Obstetric Emergencies Flashcards
Antepartum Haemorrhage
Definition
Bleeding after 20 weeks until the end of the second stage
Antepartum Haemorrhage
Causes
Marginal Bleed/other (50%) Placenta Praevia (30%) Placental Abruption (20%)
Antepartum Haemorrhage
Management
Resuscitation and delivery only if maternal/fetal compromise
Anti-D if Rh-ve
Marginal Bleed
Leak in the ‘maternal lake’
Painless and non-tender
Self-limiting
Placenta not praevia on scan
Placenta Praevia
Presence of placental tissue overlying or proximate to the internal cervical os
Painless, non-tender
No contractions
Well fetus unless there is severe maternal hypotension
R/F include previous C/S, parity and age
Low grade (placenta not crossing os) vs high grade (crosses os - requires C/S)
Placental Abruption
Premature separation of the placenta from the uterus
Blood (usually maternal) leaks between the placenta and the uterus
Painful and tender
Contractions
Fetal compromise
Maternal effects include acute blood loss, DIC, multiple organ failure and PPH
Fetal effects include acute progressive hypoxia
Management - resuscitate, coagulate, deliver if possible (anti-D if Rh-ve)
Placenta Accreta
Placenta is morbidly attached to the uterine muscle rather than the lining.
R/F include previous LUSCS and placenta praevia, and age (independent RF)
Cord prolapse
Polyhydramnios on US
Made to sit in knee chest position
Theatre for Em C/S
Shoulder dystocia
Head comes out and goes back in again - “turtle necking”
Uterine rupture
Previous C/S for placenta praevia, constant lower abdominal pain, foetal bradycardia