Obstetric Emergencies Flashcards
What is cord prolapse?
Cord descending through the cervix below the presenting part after rupture of the membranes
What are the risks of cord prolapse?
Compression of the cord or vasospasm from cord exposure causes fetal asphyxia and hypoxia
What are risk factors for cord prolapse?
2nd twin Prematurity Footling breech Polyhydramnios Unengaged head Transverse or unstable lie Long umbilical cord Placenta praevia
What is the presentation of cord prolapse?
Fetal hear rate becomes abnormal - bradycardia or decelerations
Cord palpable vaignally
Cord visible at introitus
What is management of cord prolapse?
Prevent the presenting part from occluding the cord:
Displace the presenting part by putting hand in the vagina, push it back up during contractions
Knee to chest position so that her bottom is higher than her head on all fours
Infuse 500ml saline into bladder via an IVI
Tocolytics (terbutaline) reduces contraction and helps bradycardia
Do not push cord back inside
Immediate Caesarean section
If head is low and cervix fully dilated, instrumental vaignal delivery is possible
Neonatal team present at delivery
Paired cord blood samples taken for pH and base excess - if normal, intrapartum hypoxic brain injury is excluded
What is shoulder dystocia?
Delivery requiring additional obstetric manoeuvres to release the shoulders after gentle downward traction has failed.
Inability to deliver body using gentle traction, head already delivered
What are risks of shoulder dystocia?
Associated with:
Postpartum haemorrhage
Perineal tears
Brachial plexus injuries
What are risk factors for shoulder dystocia?
Large/postmature fetus Maternal BMI > 30 Induced or oxytocin augmented labour Prolonged 1st or 2nd stage Assisted vaginal delivery Diabetes mellitus Previous shoulder dystocia
Usually occurs due to impaction of the anterior fetal shoulder on the maternal pubic symphysis
What is management of shoulder dystocia?
McRobert’s manoeuvre - flexion and abduction of maternal hips, bringing mother’s thighs towards her abdomen - this straightens the sacrum relative to the lumbar spine and rotates the symphysis superiorly
Episiotomy to allow space for internal manoeuvres
Suprapubic pressure:
With flat of hand laterally in the direction abby is facing and towards mother’s sacrum, continuously or with a rocking motion.
Apply steady traction to the fetal head
Displaces anterior shoulder allowing it to enter pelvis
Internal manoeuvres
Rotate fetal shoulder to the oblique diameter
Maternal symphysiotomy
Zavanelli - replacement of fetal head by firm pressure of the hand to reverse the movements of labour and return the head to the flexed occipital-anteiorr position and C-section delivery
What should you check baby for after delivery?
Erb’s palsy
Fractured clavicle
Apgar
Umbilical cord blood for acid base status
What is meconium stained liquor?
Some babies pass meconium in late pregnancy, staining the amniotic fluid a dull green - this is not significant
During labour, fresh meconium - dark green, sticky, lumpy, may be passed
this may be a response of stress of normal labour or sign of distress
Aspiration of fresh meconium can cause severe pneumonitis
