Obstetric Emergencies Flashcards
Antepartum haemorrhage
- Assessment
Antepartum haemorrhage
- Assessment
- Quantity
- Onset
- Colour
- Membranes
- Provoked
- post-coital - Abdominal pain
- Fetal movements
- Risk factors for abruption
Ante-partum haemorrhage
- Examination
Ante-partum haemorrhage
- Examination
- Pallor, distress, cap refill, peripheries
- Abdomen
- Uterus
- woody/tense - Palable contractions
- Lie and presentation
- CTG (26 wks+)
- Notes and scans
Shoulder dystocia
- Types
- Incidence
Shoulder dystocia
- Types
1. Anterior shoulder / pubic symphysis
2. Posterior shoulder / sacral promontory - Incidence
1. 0.6-0.7% of deliveries
Shoulder dystocia
- Risk factors
Shoulder dystocia
- Risk factors
- Previous shoulder dystocia
- Macrosomia
- DM
- BMI
- Induction
- Prolonged first/second stage
- Secondary arrest
- Oxytocin augmentation
- Assisted delivery
Shoulder dystocia
- Clinical features
Shoulder dystocia
- Clinical features
- Difficulty in delivery of head/chin
- Failure of restitution
- occipital-anterior position
- delivery by extension - Turtle neck sign
- Head retracts into pelvis
Shoulder dystocia
- Mx before manoeuvres
Shoulder dystocia
- Mx
- Call for help
- Stop pushing
- Avoid downward traction
- only axial traction
- no fundal pressure - Consider episiotomy
Shoulder dystocia
- Manoeuvres
Shoulder dystocia manoeuvres
- McRoberts (90%)
- Hyperflex maternal hips - Suprapubic pressure
- sustained or rocking
- behind anterior shoulder - Posterior arm
- Instert hand into sacral hollow - Internal rotation “corkscrew”
- Pressure in front of one shoulder and behind other
- Move baby into oblique - Patient on all fours
- Others
- Cleidotomy
- Symphysiotomy
- Zaveneli
Shoulder dystocia
- Post-delivery care
Shoulder dystocia
- Post-delivery care
- Active management of stage 3
- PPH - PR exam
- 3rd degree tear - Physiotherapy review
- Pelvic floor weakness
- PSK pain/ nerve damage - Paeds review
- Brachial plexus
- Humeral fracture
- Hypoxic brain injury
Shoulder dystocia
- Maternal complications
- Fetal complications
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
Umbilical cord prolapse
- Incidence
- Types
- Mortality
Umbilical cord prolapse
- Incidence
1. 0.1-0.6% - Types
1. Occult (incomplete) - descends alongside presenting part
- Overt
- descends past presenting part
- lower in pelvis - Cord presentation
- cord between presenting part and cervix
- with or without intact membranes
- Mortality
- 91 per 1000
- high in pre-term, breech, congenital defects
Umbilical cord prolapse
- Pathology
Umbilical cord prolapse
- Pathology
- Occlusion
- Fetus pressing on cord - Arterial vasospasm
- Cold atmosphere reduces flow
Umbilical cord prolapse
- RFs
Umbilical cord prolapse
- RFs
- Breech presentation
- Unstable lie
— transverse/oblique/breeche - ARAM
- high presenting part - Polyhydramnios
- Prematurity
Cord prolapse
- Clinical features
Cord prolapse
- Clinical features
- Non-reassuring heart rate pattern
- and absent membranes - Fetal bradycardia
Umbilical cord prolapse
- Mx
Umbilical cord prolapse
- Mx
- Avoid handling the cord
- 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
- Consider tocolysis
- terbutaline
- stop contractions - Emergency Caesarian
Eclampsia
- Definition
Eclampsia
- Definition
- One or more convulsions
- Pre-eclamptic woman
- Absence of other causes (neuro/metabolic)
Eclampsia
- Prevalence
- Mortality
Eclampsia
- Prevalence
1. 5/10,000 pregnancies - Mortality
1. Maternal 1.8%
2. Fetal 30%
Eclampsia
- Period of occurence
Eclampsia
- Period of occurence
- 38% ante-partum
- 18% intra-partum
- 44% post-partum
Eclampsia
- Seizure type
- Seizure length
Eclampsia
- Seizure type
1. Tonic-clonic - Seizure length
2. 60-75 seconds
Eclampsia complications
- Maternal
- Fetal
Eclampsia complications
- Maternal
1. HELLP syndrome (3%) - Haemolysis, liver enzymes, low platelets
2. Coagulopathy (3%)
- AKI (4%)
- ARDS (3%)
- Cerebrovascular haemorrhage (2%)
- Death
- Fetal
1. IUGR
2. Prematurity
- IRDS
- IU fetal death
- Placental abruption
Eclampsia
- DDx
Eclampsia
- DDx
- Hypoglycaemia
- Epilepsy
- Head trauma
- Stroke
- Aneurysm
- Meningitis
- Septic shock
- Brain tumour
Eclampsia
- Management
Eclampsia
- 5 Step management
- Resuscitation
- AE
- Left lateral position - Magnesium sulphate
- Blood pressure control
- IV Labetalol
- IV Hydralazine
- Monitor CTG - Caesarean section
- Mother must be stable
- Ideal mode
- Intra-partum may be managed vaginally - Monitoring
- fluid balance
Eclampsia
- Post-natal care
Eclampsia
- Post-natal care
- Regular symptom review
- daily BP for 2/52 - Bloods 72 hours
- Pre-conceptual counselling
- prophylaxis and minimising risk - Step-down to community
- when stable - 6 week follow up
- BP, proteinurea, creatinine
Uterine rupture
- Types
Uterine rupture
- Types
- Incomplete
- peritoneum is intact - Complete
- peritoneum is torn
Uterine rupture
- Risk factors
Uterine rupture
- Risk factors
- Previous Caesarian
- Previous uterine surgery
- myomectomy - Induction or augmentation
- Obstruction of labour
- Multiple pregnancy
- Multi-parity
Uterine rupture
- Clinical features
Uterine rupture
- Clinical features
- Non-specific
- Abdominal pain
- sudden and severe - Shoulder-tip pain
- Vaginal bleeding
- Regression of presenting part
- Scar tenderness
- Palpable fetal parts
- Hypovolaemic shock
- Fetal distress
Uterine rupture
- Management
Uterine rupture
- Management
- Resuscitation
- Caesarian section
- Less than 30 minutes decision-incision
Amniotic fluid embolism
- Incidence
Amniotic fluid embolism
- Incidence
2/100,000
Amniotic fluid embolism
- RFs
Amniotic fluid embolism
- RFs
- Multiple pregnancies
- Maternal age
- Induction
- Uterine rupture
- Placenta praevia
- Abruption
- Cervical laceration
- Eclampsia
- Polyhydramnios
- Caesarian or instrumental
Amniotic fluid embolism
- Clinical features
Amniotic fluid embolism
- Clinical features
- Hypoxia
- Hypotension
- Fetal distress
- Seizures
- Shock
- Confusion
- Cardiac arrest
- DIC
Amniotic fluid embolism
- management
Amniotic fluid embolism
- management
- Resuscitation
- Anaesthetics involvement
- A-E
- Haematologist involvement
- DIC - Perimortem section
