Obstetric emergencies

Question 1

What is APH vs PPH?

Answer 1

APH after 24th week but before birth

Question 2

Describe placenta praevia

Answer 2

Major- cover cervical os, minor- covers lower segment

Identified during u/s

<20mm from os need a c-section

Question 3

How do you acutely manage blood loss?

Answer 3

-14/16 G cannula, IV crystalloid fluids, group and save, cross match 6 units, bleep senior if bleeding

Question 4

Describe different types of placenta accreta

Answer 4

Accreta- uterine lining

increta –deep myometrium

Percreta- into bladder or colon

Question 5

How do you manage accreta?

Answer 5

ECS at 36 weeks, arrange blood and HDU bed

Question 6

What is vasa praevia?

Answer 6

fetal vessels coursing through the membranes over the internal cervical os and below the fetal presenting part, unprotected by placental tissue or the umbilical cord

Question 7

What are the features of placenta abruption?

Answer 7

Premature separation of the placenta from the uterine wall

Concealed or revealed

Woody-hard, tense uterus

Fetal distress

Maternal shock out of proprtion with bleed

Question 8

What are the complications of APH?

Answer 8

DIC- use up clotting factors with can result in PPH
Acute tubular necrosis
ARDS due to transfusion
Fetal death

Question 9

What are the 4 Ts of PPh and how do you manage them?

Answer 9

4 Ts- Tissue (MROP- ensure placenta complete), Tone ( contract uterus with uterotonics eg syntocinon or ergometrine), Trauma (repair tears), thrombin (clotting check- transfuse RPC, CP, FFP)

Question 10

What are the risk factors for sepsis?

Answer 10

DM, obesity, immunosuppresed, anaemia, PID/ strep b infection previous, amniocentesis, PROM

Question 11

How does sepsis present?

Answer 11

Pyrexia 
Hypothermia  
Tachycardia 
Tachypnoea 
Hypoxia  
Hypotension 
Oliguria 
Impaired consciousness

Question 12

What is the management for sepsis?

Answer 12

Check blds including platelets, renal and liver. Stabilise BP with labetalol, nifedipine and methyldopa

Question 13

How do you manage pre-eclampsia?

Answer 13

Treat htn with labetalol, nifedipine, methyldopa or hydralazine
Give magnesium sulfate for seizures

Question 14

How does pre-eclampsia present?

Answer 14

Headache, vision, papilloedema, clonus, liver tender, abnormal LFT, platelet low

Question 15

What is cord prolapse?

Answer 15

Where them cord presents before baby, this means that exposure of the cord to cold causes vasospasm and hypoxia to baby

Question 16

What are risk factors for cord prolapse?

Answer 16

PROM, polyhydramnios, long umbilical cord, malpresentation, multiparity 
Artificial amniotomy (artificial rupture of membranes) is the biggest risk factor for cord prolapse.

Question 17

How may a cord prolapse present?

Answer 17

abnormal CTG, may be able to see on speculum or PV exam

Question 18

What is the management for a cord prolapse?

Answer 18

Emergency caesarean section is indicated where cord prolapse occurs. A normal vaginal delivery has a high risk of cord compression and significant hypoxia to the baby. Pushing the cord back in is not recommended. The cord should be kept warm and wet and have minimal handling whilst waiting for delivery (handling causes vasospasm).

When the baby is compressing a prolapsed cord, the presenting part can be pushed upwards to prevent it compressing the cord. The woman can lie in the left lateral position (with a pillow under the hip) or the knee-chest position (on all fours), using gravity to draw the fetus away from the pelvis and reduce compression on the cord. Tocolytic medication (e.g. terbutaline) can be used to minimise contractions whilst waiting for delivery by caesarean section.

Question 19

What is shoulder dystocia?

Answer 19

Failure for the anterior shoulder to pass under the symphysis pubis after delivery of the fetal head

Question 20

How may shoulder dystocia present?

Answer 20

Indicated by resistance and head withdrawing back into the vagina

Question 21

What are potential complications of shoulder dystocia?

Answer 21

PPH, PTSD, hypoxia, cerebral palsy, brachial plexus injury (erb’s palsy) and death

Question 22

What are RF for shoulder dystocia?

Answer 22

macrosomia, maternal diabetes, PMH, post maturity, maternal obesity, prolonged labour, instrumental delivery

Question 23

What is management for shoulder dystocia?

Answer 23

Help
Episiotomy
Legs in McRoberts
Suprapubic Pressure whilst in McRoberts
Enter pelvis
Rotational manoeuvres
Remove posterior arm
Replace head and to LSCS is necessary

Question 24

What is the acronym to remember management for shoulder dystocia?

Answer 24

HELPERRR

Question 25

What is McRoberts positions?

Answer 25

legs are flexed hard against mothers abdomen and slightly abducted outwards which helps by straightening the sacrum relative to the lumbar

Question 26

What occurs when you enter pelvis for shoulder dystocia?

Answer 26

Rotational screw manouvre

Question 27

What is a uterine rupture?

Answer 27

Loss of integrity of the wall of uterus

Question 28

What increases risk of uterine rupture?

Answer 28

More likely to occur in those with previous c section

Ocytocin and PG increases risk

Question 29

How does uterine rupture present?

Answer 29

CTG changes, tachycardia, PV bleed, abdo pain

Question 30

What is the management for uterine rupture?

Answer 30

emergency laparotomy, if massive haemorrhage then hysterectomy - more likely if complete rupture
otherwise can attempt to stitch up wound - more likely if from prev c-section scar