Obstetric emergencies Flashcards
Who is at risk for shoulder dystocia?
Diabetic mothers. Obese mothers. Multiparous women. Assisted deliveries. History of shoulder dystocia. Suspected large baby. Patients with abnormal fetuses.
What are the fetal complications of shoulder dystocia?
Bruising. Hypoxia. HIE. CP. Dislocations. Brachial nerve injuries. Lacerations.
What are the maternal complications of shoulder dystocia?
Perineal trauma - tears and lacerations. Uterine rupture. PPH (atonic uterus). Postpartum infections. Lateral femoral nerve palsy.
What is cord prolapse?
Protrusion of the umbilical cord in front of or with the presenting part
What is overt cord prolapse?
Overt prolapse- the cord protrudes in front of the presenting part into or out of the vagina. Membranes have ruptures and the cord can be palpated on VE or seen.
What is occult cord prolapse?
Occult prolapse- the cord descends with the presenting part. Membranes can be intact or ruptured. The cord is not visible.
What are the two types of cord prolapse?.
Overt and occult
What are the risk factors for cord prolapse?
Multiple pregnancy. Uterine abnormalities. Fetal abnormalities. High presenting part. Polyhydramnios. Malpresentation. ECV. Premature delivery. IUGR. Low lying placenta. Multigravid.
What is a cord presentation?
The umbilical cord sits in front of the presenting part above the internal os. The membranes are intact.
At what gestational age does cord presentation become worrying?
32/52
Steps to follow in shoulder dystocia.
Help. Time, inform
Edge of bed
McRoberts
Anterior shoulder (supra pubic pressure on fetal back side)
- evaluate perineum if episiotomy is needed -
Posterior shoulder (rubins, corkscrew-woods, sweeping arm)
Gaskin (move onto all fours)
Salvage maneuvers (fracture clavicle, zavanelli, arm sling, symphisiotomy)
