Obstetric emergencies Flashcards
What is cord prolapse? What is cord presentation?
Occurs when the membranes are ruptured and part of the cord lies below the presenting part of the fetus or alongside of it. Cord presentation is the same situation with intact membranes.
What is the most common fetal presentation in cases with cord prolapse/presentation?
Transverse lie.
What are the mechanisms decreasing the blood supply to the fetus in cases of cord prolapse?
Mechanical compression of umbilical cord between the presenting part and maternal pelvis.
Vasospasm of umbilical vessels due to exposure/handling.
What are predisposing for cord prolapse?
Fetal: Prematurity, malpresentations, multiple pregnancy, fetal anomaly.
Maternal: High parity, small pelvis, conditions causing polyhydramnios
Amniotic fluid: Polyhydramnios, PROM
Iatrogenic: Amniotomy (with high presenting part), Balloon catheter IOL, version, IUP catheter placement, amnio-infusion.
What are signs of cord prolapse?
Abnormal FHR pattern.
Digital examination: Loops of the cord felt in the vagina.
Speculum examination: Loops of the cord seen in the vagina.
Inspection: Loops of the cord seen outside.
Ultrasound: May be useful for detecting cord presentation.
How can cord prolapse be prevented?
Hospital admission of patients with unstable/transverse lie at term.
Avoidance of amniotomy before the fetal pole has become deeply engaged in the pelvis.
Early vaginal examination following spontaneous rupture of the membranes.
How should cord prolapse be managed?
Early diagnosis.
Decompression of cord: knee chest/Trendelenburg position, tocolytics.
Deliver the baby as early as possible: C section for a viable & non-anomalous fetus,
Instrumental delivery for the second twin.
What are the two types of shoulder dystocia?
Anterior, when the anterior shoulder is impacted above the pubic symphysis.
Posterior when the posterior shoulder is impacted above the sacral promontory.
What are risk factors for shoulder dystocia?
Pre-labour: Previous history. Macrosomia (>4.5 Kg). Diabetes. High BMI (> 30Kg/M2). Induction of labor.
Intra-partum: Slow progress. Prolonged 2nd stage. Oxytocin augmentation. Instrumental delivery.
What are complications of shoulder dystocia?
Increased fetal morbidity. Fetal death. Brachial plexus injury. Fractures. Hypoxic ischemic encephalopaty. Cerebral palsy. Increased maternal morbidity. Perineal trauma. Post-partum hemorrhage. Psychological trauma.
How can shoulder dystocia be prevented?
Shoulder dystocia simulation training.
Early delivery for suspected macrosomia.
Caesarean section for suspected macrosomia (>4.5 Kg).
What are signs/symptoms of amniotic fluid embolism?
The signs & symptoms are not specific.
Prodromal symptoms (sudden onset cough, shivering, sweating, anxiety).
Acute respiratory distress (severe dyspnea, cyanosis, pulmonary edema, respiratory arrest).
Cardiovascular collapse (hypotension, tachycardia, arrhythmia, cardiac arrest).
Uterine atony, convulsions.
What are differential diagnoses to amniotic fluid embolism?
The signs & symptoms are not specific.
Prodromal symptoms (sudden onset cough, shivering, sweating, anxiety).
Acute respiratory distress (severe dyspnea, cyanosis, pulmonary edema, respiratory arrest).
Cardiovascular collapse (hypotension, tachycardia, arrhythmia, cardiac arrest).
Uterine atony, convulsions.
What is sudden maternal collapse?
Encompasses a variety: fainting episode to cardiac arrest.
May result due to onset of a new illness or exacerbation of a pre-existing condition.
Can occur at any stage in the pregnancy and up to 6 weeks postpartum.
Is serious and might be life threatening.
What makes resuscitation challenging during pregnancy?
Supine hypotension and aortocaval compression.
Increased oxygen consumption and diaphragmatic splinting.
Difficult intubation.
Increased risk of aspiration.
Increased cardiac output and vascularity of the genital tract in pregnancy make rapid rate of blood loss possible.
