Obstetric emergencies Flashcards
What is APH vs PPH?
APH after 24th week but before birth
Describe placenta praevia
Major- cover cervical os, minor- covers lower segment
Identified during u/s
<20mm from os need a c-section
How do you acutely manage blood loss?
-14/16 G cannula, IV crystalloid fluids, group and save, cross match 6 units, bleep senior if bleeding
Describe different types of placenta accreta
Accreta- uterine lining
increta –deep myometrium
Percreta- into bladder or colon
How do you manage accreta?
ECS at 36 weeks, arrange blood and HDU bed
What is vasa praevia?
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
What are the features of placenta abruption?
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
What are the complications of APH?
DIC- use up clotting factors with can result in PPH
Acute tubular necrosis
ARDS due to transfusion
Fetal death
What are the 4 Ts of PPh and how do you manage them?
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)
What are the risk factors for sepsis?
DM, obesity, immunosuppresed, anaemia, PID/ strep b infection previous, amniocentesis, PROM
How does sepsis present?
Pyrexia Hypothermia Tachycardia Tachypnoea Hypoxia Hypotension Oliguria Impaired consciousness
What is the management for sepsis?
Check blds including platelets, renal and liver. Stabilise BP with labetalol, nifedipine and methyldopa
How do you manage pre-eclampsia?
Treat htn with labetalol, nifedipine, methyldopa or hydralazine
Give magnesium sulfate for seizures
How does pre-eclampsia present?
Headache, vision, papilloedema, clonus, liver tender, abnormal LFT, platelet low
What is cord prolapse?
Where them cord presents before baby, this means that exposure of the cord to cold causes vasospasm and hypoxia to baby
What are risk factors for cord prolapse?
PROM, polyhydramnios, long umbilical cord, malpresentation, multiparity Artificial amniotomy (artificial rupture of membranes) is the biggest risk factor for cord prolapse.
How may a cord prolapse present?
abnormal CTG, may be able to see on speculum or PV exam
What is the management for a cord prolapse?
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.
What is shoulder dystocia?
Failure for the anterior shoulder to pass under the symphysis pubis after delivery of the fetal head
How may shoulder dystocia present?
Indicated by resistance and head withdrawing back into the vagina
What are potential complications of shoulder dystocia?
PPH, PTSD, hypoxia, cerebral palsy, brachial plexus injury (erb’s palsy) and death
What are RF for shoulder dystocia?
macrosomia, maternal diabetes, PMH, post maturity, maternal obesity, prolonged labour, instrumental delivery
What is management for shoulder dystocia?
Help Episiotomy Legs in McRoberts Suprapubic Pressure whilst in McRoberts Enter pelvis Rotational manoeuvres Remove posterior arm Replace head and to LSCS is necessary
What is the acronym to remember management for shoulder dystocia?
HELPERRR
What is McRoberts positions?
legs are flexed hard against mothers abdomen and slightly abducted outwards which helps by straightening the sacrum relative to the lumbar
What occurs when you enter pelvis for shoulder dystocia?
Rotational screw manouvre
What is a uterine rupture?
Loss of integrity of the wall of uterus
What increases risk of uterine rupture?
More likely to occur in those with previous c section
Ocytocin and PG increases risk
How does uterine rupture present?
CTG changes, tachycardia, PV bleed, abdo pain
What is the management for uterine rupture?
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
