Obstetric emergencies

Question 1

What are the obstetric emergencies?

Answer 1

Breech
Cord prolapse
PPH
Uterine Rupture
Shoulder dystocia

Question 2

What is Breech?

Answer 2

fetal buttock or lower limb presenting

Question 3

What are the types of Breech + incidence

describe each type

Answer 3

Frank: 60% - flex hips extend knees
Complete: 10% - flex flex
Footling: 30% foot presenting

Question 4

Indicence of breech?

Answer 4

3-4% of pregnancies

Question 5

Breech risk factors?

Answer 5

Maternal
uterine
pelvic: fibroids, shape
grand multi

Materno-fetal
placenta previa, amniotic fluid (poly/oligo)

Fetal
congenital malformations
PRE TERM!!
mutliple gestation

Question 6

How would you manage Breech?

Answer 6

Mx

1. ECV
2. Trial of vaginal birth
3. C/S

but as always:
Hx, Ex, Ix, Mx

Question 7

Explain ECV

risks? success rate? contraindications?

Answer 7

risks= abruption or cord compression
success= 65%
contraindications: T3 bleed, prior classic C/S, abnormal USS, PROM, IUGR, HPTN, Previa

Question 8

In what instances do you give Anti-D?

Answer 8

Normally:
at 28 and 34 weeks in Rh-ve
at birth if baby is O pos and mother O neg

Also:
Ectopic
Miscarriage
TOP
APH: abruption, previa
Invasive manouvers: ECV
Abdo trauma
CVS/Aminiocentesis

Question 9

What is checked at the 20 week morphology screen?

Answer 9

morphology: HC, AC, BPD, femur+humerous (calculate age)
AFI
placental location
cervix dimension
multiple gestation
congenital abnormalities
gender

Question 10

What is uterine rupture?

Answer 10

uterine cavity and peritoneal cavity communicate.

tear of old scar commonly after C/S

Question 11

What are the risks for Uterine ruptue?

Answer 11

previous LSCS, 
classicac C/S, 
uterine abnromalities, 
uterine trauma, 
EXCESSIVE STIMULATION

Question 12

Clinically signs of uterine rupture?

Answer 12

Abdo pain, 
PV bleed, 
fetal distress,
 signs of shock,
 hypotonic uterus

Question 13

Mx of uterine rupture

Answer 13

DELIVER AND SURGICAL MX

usually requires hysterectomy

Question 14

Complications of uterine rupture

Answer 14

death
 shock
DIC
Hx
fetal death
 Amniotic fluid embolus

Question 15

What is umbilical cord prolapse?

Answer 15

descent of cord below presenting art of fetus causing cord compression

Question 16

Aeitiology/Risk factors of cord prolapse

Answer 16

malpresentation
 oligohydramnios
Preterm
 PROM
 multiple gestiation

Question 17

Clinical features of cord prolapse

Answer 17

visible or palpable cord

CTG/FHR changes

Question 18

Mx of cord prolapse

Answer 18

1. HEIM
2. CTG monitoring + USS + O2 for mum
3. Assess labor
4. do not replace cord
5. tocolytics
6. emergecny C/S

Question 19

What is shoulder dystocia

Answer 19

impaction of anterior shoulder against symphysis

life threatening emergency

Question 20

What are the risk factors for shoulder dystocia?

Answer 20

Maternal
DM
Obese
multiparity

Fetal
macrosomia

Other: prolonged LABOR

Question 21

Clinical features of Shoulder Dystocia?

Answer 21

Turtles sign

Question 22

Complications of shoulder dystocia?

Answer 22

1. fetal asphyxiation/death
2. fetal fractures
3. erbs palsy
4. Maternal perineal damage

Question 23

Mx of Shoulder Dystocia

Answer 23

Help
Eepisiotomy
Leg lift (Mc roberts)
Pressure suprapubically (RUBINS I)
Enter manouvers
Remove anterior shouler
Roll over
Resort (LAST) -- x3: Zavenalli, symphisiotomy, clavicle fracture