Obstetric Emergencies Flashcards
What are the risk factors for amniotic fluid embolism?
Mutli preg Increasing age IOL Uterine rupture PP PA Eclampsia Polyhydramnios
How does amniotic fluid embolism present?
Acute onset hypoxia, hypotension and confusion
Seizures
Shock
DIC
How is amniotic fluid embolism investigated?
FBC
ECG
CXR
How is amniotic fluid embolism managed??
ABCDE
Get senior help
What is shoulder dystocia?
One of the shoulders of the foetus gets stuck (usually on a bony prominence)
Which structure may shoulder dystocia result in damage of?
Brachial plexus
What are the pre-labour risk factors for shoulder dystocia?
Prev event Macrosomia Diabetes Maternal BMI >30 IOL
What are the intrapartum risk factors for shoulder dystocia?
Prolonged stage 1 or 2
Secondary arrest
Oxytocin
Operative delivery
What is the “turtle neck” sign in shoulder dystocia?
Foetal head retracts in towards the pelvis
How is shoulder dystocia managed?
Senior help
Stop pushing
Avoid downwards traction
Episiotomy
What examination is recommended after albour with shoulder dystocia?
PR
What is an umbilical cord prolapse?
When cord comes through the cervix before/with the infant
What is occult complete cord prolapse?
Descends alongside presenting part of foetus, but not in front of it
What is overt incomplete cord prolapse?
Cord comes out first and is beyond the presenting part of the feotus
By which two mechanisms does foetal hypoxia occur with cord prolapse?
Occlusion - presenting part presses on the cord and stops blood flow
Arterial vasospasm - exposure of umbilical cord to cold atmosphere causes vasospasm
What are the main risk factors for cord prolapse?
Breech Unstable lie Artificial rupture of membranes Polyhydramnios Prematurity
How is umbilical cord prolapse managed?
Senior help Don't touch cord Lift presenting part C-section Terbutaline
Why is terbutaline given in cord prolapse?
Relaxes uterus and stops contractions
What is eclampsia?
TC seizure in pre-eclamptic woman with absence of neuro or metabolic explanation
What a high risk factor for eclampsia?
Prev event HTN DM CKD Autoimmune
What are mod risk factors for eclampsia?
>40yrs BMI>35 FHx Nulliparity Preg interval >10 years Multi preg
What may eclampsia cause in the foetus?
IUGR Premature delivery Infant RDS Foetal death Placental abruption
Why may USS be performed in eclampsia?
Rule out placenta abruption
In which position should the patient be in in eclampsia?
Left lateral
How are eclamptic seizures treated?
MgSO4
Which anti-hypertensives can be used in pre-eclampsia and eclampsia?
Labetalol
Hydralazine
What is the definitive treatment for eclampsia?
Deliver the baby
What is uterine rupture?
Full-thickness disruption of the uterine muscle and overlying serosa
What are the two types of uterine rupture?
Complete
Incomplete
Describe an incomplete uterine rupture
Peritoneum over uterus in still intact
Describe a complete uterine rupture
Peritoneum also torn - uterine contents can escape into peritoneal cavity
What are the main risk factors for uterine rupture
Anything that makes the uterus weaker Prev C-sec or uterine surgery IOL obstruction Multi preg Multiparous
How does uterine rupture present?
Severe continuous abdo pain between contractions
With/out vaginal bleeding
What is the surgical management of uterine rupture?
C-sec
Uterine repair or removal
