Obstetric emergencies Flashcards
What are the 4 steps of calling for help in an obstetric emergency?
- Pull the emergency bell
- Tell an appropriate person to call 2222 stating the appropriate name of emergency + accurate location
- Tell the person to feedback to you when they are done
- Tell someone to bring the appropriate equipment trolley
How do you approach any obstetric emergency?
Is it safe to approach?
ABCDE
How do you check the patients Airway?
- Is the patient talking
- look inside the mouth for obstruction
- Flatten the bed
How do you asses B?
- SATS
- RR
- Chest auscultation
How do you asses Circulation
- Pulse
- BP
- Cap refill time
- Cold periphery
- IV Access - take bloods and give fluids if indicated
- Urine output + catheter if indicated
How do you assess Disability?
- AVPU
- Blood sugar
- light reflex
How do you asses exposure?
- Head to toe assessment
2. Review ABCDE again
Which 4 people do you call for help in any obstetric emergency?
- Scribe
- Obs
- Anaesthatist
- Paediatricin
What are the 5 D’s of OBS?
- Document
- De-brief
- Datix
- Duty of candor
- DVT
What is the commonest organism that causes sepsis in pregnant women?
Group A strep
What is sepsis?
Bodies response to an infection
When are women at a high risk of developing sepsis?
6 weeks postnatally due to cardiovascular and immune changes
Name 8 causes of maternal sepsis (infections)
- Mastitis
- UTI
- Pneumonia
- Episiotomy infection
- Gastrointestinal infection
- Spinal site infection
- Vaginal infection
- Wound infection
How do you prevent sepsis?
- Proper hand hygiene + use of anti-septics
What are the symptoms of sepsis?
Depends on the cause -
Fever, diahrrhoea, vomiting, abdominal pain, soar throat, URTI, offensive vaginal discharge, wound infection, heavy lochia
List 7 signs of sepsis?
- Rash
- tachycardia
- tachypnoea
- pyrexia/hypothermia
- hypotension
- low urine output
- pallor
List 6 Red flags associated with sepsis
- Pyrexia > 38 or hypothermia <36
- Tachycardia >90
- RR >20
- Abdominal/chest pain
- Diarhhoea/N + V
- Uterine tenderness
What does Puerperium mean?
The period after childbirth - up to 6 weeks
List 6 risk factors for developing sepsis during pregnancy
- Obeisity
- HIV
- Diabetes
- PROM
- Anaemia
- Previous pelvic infection
List 7 risk factors for developing sepsis during the puerperium period
- Obeisity
- Anaemia
- Diabetes
- CS
- Wound haematoma
- Retained products of conception
- History of pelvic infection
List 4 organism that can cause sepsis during pregnancy
- Group A strep
- E-coli
- Staph
- MRSA
what is the initial management for sepsis?
- Call for help
- ABCDE
- High flow oxygen
- Left lateral position
- Wide bore cannula
List sepsis 6 protocol
Take:
- Blood cultures
- Serum lactate
- UO
Give:
- Oxygen
- IV fluids
- IV AB
What 3 antibiotics could you give to manage sepsis?
High dose cefuroxime, metronidazole OR co-amoxiclav
When would you start IV fluids for sepsis (under what conditions)?
- Hypotensive
2. High lactate >4
What fluid would you give a patient with sepsis? how much and over how long?
0.9% normal saline
either
- 500 ml over 15 mins
- 20 mg/Kg
What do you use to monitor a patient with sepsis? and how often?
MEOWS chart every 15 mins
Name 8 cultures you would send for a patient with sepsis
- Blood
- vaginal
- urine
- woun
- stool
- throat
- sputum
- placental
What further investigation do you do in a patient with sepsis?
Depends on cause
CXR
abdominal US
CT abdo/pelvis
What condition does sepsis increase the risk of developing?
DVT
How do you escalate any obstetric emergency?
SBAR
Situation
Background
Assessment
Review
How does the umbilical cord present normally?
Presence of the umbilical cord between the foetal presenting part and the cervix +/- ROM
What is cord prolapse?
Where the umbilical cord descends through the cervix alongside or past the presenting foetal part in the presence of ruptured membrane
Name 8 pregnancy related risk factors for cord prolapse
- Unengaged presenting part
- Multiple pregnancy
- Multiparity
- Malpresentation, malposition or unstable lie
- Polyhydraminous
- Prematurity
- Low lying placenta/ placenta privea
- Foetal congenital abnormality
Name 5 procedure related risk factors for cord prolapse
- ARM - artificial rupture of membrane
- ECV
- Controlled ARM for IOL with high head
- Rotational instrumental delivery
- Vaginal manipulation of the foetus with ruptured membrane - FSE
What percentage of cord prolapse are preceded by an obstetric procedure?
50%
How do you manage cord prolapse?
If membranes are intact, stop VE to avoid ARM
Exaggerated SIMS
Monitor foetal heart
Escalate
Consider operative birth
Four steps of managing cord prolapse (4 r’s)
- Recognise
- Run for help
- Relieve
- Remove
How do you recognise cord prolapse?
- Cord visible/protruding from vagina
- Palpable cord
- Abnormal foetal heart on auscultation/CTG
How do you relieve cord prolapse?
- Exaggerated SIMs position
- Knee chest position
- Manually elevating the presenting part
- Trendelenburg position
- tocolysis - if premature
What is Eclampsia?
1+ convulsions associated with pre-eclampsia
When is the highest risk of developing seizures?
Postoartum > antepartum > intrapartum
What is the commonest cause of death associated with Eclampsia?
Cerebral haemorrhage
What type of seizure does eclampsia present with?
Generalised seizure
Who do you call for help in eclampsia?
Senior midwife
Experienced OBS
Anaesthatist
How do you treat eclampsia?
- Seizures are self limiting
- ABCDE - be careful with fluid
- Left lateral position/ manual displacement of placenta
Why do you put women with eclampsia in a left lateral position?
To avoid IVC/SVC obstruction