Obstetric emergencies Flashcards
Risk factors for cord prolapse
Unstable, transverse or oblique lie Breech Multiple pregnancy Multiparous Low birth weight Preterm Polyhydramnios Unengagement Low placenta
Management of cord prolapse
Give oxygen
Mother in knee chest position for overt, left lateral position for occult
Try to push head back in to take pressure off cord
Fill bladder with foley’s catheter to keep cord inside
Deliver baby by fastest method (likely grade 1 C/S)
Take cord gases
Neonatal review
Signs of uterine rupture
Severe abdominal pain which is continuous!
Pain usually across previous C section scar
Rigid abdomen
Pathological CTG
Surgical management of uterine rupture
Grade 1 C section
Suture uterus if possible, if not need hysterectomy
Management of shoulder dystocia in chronological order
Help Episiotomy Legs into McRoberts manoeuvre supraPubic pressure in sync with contraction Enter pelvis - corkscrew manoeuvre Release posterior shoulder Roll onto all fours and repeat Convert to grade 1 C/S
Describe corkscrew manoeuvre
Done by consultant obstetrician
Try to deliver one elbow
A-E management of eclampsia
Secure airways Give high flow oxygen IV access Take bloods - FBC, U+Es, LFTs, urates, clotting Fluid restrict IV labetalol and IV magnesium sulphate Temperature, glucose, GCS, pupils, reflexes, clonus Deliver baby by fastest method
Management of cardiac arrest in pregnancy
Put out obstetric crash call Secure airway CPR (keep mother slightly lateral) Ventilate Defibrillator Delivery baby at any gestational age
Causes of cardiac arrest in pregnancy
Preexisting cardiac condition PE Amniotic fluid embolism Aortic dissection Stroke Haemorrhage Trauma
Monitoring for magnesium sulphate
Respiratory rate
Urine output
Reflexes
Dosage of magnesium sulphate
4g stat
1g/hour for 24 hours
Risk factors for shoulder dystocia
Gestational diabetes Maternal obesity Post term Instrumental delivery Previous history (pelvic anatomy abnormality)
Types of cord prolapse
Occult - cord alongside presenting part (compressed against pelvis)
Overt - cord below presenting part
Cord presentation - cord visibly protruding into cervix
