Obstetric emergencies Flashcards
shoulder dystocia
Shoulder dystocia occurs when the anterior fetal shoulder becomes impacted behind the maternal pubic symphysis after delivery of the fetal head.
thought process initially before managemnet of shoulder dystocia
A series of manoeuvres are used to dislodge the fetal shoulder. As fetal oxygen levels can drop steeply during the management of shoulder dystocia, effective teamwork and a well-rehearsed approach to management is essential. A helicopter view of the situation is important in order to anticipate what will be needed.. Eg. a senior obstetrician, a paediatrician to attend to baby immediately after the birth, a scribe to keep a note of timings which can help decide on what manoeuvre to try next
Management of Shoulder Dystocia
H – Call for Help
E – Evaluate for Episiotomy
L – Legs (McRoberts Position)
P – Suprapubic Pressure
E – Enter Manouvers (Internal Rotation)
R – Remove the Posterior Arm
R – Roll the Patient (Onto all Fours)
what are the causes of PPH
thrombin
tissue
tone
trauma
other
thrombin
preeclampsia
placental abruption
pyrexia in labour
bleeding disorders
tissue
retained placenta
placenta accreta
retained products of conception
tone
placenta praevia
over distention of uterus
uterine relaxants
previous PPH
trauma
previous caesarian
episiotomy
macrosomnia
other
asian ethnicity
anaemia
induction
bmi>35
prolonged labour
age
primary PPH
(99% of all PPH) - in first 24 hours after delivery >500ml blood (common 1/20 women)
Severe Haemorrhage >2000ml (rare 6/1000)
secondary PPH
24 hours to up to 6 weeks post delivery. (often cause by RPOC)
management of PPH medically
Call for help!
ABCDE…
Empty Bladder
Rub up uterine fundus by massaging above the umbilicus
Medications:
Oxytocin 5iu slow iv injection
Ergometrine 0.5mg slow iv injection (not if high BP)
Oxytocin infusion
Tranexamic acid 1g IV
Carboprost 0.25mg im (max 8 doses
Misoprostol 800 micrograms)
surgical management of PPH
Intrauterine Balloon tamponade
Interventional Radiology
B-Lynch Suture
Hysterectomy
Manage on clinical signs not just EBL.
Fluid Replacement +/- Blood Products
what is a cord prolapse
the descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membrane.
The overall incidence of cord prolapse ranges from 0.1–0.6%. In the case of breech presentation, the incidence is higher at 1%.
management of cord prolapse
Call for Help!
Replace cord into vagina (not uterus)
Perform digital elevation of the presenting part
Catheterise and fill bladder to elevate presenting part.
Encourage mother to adopt Knee-Chest or left lateral position with raised hips
Consider tocolysis
Arrange for a Category 1 C-Section.
