multiple pregnancy
placenta praevia
previous traumatic delivery/maternal request

45
Q

`List three indications for EMERGENCY c-section

A

fetal distress
malpresentation
cord prolapse
APH
maternal sepsis
cardiac arrest
uterine rupture

46
Q

Two risk factors for shoulder dystocia?

A

big baby
small mum
gestational diabetes
previous shoulder dystocia

47
Q

Two complications of shoulder dystocia?

A

fetal hypoxia
fetal death
brachial plexus injury
clavicle/humerus fracture

48
Q

Which position should patient be placed if shoulder dystocia?

A

McRoberts- knee to chest
THen turn over onto all fours

49
Q

List two causes of preterm labour

A

cervical incompetence
infection
placental abruption
polyhydramnios
multiple pregnancy

50
Q

What is the management of preterm labour?

A

IM steroids
IV antibiotics
Tocolysis

51
Q

What is tocolysis?

A

Tocolysis is an obstetrical procedure carried out with the use of medications with the purpose of delaying the delivery of a fetus in women presenting preterm contractions.

52
Q

Why are steroids prescribed in preterm labour?

A

to promote fetal lung maturity

53
Q

List three most common clinical manifestations of pre-eclampsia

A

headache
visual disturbance
epigastric pain
irritability and reduced consciousness

54
Q

Two complications of pre-eclampsia?

A

eclampsia
cerebral vascular damage
HELLP
DIC
liver and renal failure

55
Q

List two reasons why you would induce a pregnancy

A

post estimated due date (after term +10days)
multiple pregnancy
maternal complication

1 Obs & Gyn (31 decks)

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