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Year 4 - ObGyn > Obstetric Emergencies > Flashcards

Obstetric Emergencies Flashcards

1
Q

Antepartum haemorrhage
- Assessment

A

Antepartum haemorrhage
- Assessment

  1. Quantity
  2. Onset
  3. Colour
  4. Membranes
  5. Provoked
    - post-coital
  6. Abdominal pain
  7. Fetal movements
  8. Risk factors for abruption
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2
Q

Ante-partum haemorrhage
- Examination

A

Ante-partum haemorrhage
- Examination

  1. Pallor, distress, cap refill, peripheries
  2. Abdomen
  3. Uterus
    - woody/tense
  4. Palable contractions
  5. Lie and presentation
  6. CTG (26 wks+)
  7. Notes and scans
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3
Q

Shoulder dystocia
- Types
- Incidence

A

Shoulder dystocia

  • Types
    1. Anterior shoulder / pubic symphysis
    2. Posterior shoulder / sacral promontory
  • Incidence
    1. 0.6-0.7% of deliveries
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4
Q

Shoulder dystocia
- Risk factors

A

Shoulder dystocia
- Risk factors

  1. Previous shoulder dystocia
  2. Macrosomia
  3. DM
  4. BMI
  5. Induction
  6. Prolonged first/second stage
  7. Secondary arrest
  8. Oxytocin augmentation
  9. Assisted delivery
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5
Q

Shoulder dystocia
- Clinical features

A

Shoulder dystocia
- Clinical features

  1. Difficulty in delivery of head/chin
  2. Failure of restitution
    - occipital-anterior position
    - delivery by extension
  3. Turtle neck sign
    - Head retracts into pelvis
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6
Q

Shoulder dystocia
- Mx before manoeuvres

A

Shoulder dystocia
- Mx

  1. Call for help
  2. Stop pushing
  3. Avoid downward traction
    - only axial traction
    - no fundal pressure
  4. Consider episiotomy
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7
Q

Shoulder dystocia
- Manoeuvres

A

Shoulder dystocia manoeuvres

  1. McRoberts (90%)
    - Hyperflex maternal hips
  2. Suprapubic pressure
    - sustained or rocking
    - behind anterior shoulder
  3. Posterior arm
    - Instert hand into sacral hollow
  4. Internal rotation “corkscrew”
    - Pressure in front of one shoulder and behind other
    - Move baby into oblique
  5. Patient on all fours
  6. Others
    - Cleidotomy
    - Symphysiotomy
    - Zaveneli
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8
Q

Shoulder dystocia
- Post-delivery care

A

Shoulder dystocia
- Post-delivery care

  1. Active management of stage 3
    - PPH
  2. PR exam
    - 3rd degree tear
  3. Physiotherapy review
    - Pelvic floor weakness
    - PSK pain/ nerve damage
  4. Paeds review
    - Brachial plexus
    - Humeral fracture
    - Hypoxic brain injury
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9
Q

Shoulder dystocia
- Maternal complications
- Fetal complications

A

Shoulder dystocia

  • Maternal complications
    1. 3rd/4th degree tear (3-4%)
    2. PPH (11%)
  • Fetal complications
    1. Humerus/clavicle
    2. Brachial plexus (2-16%)
    3. Hypoxic brain injury
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10
Q

Umbilical cord prolapse
- Incidence
- Types
- Mortality

A

Umbilical cord prolapse

  • Incidence
    1. 0.1-0.6%
  • Types
    1. Occult (incomplete)
  • descends alongside presenting part
  1. Overt
    - descends past presenting part
    - lower in pelvis
  2. Cord presentation
    - cord between presenting part and cervix
    - with or without intact membranes
  • Mortality
  • 91 per 1000
  • high in pre-term, breech, congenital defects
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11
Q

Umbilical cord prolapse
- Pathology

A

Umbilical cord prolapse
- Pathology

  1. Occlusion
    - Fetus pressing on cord
  2. Arterial vasospasm
    - Cold atmosphere reduces flow
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12
Q

Umbilical cord prolapse
- RFs

A

Umbilical cord prolapse
- RFs

  1. Breech presentation
  2. Unstable lie
    — transverse/oblique/breeche
  3. ARAM
    - high presenting part
  4. Polyhydramnios
  5. Prematurity
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13
Q

Cord prolapse
- Clinical features

A

Cord prolapse
- Clinical features

  1. Non-reassuring heart rate pattern
    - and absent membranes
  2. Fetal bradycardia
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14
Q

Umbilical cord prolapse
- Mx

A

Umbilical cord prolapse
- Mx

  1. Avoid handling the cord
  2. Manually elevate the presenting part
    - Or fill maternal bladder with normal saline

3a Left lateral position
- head down
- pillow under left hip

3b Knee-chest position

  1. Consider tocolysis
    - terbutaline
    - stop contractions
  2. Emergency Caesarian
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15
Q

Eclampsia
- Definition

A

Eclampsia
- Definition

  1. One or more convulsions
  2. Pre-eclamptic woman
  3. Absence of other causes (neuro/metabolic)
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16
Q

Eclampsia
- Prevalence
- Mortality

A

Eclampsia

  • Prevalence
    1. 5/10,000 pregnancies
  • Mortality
    1. Maternal 1.8%
    2. Fetal 30%
17
Q

Eclampsia
- Period of occurence

A

Eclampsia
- Period of occurence

  1. 38% ante-partum
  2. 18% intra-partum
  3. 44% post-partum
18
Q

Eclampsia
- Seizure type
- Seizure length

A

Eclampsia

  • Seizure type
    1. Tonic-clonic
  • Seizure length
    2. 60-75 seconds
19
Q

Eclampsia complications

  • Maternal
  • Fetal
A

Eclampsia complications

  • Maternal
    1. HELLP syndrome (3%)
  • Haemolysis, liver enzymes, low platelets
    2. Coagulopathy (3%)
  1. AKI (4%)
  2. ARDS (3%)
  3. Cerebrovascular haemorrhage (2%)
  4. Death
  • Fetal
    1. IUGR
    2. Prematurity
  1. IRDS
  2. IU fetal death
  3. Placental abruption
20
Q

Eclampsia
- DDx

A

Eclampsia
- DDx

  1. Hypoglycaemia
  2. Epilepsy
  3. Head trauma
  4. Stroke
  5. Aneurysm
  6. Meningitis
  7. Septic shock
  8. Brain tumour
21
Q

Eclampsia
- Management

A

Eclampsia
- 5 Step management

  1. Resuscitation
    - AE
    - Left lateral position
  2. Magnesium sulphate
  3. Blood pressure control
    - IV Labetalol
    - IV Hydralazine
    - Monitor CTG
  4. Caesarean section
    - Mother must be stable
    - Ideal mode
    - Intra-partum may be managed vaginally
  5. Monitoring
    - fluid balance
22
Q

Eclampsia
- Post-natal care

A

Eclampsia
- Post-natal care

  1. Regular symptom review
    - daily BP for 2/52
  2. Bloods 72 hours
  3. Pre-conceptual counselling
    - prophylaxis and minimising risk
  4. Step-down to community
    - when stable
  5. 6 week follow up
    - BP, proteinurea, creatinine
23
Q

Uterine rupture
- Types

A

Uterine rupture
- Types

  1. Incomplete
    - peritoneum is intact
  2. Complete
    - peritoneum is torn
24
Q

Uterine rupture
- Risk factors

A

Uterine rupture
- Risk factors

  1. Previous Caesarian
  2. Previous uterine surgery
    - myomectomy
  3. Induction or augmentation
  4. Obstruction of labour
  5. Multiple pregnancy
  6. Multi-parity
25
Q

Uterine rupture
- Clinical features

A

Uterine rupture
- Clinical features

  1. Non-specific
  2. Abdominal pain
    - sudden and severe
  3. Shoulder-tip pain
  4. Vaginal bleeding
  5. Regression of presenting part
  6. Scar tenderness
  7. Palpable fetal parts
  8. Hypovolaemic shock
  9. Fetal distress
26
Q

Uterine rupture
- Management

A

Uterine rupture
- Management

  1. Resuscitation
  2. Caesarian section
    - Less than 30 minutes decision-incision
27
Q

Amniotic fluid embolism
- Incidence

A

Amniotic fluid embolism

  • Incidence
    2/100,000
28
Q

Amniotic fluid embolism
- RFs

A

Amniotic fluid embolism
- RFs

  1. Multiple pregnancies
  2. Maternal age
  3. Induction
  4. Uterine rupture
  5. Placenta praevia
  6. Abruption
  7. Cervical laceration
  8. Eclampsia
  9. Polyhydramnios
  10. Caesarian or instrumental
29
Q

Amniotic fluid embolism
- Clinical features

A

Amniotic fluid embolism
- Clinical features

  1. Hypoxia
  2. Hypotension
  3. Fetal distress
  4. Seizures
  5. Shock
  6. Confusion
  7. Cardiac arrest
  8. DIC
30
Q

Amniotic fluid embolism
- management

A

Amniotic fluid embolism
- management

  1. Resuscitation
  2. Anaesthetics involvement
  3. A-E
  4. Haematologist involvement
    - DIC
  5. Perimortem section

Year 4 - ObGyn (9 decks)

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