Obstetric Emergencies Flashcards
What is shoulder dystocia?
Any pregnancy requiring an additional manoeuvre after delivery of the fetal head but before delivery of the shoulders (usually anterior shoulder on pubic symphysis)
Complications of shoulder dystocia
Fetal - Fractured clavicle - Intracranial haemorrhage - Erbs palsy - Cerebral palsy Maternal - PPH - Genital tract trauma
Risk factors for shoulder dystocia
LARGE BABY!
- Macrosomia
- Previous dystocia
- Gestational diabetes
Outline management of shoulder dystocia
HELPERR
- Call for help
- Episiotomy
- Legs into McRoberts
- Pressure (suprapubic)
- Enter pelvis for internal manoeuvres (Wood’s Screw)
- R release of posterior arm
- Roll over on all fours
Management of massive obstetric haemorrhage
1) Empty uterus
2) Massage uterus
3) Give drugs
- Oxytocin
- Ergometrine
- Misoprostol
4) Bimanual compression
5) Repair genital tract injury
6) Uterine tamponade with rusch balloon
Immediate management of massive obstetric haemorrhage
1) HELP
2) A-E (high flow O2, assess airway, large bore cannula)
3) Catheterize
4) Blood transfusion
5) Replace clotting factors
Uterine inversion management
- Push back in
- Fill with warm saline
Cord prolapse risk factors
Multiple pregnancy
polyhydramnios
prematurity
Cord prolapse management
- deliver fetes by c-sectin
- prevent further cord compression during transfer for CS with knee to chest position
Fetal CTG acronym
DR - define risk (and assess contractions) BRa - baseline rate V - variability A - acceleration D - Decellleration O - Overall assessment
Baseline rate CTG
110-160
Tachycardia definition and causes
> 160
- thyrotoxicosis
- Chorioamnionitis
- Fetal hypoxia
- fetal anaemia
Bradycardia definition
Mild Brady
100-120 for >3 minutes
Severe Brady
<80 for >3 minutes
Mild Brady causes
- Post-dates
-
Severe Brady causes
- Prolonged cord compression
- Cord prolapse
- Epidural and spinal anaesthesia
- rapid fetal descent
Variability categores
Reassuring - 5-25bpm
Non-reassuring - <5 for 30-50 minutes, >25 for 15-25 minutes
Abnormal - <5 for >50 mins, >25 for >25 mins
Standard cause of reduced variability
Fetal sleeping
Worrying causes of reduced variability
- hypoxia
- tachycardia
- prematurity
What is an acceleration?
Abrupt increase in fetal heart rate >15bpm for >15 seconds
Are accelerations reassuring or non-reassuring?
Reassuring
Three types of deceleration
Early - begin with contraction end with contraction
Variable - may not have relation to contraction (umbilical cord compression). Will have acceleration before and after (V for variable, V is shape!)
Late deceleration - begin at peak of contraction and recover after it ends
What is a prolonged deceleration?
Greater than 2 minute deceleration
2-3 is non-reassuring
>3 is abnormal
What is a sinusoidal pattern?
Smooth up and down
- severe fetal hypoxia, severe fetal anaemia
Three types of overall impression?
Reassuring, suspicious, abnormal
C-section indications (4)
1) repeat c-section
2) breech
3) failure to progress
4) fetal compromise
Complications of c-section (3, 3 & 3)
Intra-operative
- blood loss >1L
- hysterectomy
- bladder laceration
Post-operative
- wound infection
- endometritis
- VTE
subsequent pregnancies
- uterine rupture
- placenta praaevia
- Placenta accreta
Conservative management of PROM
Record temp every 4 hours
report any change in discharge or offensive smell
Avoid sexual intercourse
report decrease in fetal movements
Known group B strep carrier in PROM
- immediate induction should be encouraged
- mother offered benzylpeniccilin
- neonates screened after birth
