Obstetric Emergencies

Question 1

What is the definition of eclampsia?

Answer 1

The occurrence of tonic-clinic seizures with a diagnosed pre-eclampsia.

Question 2

What are the possible causes of eclampsia?

Answer 2

Cerebral oedema and ischemia.

Question 3

What is the risk of seizure occurrence in relation to delivery?

Answer 3

Risk of seizure greatest in first 24 hours; can occur before, during, or after delivery.

Question 4

What is the initial management step for a seizure?

Answer 4

Call for help.

Question 5

What is the treatment regimen for eclampsia?

Answer 5

MgSO4 4g loading + 1g/h IVI.

Question 6

What is the primary cure for eclampsia?

Answer 6

Delivery of the placenta.

Question 7

What characterizes HELLP syndrome?

Answer 7

Haemolysis, elevated LFTs, low platelets.

Question 8

What are common symptoms of HELLP syndrome?

Answer 8

RUQ/epigastric pain, nausea, vomiting, tea-colored urine.

Question 9

What are the complications associated with HELLP syndrome?

Answer 9

AKI, placental abruption, stillbirth.

Question 10

What are the differential diagnoses for HELLP syndrome?

Answer 10

• Biliary colic * Cholecystitis * Hepatitis * GORD * Gastroenteritis * Pancreatitis * Ureteral calculi or pyelonephritis * ITP or TTP.

Question 11

What is the management approach for HELLP syndrome?

Answer 11

As per severe pre-eclampsia: stabilize mum, evaluate fetus, determine delivery timing/route.

Question 12

What is the definition of postpartum hemorrhage?

Answer 12

> 500 ml blood loss.

Question 13

What are some antepartum risk factors for postpartum hemorrhage?

Answer 13

• Pre-eclampsia
• Nulliparity
• Multiple gestation
• Previous PPH
• Previous C-section.

Question 14

What is one key prevention strategy for postpartum hemorrhage?

Answer 14

Actively manage the third stage of labor.

Question 15

What are the two types of third stage management?

Answer 15

• Expectant * Active.

Question 16

What is the most common cause of postpartum hemorrhage?

Answer 16

Tone (uterine atony).

Question 17

What are the four main causes of postpartum hemorrhage known as the 4Ts?

Answer 17

• Tone (70%) * Trauma (20%) * Tissue (10%) * Thrombin (1%).

Question 18

What is the first-line oxytocic agent for managing postpartum hemorrhage?

Answer 18

Oxytocin.

Question 19

What are the side effects of prostaglandins used in postpartum hemorrhage?

Answer 19

• Nausea * Diarrhea * Flushing * Headache.

Question 20

What is a key sign of uterine inversion?

Answer 20

Shock disproportionate to blood loss.

Question 21

What are the signs of uterine rupture?

Answer 21

• Sudden change in FHR tracing * Vaginal bleeding * Abdominal tenderness * Maternal tachycardia.

Question 22

What characterizes retained placenta?

Answer 22

Placenta not delivered within 30 minutes.

Question 23

What is the management for coagulopathy in postpartum hemorrhage?

Answer 23

Treat underlying disorder, maintain fibrinogen, platelets, and hematocrit levels.

Question 24

What is the first step in the OSCE PPH drill?

Answer 24

Call for senior help.

Question 25

What are the signs and symptoms of sepsis in the postpartum period?

Answer 25

• Vaginal bleeding/pain * Fever * Nausea * Tachycardia * Tender uterus.

Question 26

What is the definition of shoulder dystocia?

Answer 26

Delivery that requires additional obstetric manoeuvres to release the shoulder after gentle downward traction fails.

Question 27

What are the antenatal risk factors for shoulder dystocia?

Answer 27

• Macrosomia * Previous big baby or shoulder dystocia * Maternal diabetes * Obesity.

Question 28

What is the management acronym for shoulder dystocia?

Answer 28

HELPER.

Question 29

What is cord prolapse?

Answer 29

When the umbilical cord descends alongside the presenting part before delivery.

Question 30

What are the types of cord prolapse?

Answer 30

• Occult prolapse
• Cord presentation
• Cord (overt) prolapse.

Question 31

What is the management aim for cord prolapse?

Answer 31

Preserve membranes and expedite delivery.

Question 32

What can be a complication of cord prolapse?

Answer 32

Foetal anoxia and death.