Obstetric Emergencies

Question 1

Supine Hypotension Syndrome

Answer 1

Aortalcaval compression - compression of inferior vena cava and aorta by the gravid uterus
Risk factors: late pregnancy, supine

Question 2

Pre-Eclampsia

Answer 2

Widespread vascular endothelial malfunction and vasospasm occuring after 20 weeks gestation
Caused by mismatch of placental and vascular endothelial growth factors
Hyertension

Question 3

Eclampsia

Answer 3

New onset of tonic clonic seizure or coma during pregnancy
Includes: seizure, headache, hyperactive reflexes, marked proteinuria, generalised oedema, visual disturbances, RUQ or epigastric pain

Question 4

Ectopic Pregnancy

Answer 4

The embryo attaches outside the uterus

Question 5

Signs and Symptoms of Ectopic Pregnancy

Answer 5

abdo pain, vaginal bleeding, sharp dull or crampy pain, pain may spread to shoulder, severe bleeding may cause fast HR, fainting and shock

Question 6

Risk factors of Ectopic Pregnancy

Answer 6

PID, tobacco smoking, assisted reproductive technology, previous ectopic

Question 7

Vaginal Bleeding causes

Answer 7

implantation bleeding, cervical lesions, abortion, ectopic pregnancy, incompetent cervix

Question 8

Abortion

Answer 8

expulsion of products of conception from the uterus via the birth canal before 20 weeks
Foetal causes: foetal abnormality, poor implantation, abruption of the ovum
Trauma: MCA, direct blow, criminal interference, abdo surgery
Maternal causes: diseases, ABO incompatibility, drugs, psychological, retroverted uterus, myomas

Question 9

Spontaneous abortion

Answer 9

period of unease prior to onset of symptoms

vaginal bleeding, pain in centre lower abdo, intermittent backache

Question 10

Missed abortion

Answer 10

foetus has died and is retained with placenta in uterus

pain and bleeding stops, followed by brown discharge

Question 11

Threatened abortion

Answer 11

pain, vaginal bleeding, cervical as closed, membranes intact

Question 12

Inevitable abortion

Answer 12

free vaginal bleeding, ruptured membranes
amniotic fluid seen, more acute abdo pain
rhythmic, foetal sac and content protruding through dilating cervical os

Question 13

Incomplete abortion

Answer 13

usually before 2nd trimester
foetus expelled but part of placenta retained
profuse bleeding, abdo pain, backache may cease

Question 14

Septic Abortion

Answer 14

infection resulting from abortion

unwell, headache, nausea, sweating and shivering, flushed skin, increased temp

Question 15

Incompetent Cervix

Answer 15

cervix dilates painlessly, feotus is expelled complete with placenta and membranes
due to weakness of retaining sphincter mechanism at the function of the uterus and cervix
most frequently at 16 weeks

Question 16

Cervical Shock

Answer 16

cervix goes into shock spasm due to foreign body being caught in neck of cervix
Stimulation/irritation of cervix leads to PNS hyperactivity leads to bradycardia and hypotension

Question 17

Antepartum Haemorrhage

Answer 17

after 20 weeks gestation and before onset of labour
If bleeding severe, increased risk of death to foetus and mother
If not severe, foetus may be subject to hypoxia
Causes: placenta praevia, placental abruption, vasa praevia, other

Question 18

Placental Praevia

Answer 18

Placenta is partially or wholly implanted in the lower uterine segment
Type 1 - majority of placenta in upper segment
Type 2 - partially located into the lower segment near the internal os
Type 3 - placenta loated over internal os but not centrally
Type 4 - placenta located centrally over os

Question 19

Causes of Placenta Praevia

Answer 19

delay implantation, multiparity, uterine scarring

Question 20

Presentation of Placenta Praevia

Answer 20

painless bleeding from vagina, may be mild mod or severe, blood will be bright red, premature labour, shock

Question 21

Placental Abruption

Answer 21

Premature separation of a normally situated placenta occurring after 20 weeks
Bleeding from maternal venous sinuses into placenta bed leads to further separation of placenta leads to blood retained in placenta therefore infiltrates myometrium leads to extravasations causing marked damage such as bruising and oedema

Question 22

Causes of Placental Abruption

Answer 22

pre-eclampsia, sudden reduction in size of uterus, direct trauma to abdo, domestic violence

Question 23

Cord Prolapse

Answer 23

umbilical cord lies in front or beside presenting part in presence of ruptured membranes
Predisposing factors: high presenting part of uterus, woman whos had more than 5 babies, prematurity, multiple pregnancy, polyhydraminos - excessive fluid volume, malpresentation - breech

Question 24

Shoulder dystocia

Answer 24

failure of shoulders to traverse the pelvis spontaneously after delivering the head
Warning signs: head advanced slowly, chin has difficulty, once head delivered, may seem like it wants to go back in, alternately prolonged head to body delivery time, do not restitute baby’s head

Question 25

Risk factors for shoulder dystocia

Answer 25

``` mother over 35 maternal weight greater than 90kg large baby maternal diabetes platypelloid pelvis ```

Question 26

Post-partum haemorrhage

Answer 26

excessive bleeding from woman's genital tract or anytime following baby's birth up to 6 weeks after caused by atonic uterus which fails to contract

Question 27

Causes of post-partum haemorrhage

Answer 27

incomplete placental separation, retained cotyledons, precipate labour, prolonged labour, polydraminos or multiple pregnancy, placenta praevia, infection, general anaesthesia, mismanagement of 3rd stage labour

Question 28

Risk factors of post-partum haemorrhage

Answer 28

previous history, high parity, uterine fibroids, anaemia