Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Womens health > Obstetric emergencies > Flashcards

Obstetric emergencies Flashcards

1
Q

Placental praevia

A

low lying placenta: placenta overlying or within 2cm of the OS -> repeat US at 34wk to confirm true placenta praevia

major: overlying the OS
minor: within 2cm of OS

if normal at 34wk -> low lying placents

between 20-34wk: no sex, no VE, present if bleeding, consent for blood transfusion, hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Placenta Praevia RX factors and Symptoms

A

Previous C section or Uterine surgery

Painless PV bleeding after 20wk

Abnormal Lie (placenta in the way) + high presenting part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Placenta Praevia IX + MX

A

IX as per APH

Early term elective C section at 38wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Placental abrutpion definition

A

premature separation of the placenta from the uterine wall -> visible or concealed bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Placental abrutpion RX and SX

A

Cocaine, Trauma (MVA)

Painful PV bleeding + constantly tender uterine contraction (not intermittent like in labour)

decreased fetal movements

EX: extremely tender woody hard uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Placental abruption IX and MX

A

IX as per APH
- TVUS or ABUS for retroplacental clot (cannot R/O retroplacental clot)

MX
- as per APH
- next presentation -> aspirin and high dose folate supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Placenta Accreta definition

A

Accreta: placental villi attached to myometrium and not decidua
Increta: penetrates into myometrium
percreta: penetrates through myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Placenta Accreta RX and SX

A

history of uterine surgery (affecting the myometrium like FIBROIDS)
previous C/S

SX: painless APH

EX: abnormal lie and mobile presenting part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Placental accreta IX and MX

A

IX
- US at 20wk : venous lakes on the placenta and bulging of the placenta
- repeat at 34wk to confirm +/- MRI to determine level of invasion
- Elevated AFP

MX
- nothing in vagina, to hospital if bleeding, consent for blood transfusion, hysterectomy
- 36+ elective C/S to beat labor + manual removal of placenta +/- hysterectomy if too attached.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Vasa Praevia definition

A

fetal blood vessels are present in the membranes covering the internal OS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vasa Praevia RX and SX

A

RX: not been to previous antenatal appointments -> not picked up on US

SX: painless APH with ROM, Fetal distress with sinusoidal pattern

IX: vasa praevia and velamentous cord insertion on US 20wk -> do color TVUS doppler

EX: VE -> palpation of vessels on fetal membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vasa praevia MX

A

Elective C/S at 34wk prior to ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Uterine rupture

A

Separation of the entire thickness of uterine wall -> extrusion of fetal parts/ intra-amniotic contents into the peritoneal cavity

mainly in VBAC
previous myomectomy

SX: sudden peritonism during labour with constant abdominal pain, bleeding, shoulder tip pain, maternal shock

EX: bandl’s ring

emergency C/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PPH definitions

A

loss of >500ml blood in vaginal
loss of >750ml in C/S

Severe PPH >1000ml or hemodynamically unstable

Primary PPH within 24h of delivery
secondary >24h but within 6wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

secondary PPH usually due to?

A

Endometritis or retained products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Uterine Atony for PPH

A

Prolonged Labour (uterine exhaustion)

Overdistension (twins, polyhydramniosis, macrosomia)

Oxytocin withdrawal (loss of stimulus to contact)

Instrumental birth

Uterus is soft, boggy and enlarged (filled with blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Uterine Atony for PPH

A

Prolonged Labour (uterine exhaustion)

Overdistension (twins, polyhydramniosis, macrosomia)

Oxytocin withdrawal (loss of stimulus to contact)

Instrumental birth

Uterus is soft, boggy and enlarged (filled with blood)

17
Q

Trauma causes of PPH

A

Uterine rupture or inversion (pull out placenta prior to clinical signs of separation (gush of blood from vagina and lengthening of the cord) -> inversion
uterus cannot be palpated on abdominal exam
Uterus inverting and striking cervix -> can cause cervical shock (bradycardia and hypotension, vagus nerve)
RX: grand multiparity and accreta

Perineal, cervical, vaginal, uterine (C/S) tears

18
Q

Tissue PPH

A

Retained POC, placenta, clots, membranes -> prevent contraction

19
Q

Thrombin PPH

A

Coagulopathy, DIC (from amiotic fluid embolus), PET

20
Q

PPH MX

A
  1. Call code, send for help, communicate with patient/partner, allocate roles so following steps can be done simultaneously
  2. DRSABCDE
  3. Stop bleeding
  4. Document and debrief
21
Q

PPH DRSABCDE

A

estimate blood loss, fluid chart, IDC (deflate bladder for uterine contractions, FBE for coauglopathy, G+H, 2 IV access, warm crystaloid fluids

keep warm with blankets

Activate Massive transfusion protocol

22
Q

PPH stop bleeding

A
  1. uterine fundal massage
  2. bimanual compression
  3. Give TXA
  4. Uterotonics
23
Q

PPH Utero tonics first line

A

1 of

Oxytocin (AKA syntocinon)
- 10u IM if no IV access or 10u slowly via IV
- Hypotension, hyponatremia, ECG changes

Ergometrine IV or IM
- CI: HTN, cardiac disease, PVD, placenta in situ
- ADR: V, HTN, placental entrapment. give with anti-emetic

Sytometrin IM
- Oxy and Ergometrin

24
Q

PPH utero tonics Second line

A

IV oxytocin 40u in 500ml over 4h

25
Q

PPH 3rd line uterotonics

A

Misoprostol (sublingual or rectally)
CI asthma
ADR: abdominal pain, V, diarrhea, BP changes

26
Q

PPH fourth line uterotonic

A

Carboprost IM or intramyometrial
CI asthma

27
Q

PPH Surgical management

A

Balloon tambonade and take to therater
Bakari balloon
bilateral ligation of uterine arteries
hysterectomy

28
Q

PPH stop bleeding

A

deliver the placenta, make sure its complete -> not coming out -> theater

29
Q

PPH tears

A

inspect genitals for tears and suture and apply pressure

30
Q

Shoulder dystocia definition

A

anterior shoulder is stuck behind the pubic symphysis

During second stage of delivery, exaggerated delay between when head comes out and body comes out (more than 1 min)

Failure to deliver shoulders using gentle downward traction only

Requirement of additional delivery maneuvers are needed.

31
Q

SX of shoulder dystocia

A

difficult to deliver face and chin

head remaining tightly applied to vulva or retracting -> turtle neck sign

32
Q

Shoulder dystocia MX

A
  1. send for help
  2. stop pushing, CTG, DRSABCD
  3. Mc Robert’s: Knees to Nips
  4. suprapubic pressure (rubin 1)
  5. evaluate for episiotomy -> do it
  6. deliver the posterior shoulder
  7. Internal maneuver: Rubin 2 -> woods screw -> reverse wood screw
  8. all fours and repeat internal maneuvers
  9. last line symphysiotomy, zavanelli, cleidotomy
  10. acitve 3rd stage management
  11. cord lactates
  12. document debrief
33
Q

Shoulder dystocia maneuver purpose

A

increased pelvic diameter
narrow bisarcomial diameter by shoulder adduction
movement of bisarcomial diameter into oblique

34
Q

prevention of shoulder dystocia

A

elective C/S for women with DM and estimated wiehgt >4500 or women with baby >5000g

35
Q

CX of shoulder dystocia

A

Erbs palsy: adducted and internally rotated arm

clavicle fracture (asymetrical morrow reflex, decreased ROM)

birth asphyxia

Rash on face due to venous congestion

36
Q

Cord prolapse

A

Occult: umbilical cord and presenting part together but not past

overt: umbilical cord past the presenting part

37
Q

cord prolapse CX

A

fetal hypoxia

38
Q

RX of cord prolapse

A

breech

polyhydramnios: more fluid

multi gestation

disengaged head, high presenting part

preterm/SGA, LBW

Artificial ROM when presenting part is not engaged/high presenting part

39
Q

Cord prolapse SX

A

pulsatile mass on VE or visualized on speculum

CTG: deep variable decelerations after ROM, bradycardia due to hypoxia

40
Q

Cord prolapse MX

A

send for help
do not touch cord
CTG, DRSABCD
knees to chest or left lateral
push presenting part upwards using fingers
or fill bladder with a catheter
discontinue oxytocin and consider tocolysis if CS delay
emergency C/S (within 30mins if prolapse occuring)
- if delay to theater -> instrumentation if safe
post birth -> cord lactates -> assess fetal hypoxia
debrief and document

Womens health (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions