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Women's Health > Obstetric emergencies > Flashcards

Obstetric emergencies Flashcards

1
Q

List the maternal obstetric emergencies?

A

Antepartum haemorrhage
Postpartum haemorrhage
Pre-eclampsia
Venous thromboembolism

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2
Q

List the fetal obstetric emergencies?

A

Fetal distress
Cord prolapse
Shoulder dystocia

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3
Q

Define ante-partum haemorrhage?

A

Bleeding from anywhere in the genital tract after 24 weeks

Often painless

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4
Q

What are the causes of ante-partum haemorrhage?

A

Placenta praevia

Placenta accreta

Vasa praevia

Placental abruption

Infection

Unexplained (in 40% of cases)

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5
Q

What is placenta praevia?

What types are there?

A

AKA low-lying placenta

The placenta has implanted into the lower segment of the uterus

Major: covering the os completely or partially

Minor: in lower segment but not covering os

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6
Q

What causes placenta praevia?

A

Unknown

More common with twins, high parity, older age, scarred uterus

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7
Q

Presentation of placenta praevia?

A

Intermittent painless bleeds which increase in severity and frequency over weeks

OE: fetal head not engaged, breech presentation common

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8
Q

When is placenta praevia usually picked up?

How should a woman be monitored if placenta praevia was diagnosed?

A

At the 20 week anomaly scan

Minor praevia, repeat TV USS at 36 weeks

Major praevia, repeat TV USS at 32 weeks

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9
Q

How would you decide whether a lady with placenta praevia needs an elective C section to give birth or not?

A

If the placenta is under 25mm from the cervical os then C section is indicated

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10
Q

Management of placenta praevia (that’s not acutely bleeding)?

When would you deliver?

A

If asymptomatic, outpatient management

Admission if recurrent bleeds

Anti-D if Rh-ve

Elective C section if needed at 38-39 weeks

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11
Q

Management of an acutely bleeding placenta praevia?

A

Regular obs

Resuscitate ABC if needed
Blood transfusion

Fetal monitoring (CTG)

Deliver baby as late as is safe

Will need steroids if before 34 weeks

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12
Q

Who is anti-D given to in pregnancy? And why?

A

Rh -ve mothers

In-case they have a Rh +ve baby

Anti-D stops them producing antibodies against Rh+ve antigens in baby’s blood

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13
Q

You shouldn’t do a digital vaginal examination on a woman with placenta praevia. True or false?

A

True

Because there’s a chance you could cause more bleeding

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14
Q

What is placenta accreta?

A

When the placenta invades through the decidua basalis and adheres to the myometrium

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15
Q

What should the placenta normally adhere to?

A

The decidua basalis which is a membrane lining the uterus in pregnancy

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16
Q

There are two, more extreme versions of placenta accreta? Describe them?

A

Placenta increta: placenta penetrates the myometrium

Placenta percreta: placenta invades through the entire uterine wall

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17
Q

Management of placenta accreta?

A

Elective C section at 36-37 weeks

Make sure blood is available and a critical care bed

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18
Q

Investigation and findings of placenta accreta?

A

USS and MRI

Shows loss of definition between wall of uterus and abnormal vasculature

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19
Q

What is vasa praevia?

A

When fetal vessels are lying over the cervical os, below the fetal presenting part

They are unprotected by placenta or umbilical cord

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20
Q

What are the problems that vasa praevia can cause?

A

Major fetal haemorrhage if the supporting membranes and therefore the vessels rupture

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21
Q

How does vasa praevia usually present?

What’s the prognosis?

A

With painless, moderate vaginal bleeding

Severe fetal distress

C section often not quick enough to save the fetus

22
Q

What is placental abruption?

A

Premature separation of all or part of the placenta from the uterine wall

After 24 weeks

This leads to a haemorrhage

23
Q

What types of haemorrhage can placental abruption result in?

A

Concealed: no PV bleeding, the blood is trapped in the uterus, goes into myometrium or between membranes

Revealed: PV bleeding occurs as blood is able to escape uterus

24
Q

What are the risk factors of placental abruption?

A 
Previous placental abruption
Hypertension
Multiple pregnancy
Trauma
Drugs: cocaine
Infection
Thrombophilia
Smoking
25
Q

Presentation of placental abruption?

A

Painful bleeding

Woody-hard, tense uterus
Fetal distress

Maternal shock which is out of proportion to PV bleeding

26
Q

Investigation of placental abruption?

A

Clinical

CTG for fetal well-being

USS to exclude placenta praevia

Bloods and obs for mother

27
Q

Management of severe placental abruption?

A

Resuscitation, with blood if maternal shock

If there’s fetal distress baby should be delivered by C section immediately

If not, watch and wait and induce and deliver at 37 weeks

28
Q

Management of minor placental abruption?

A

Watch and wait, monitor with USS

29
Q

You see a lady who is 27 week pregnant. She complains of painful PV bleeding. OE the uterus feels hard and she is in shock.
What’s the possible diagnosis?

A

Placental abruption revealed

30
Q

You see a lady who’s 28 weeks pregnant. She complains of abdominal pain, there’s no PV bleeding. OE the uterus feels hard and she’s in shock.

What’s the possible diagnosis?

A

Placental abruption concealed

31
Q

You see a lady who’s 25 weeks pregnant. She complains of PV bleeding that comes and goes, but no pain.

What are the possible diagnoses?

A

Placenta praevia

Vasa praevia (if fetal distress)

Placenta accreta?

32
Q

Define post-partum haemorrhage.

A

Bleeding

Primary: within 24hrs of delivery

33
Q

What are the causes of post-partum haemorrhage?

A

The 4 T’s

Tissue: not all placenta had been passed

Tone: the uterus hasn’t contracted

Trauma: tears

Thrombin: coagulopathy (rare)

34
Q

What is coagulopathy and what could it be caused by?

A

Problem with clotting

  • congenital disorder
  • anti-coag therapy
  • DIC
35
Q

Is there anything that could prevent a post-partum haemorrhage?

A

Give oxytocin in the 3rd stage of labour

36
Q

What are the risk factors for post-partum haemorrhage?

A

Big baby, shoulder dystocia (tears)
Nulliparity or grand multiparity
Multiple pregnancy
Prolonged labour

37
Q

What is meant by venous thromboembolism?

A

A blood clot in the veins (usually in the calf) that can travel to the lungs and cause death

38
Q

Is there anything that could prevent venous thromboembolism?

A

LMW heparin

TED stockings

39
Q

What are the risk factors of VTE?

A 
Previous VTE
Thrombophilia
Comorbidities
Age over 35
BMI over 30
Smoking
Pre-eclampsia
C section
Immobility
Systemic infection
40
Q

What are the risk factors for sepsis?

A 
Obesity
Diabetes
Impaired immunity
Anaemia
Group B strep
Prolonged rupture of membranes
41
Q

Clinical features of sepsis?

A 
Pyrexia
Hypothermia
Tachycardia + pnoea
Hypoxia
Hypotension
Oliguria
Impaired consciousness
42
Q

What is cord prolapse? Why does it cause issues?

A

When the membranes have ruptured and the umbilical cord is the presenting part

Cord can be compressed
Or
Exposure of the cord leads to vasospasm and causes hypoxia and fetal morbidity and mortality

43
Q

What are the risk factors for cord prolapse?

A

Pre-term labour
Breech presentation
Abnormal lie
Twins

44
Q

Management of cord prolapse?

A

Call 999

Cord pushed up

If it can’t be then should be kept warm and moist

Emergency C section or instrumental vaginal delivery

45
Q

What’s shoulder dystocia?

A

Failure for the anterior shoulder to pass after delivery of the fetal head

46
Q

What are the risk factors of shoulder dystocia?

A

Big baby
Maternal diabetes
Obesity

47
Q

What are the consequences of shoulder dystocia?

A

If results in delay in delivery, brain injury or death can occur

Erb’s palsy due to damage to brachial plexus

For mothers: episiotomy, post-partum haemorrhage

48
Q

Clinical features of Erb’s palsy? Does it resolve?

A

Waiter’s tip
Paralysis of arm

Its permanent in 10% of cases

49
Q

Management of shoulder dystocia?

A

Emergency

Episiotomy

Specific manoeuvres to get baby out: McRoberts - hip flexion (thigh to chest)

50
Q

Management of collapsed mother?

A

Airway: check patency, high flow oxygen
Breathing: spO2
Circulation: BP, pulse, IV access, fluids

Assess baby: CTG

Women's Health (23 decks)

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