Obstetric Emergencies Flashcards
What happens during labour to result in shoulder dystocia?
- Intrauterine pressure is caused by maternal contractions
2. Anterior shoulder impacted on pubic symphysis
Results of shoulder dystocia
Umbilical cord entrapment
Inability of childs chest to expand properly
Severe brain damage or death due to hypoxia or acidosis if delay in delivery
Brachial plexus damage
Management of shoulder dystocia - HELPERR
Help (call) Evaluate for episiotomy Legs (Macroberts position) P (suprapubic) pressure Enter manoeuvres (internal rotation) Remove the posterior arm Roll the patient (onto all 4s)
The 4T causes of PPH
Tissue
Trauma
Tone
Thrombin
Thrombin causes of PPH
Pre-eclampsia Placental abruption Pyrexia in labour Bleeding disorders - haemophilia, anticoagulation, VW disease
Tissue causes of PPH
Retained placenta
Placenta accreta
Retained products of conception (POC)
Tone causes of PPH
Placenta praevia Over distention of uterus - multiple pregnancy - polyhydramnios - macrosomnia Uterine relaxants Previous PPH
Trauma causes of PPH
C section
Episiotomy
Macrosomnia (>4kg baby)
Increased risk of PPH if…
Asian ethnicity Anaemia Induction BMI > 35 Prolonged labour Age
Treatment of PPH
ABCDE Empty bladder Rub up fundus Drugs - oxytocin - ergometrine - carboprost - misoprostol Surgical - IU balloon tamponade - Interventional radiology - B-lynch suture - hysterectomy
Definition of primary PPH
in first 24 hours of delivery, >500ml of blood (common) or severe haemorrhage >2000ml (rare)
Types of PPH
primary
secondary
Definition of secondary PPH
> 24 hours up to 6 weeks post delivery (often cause by RPOC)
Definition of cord prolapse
The descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membrane
When is the incidence of cord prolapse higher?
Breach presentation
Risk factors for cord prolapse
Multiparity low birthweight (<2.5kg) Pre term labour (<37 weeks) Foetal congenital abnormalities Breech presentation Transverse, oblique and unstable lie Second twin Polyhydramnios Unengaged presenting part Low lying placenta Artificial rupture of membranes with high presenting part Stabilising induction of labour Large balloon catheter IOL vaginal manipulation of foetus with ruptured membranes
Definition of unstable lie
The longitudinal axis of the foetus (lie) is changing repeatedly after 37 (+0) weeks
Treatment of cord prolapse
Replace cord into vagina (not uterus)
Catheterise and fill bladder to elevate presenting part
Perform digital evaluation of presenting part
Encourage mother to have knee-chest or left lateral position with raised hips
Consider tocolysis
Arrange for category 1 C section
What should NOT be given in shoulder dystocia?
Oxytocin
What position should be used for the mother in umbilical cord prolapse?
On all fours, knees and elbows
