Obstetric emergencies Flashcards
List three differentials for antepartum bleeding
Placental abruption
Local trauma
Placenta praevia
What is the management of antenatal bleeding?
Senior escalation
IV access
Blood tests
X-match
IV fluids (whilst awaiting packed RBC)
Analgesia
CTG
Communication
Whilst awaiting blood, what interventions can you do in the meantime?
oxygen <04%
urinary catheter
tranexamic acid
What does activation of major haemorrhage protocol result in?
designated porter
packed RBCs
FFP
+- cryoprecipitate +- platelets (only once X-match has been sent off)
Where can you get O- blood from?
A&E
Theatres
Labour ward
Cryoprecipitate contains which clotting factors?
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).
Patient has bleeding and ‘woody’ uterus. What is the likely diagnosis?
placental abruption
What is the best scoring system for sepsis
qSOFA
Why is SIRS not useful for diagnosing sepsis
Raised WCC and pyrexia- patient might feel completely with no worrying signs/symptoms
List two investigations in a patient presenting with likely ectopic pregnancy
bHCG
FBC
(no need for AXR or CT if there is no evidence of obstruction)
Which team should be phoned with ectopic pregnancy emergency?
gynae (NOT obstetrics)
How long does it take to wait for X-match?
up to 1 hour
Is free fluid on pelvic FAST scan concerning?
yes, indicates blood in abdomen
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?
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
List three signs of pre-eclapmsia
proteinuria
peripheral oedema
blurry vision
headache (signs of raised ICP)
brisk reflexes
clonus
How is significant proteinuria defined?
24 hour urine collection >300 mg protein
OR
urinary protein: creatinine ratio (PCR) > 300 mg/mmol
Is nulliparity of multiparity a risk factor for pre-eclampsia?
nulliparity
List four risk factors for pre-eclampsia
BMI >35
Age >40
pre-existing diabetes
chronic kidney disease
FH of pre-eclampsia
prev gestational hypertension
What is the initial pharmacological management of pre-eclampsia?
oral labetolol 200 mg (not IV!)
Why should you arrange LFTs in patient with pre-eclampsia?
HELLP!
haemolysis
elevated liver enzymes
low platelets
Hemolysis
Elevated
Liver enzymes
Low
Platelets
What is the management of pre-eclampsia?
Antihypertensive medication
Magnesium IV
Fluid restriction
CTG monitoring
Arterial line for blood pressure monitoring
NBM if operation
Early communication with paeds/neonates
Why is magnesium administered in pre-eclampsia?
to prevent progression to eclampsia. Monitor for magnesium toxicity
Why should steroids be administered in pre-eclampsia?
to improve fetal lung development
List three maternal complications of pre-eclampsia
eclampsia
HELLP
pulmonary oedema
intra-cerebal haemorrhage
acute renal failure
List two fetal complications of pre-eclampsia
placental abruption
intrauterine growth restriction
death
premature delivery
Green smelly discharge, fever, abdo pain in pregnant lady. What are you worried about?
chorioamnionitis
Differentials for fever and abdo pain in pregnant woman?
sepsis secondary to:
chorioamnionitis
urinary
intraperitoneal
Which empirical antibiotics would you prescribe for sepsis?
amox, gent, met
List three risk factors for placental abruption
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
List two risk factors for ectopic pregnancy
smoking
pelvic inflammatory disease history
chlamydia infection
pelvic/abdo surgery e.g. c-section or lap appendicetomy
What is the management of ectopic pregnancy?
conservative management
methotrexate
salpingectomy (in haemodynamically unstable patients)
What is the criteria for methotrexate in ectopic pregnancy?
haemodynamically stable
no intrauterine pregnancy
no fetal cardiac activity
bHCG <1500
Name two common organisms ID in pregnant women with sepsis
e.coli
beta-haemolytic strep
What is the main risk factor for pre-eclampsia?
primiparity
List three maternal emergencies
- Ante partum haemorrhage (APH)
- Post partum haemorrhage (PPH)
- Eclampsia
- Maternal collapse
- Uterine inversion
List three fetal labour emergencies
- Shoulder dystocia
- Cord prolapsed
- Fetal distress (hypoxia/acidosis)
- Malpresentation
- Failed operative delivery
List three differentials for antepartum haemorrhage
placental abruption
placental praevia
uterine rupture
cervical polyp
cervical cancer
vaginal infection
vasa previa
List three differentials for post partum haemorrhage
aTony
Trauma
Tissue
Thrombin
uTerine inversion
List three risk factors for PPH
big baby
multiple pregnancy
polyhydramnios
fibroids
prolonged labour/op
antepartum haemorrhage
List two oxytocic medicines
syntocinon
ergometrine
carboprost
misoprostol
Can oxytocic medicines be used in antepartum and postpartum haemorrhage?
ONLY in PPH!!
List two surgical options for PPH management?
intra uterine balloon device
uterine artery embolisation
hysterectomy
List two complications of the third stage of labour
PPH
uterine inversion
third/fourth degree tear
amniotic fluid embolisation
List three indications for ELECTIVE c-section/lower uterine segment c section
previous c-section
breech/abnormal lie
multiple pregnancy
placenta praevia
previous traumatic delivery/maternal request
`List three indications for EMERGENCY c-section
fetal distress
malpresentation
cord prolapse
APH
maternal sepsis
cardiac arrest
uterine rupture
Two risk factors for shoulder dystocia?
big baby
small mum
gestational diabetes
previous shoulder dystocia
Two complications of shoulder dystocia?
fetal hypoxia
fetal death
brachial plexus injury
clavicle/humerus fracture
Which position should patient be placed if shoulder dystocia?
McRoberts- knee to chest
THen turn over onto all fours
List two causes of preterm labour
cervical incompetence
infection
placental abruption
polyhydramnios
multiple pregnancy
What is the management of preterm labour?
IM steroids
IV antibiotics
Tocolysis
What is tocolysis?
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.
Why are steroids prescribed in preterm labour?
to promote fetal lung maturity
List three most common clinical manifestations of pre-eclampsia
headache
visual disturbance
epigastric pain
irritability and reduced consciousness
Two complications of pre-eclampsia?
eclampsia
cerebral vascular damage
HELLP
DIC
liver and renal failure
List two reasons why you would induce a pregnancy
post estimated due date (after term +10days)
multiple pregnancy
maternal complication
