Obstetric emergencies

Question 1

What is shoulder dystocia

Answer 1

When the anterior foetal shoulder becomes impacted behind the mothers pubic symphysis after delivery of the foetal head

Question 2

What is the sign that shoulder dystocia has occurred

Answer 2

Turtle neck sign - the foetal head retracts back into the perineum

Question 3

What is the management of shoulder dystocia

Answer 3

Management of shoulder dystocia is putting the mother into McRoberts position and then push the anterior shoulder towards the foetal chest and the postural shoulder towards the foetal back

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)

Question 4

What is Primary PPH - post partum haemorrhage

Answer 4

More than 500ml blood in first 24 hours following birth

Question 5

What is secondary PPH

Answer 5

more than 500ml blood between 24 hours and up to 6 weeks post delivery

Question 6

What is the management of PPH

Answer 6

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)