Obstetric Emergencies

Question 1

What is shoulder dystocia?

Answer 1

Any pregnancy requiring an additional manoeuvre after delivery of the fetal head but before delivery of the shoulders (usually anterior shoulder on pubic symphysis)

Question 2

Complications of shoulder dystocia

Answer 2

Fetal
- Fractured clavicle 
- Intracranial haemorrhage
- Erbs palsy 
- Cerebral palsy 
Maternal 
- PPH 
- Genital tract trauma

Question 3

Risk factors for shoulder dystocia

Answer 3

LARGE BABY!

• Macrosomia
• Previous dystocia
• Gestational diabetes

Question 4

Outline management of shoulder dystocia

Answer 4

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

Question 5

Management of massive obstetric haemorrhage

Answer 5

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

Question 6

Immediate management of massive obstetric haemorrhage

Answer 6

1) HELP
2) A-E (high flow O2, assess airway, large bore cannula)
3) Catheterize
4) Blood transfusion
5) Replace clotting factors

Question 7

Uterine inversion management

Answer 7

• Push back in

- Fill with warm saline

Question 8

Cord prolapse risk factors

Answer 8

Multiple pregnancy
polyhydramnios
prematurity

Question 9

Cord prolapse management

Answer 9

• deliver fetes by c-sectin

- prevent further cord compression during transfer for CS with knee to chest position

Question 10

Fetal CTG acronym

Answer 10

DR - define risk (and assess contractions) 
BRa - baseline rate
V - variability 
A - acceleration
D - Decellleration
O - Overall assessment

Question 11

Baseline rate CTG

Answer 11

110-160

Question 12

Tachycardia definition and causes

Answer 12

> 160

• thyrotoxicosis
• Chorioamnionitis
• Fetal hypoxia
• fetal anaemia

Question 13

Bradycardia definition

Answer 13

Mild Brady
100-120 for >3 minutes

Severe Brady
<80 for >3 minutes

Question 14

Mild Brady causes

Answer 14

• Post-dates

-

Question 15

Severe Brady causes

Answer 15

• Prolonged cord compression
• Cord prolapse
• Epidural and spinal anaesthesia
• rapid fetal descent

Question 16

Variability categores

Answer 16

Reassuring - 5-25bpm
Non-reassuring - <5 for 30-50 minutes, >25 for 15-25 minutes
Abnormal - <5 for >50 mins, >25 for >25 mins

Question 17

Standard cause of reduced variability

Answer 17

Fetal sleeping

Question 18

Worrying causes of reduced variability

Answer 18

• hypoxia
• tachycardia
• prematurity

Question 19

What is an acceleration?

Answer 19

Abrupt increase in fetal heart rate >15bpm for >15 seconds

Question 20

Are accelerations reassuring or non-reassuring?

Answer 20

Reassuring

Question 21

Three types of deceleration

Answer 21

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

Question 22

What is a prolonged deceleration?

Answer 22

Greater than 2 minute deceleration
2-3 is non-reassuring
>3 is abnormal

Question 23

What is a sinusoidal pattern?

Answer 23

Smooth up and down

- severe fetal hypoxia, severe fetal anaemia

Question 24

Three types of overall impression?

Answer 24

Reassuring, suspicious, abnormal

Question 25

C-section indications (4)

Answer 25

1) repeat c-section
2) breech
3) failure to progress
4) fetal compromise

Question 26

Complications of c-section (3, 3 & 3)

Answer 26

Intra-operative

• blood loss >1L
• hysterectomy
• bladder laceration

Post-operative

• wound infection
• endometritis
• VTE

subsequent pregnancies

• uterine rupture
• placenta praaevia
• Placenta accreta

Question 27

Conservative management of PROM

Answer 27

Record temp every 4 hours
report any change in discharge or offensive smell
Avoid sexual intercourse
report decrease in fetal movements

Question 28

Known group B strep carrier in PROM

Answer 28

• immediate induction should be encouraged
• mother offered benzylpeniccilin
• neonates screened after birth