Obstetric emergencies

Question 1

Major causes of Pph

Answer 1

Tone- atonic uterus
Trauma including ruptured uterus
Tissue- retained placenta/ retained fragment of a placenta
Thrombin- coagulopathies

Uterine inversion (rare)

Question 2

Prevention of pph

Answer 2

1. Routine iron supplementation to prevent anaemia
2. At risk women deliver in level 1 or level 2 hospital
3. Prevent prolonged labour
4. Active management of third stage of labour
5. Routine post partum monitoring of vital signs and bleeding
6. The bladder should be empty

Question 3

What defines excessive blood loss?

Answer 3

> 500 ml after vaginal delivery and > 1000 ml at Caesarian section

Question 4

What are the predisposing factors for cord prolapse?

Answer 4

• polyhydramnios
• abnormal lie or presentations
• high presenting part ( eg second twin)
• SGA
• pre term labour

Question 5

What is important when artificially rupturing membranes to prevent cord prolapse?

Answer 5

Controlling the escaping fluid after rupturing membranes and checking for a prolapsed cord

Question 6

What problem could be precipitated when a cord prolapses?

Answer 6

Rapid outflow of fluid that produced the prolapse may equally be responsible for detachment of the placenta

Question 7

What does a cord prolapse set contain?

Answer 7

• 2 x foleys catheters
• 5 ml syringe
• vacolitre of normal saline
• infusion set and clamp for catheter

Question 8

What are the risk factors for shoulder dystocia?

Answer 8

1. Obese patients
2. Diabetic patients
   3 suspected or predicted large baby
3. History of previous shoulder dystocia
4. Patients with abnormal fetus
5. Instrumental deliveries

Question 9

How can it be predicted?

Answer 9

• head tends to ascend between bearing down efforts or if external rotation of the head fails to occur spontaneously
• delay in 1 at stage especially in multi patois patients

Question 10

What are the complications arising from shoulder dystocia?

Answer 10

Fetal: 
Bruising 
Lacerations
Fractures - humerus and clavicle
Brachial plexus injury
Hypoxia 
Cerebral palsy 

Maternal: 
Perineal trauma 
Cervical tears 
3rd/4th degree tears 
Significant blood loss 
Post part in infections 
Large femoral nerve palsies

Question 11

Who is at risk for PPH?

Answer 11

APH 
grand multipara 
Previous PPH 
Multiple pregnancy 
Prolonged labour