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Reproductive > Obstetric emergencies > Flashcards

Obstetric emergencies Flashcards

1
Q

What is shoulder dystocia?

A

When the baby’s head has been born but one of theshouldersbecomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body

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2
Q

What are the normal stages of labour?

A 
Engagement
Descent
Flexion
Internal rotation of the head
Crowning and extension of the head
Restitution
Internal rotation of the shoulders
External rotation of the head
Lateral flexion
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3
Q

What are the dangers of shoulder dystocia?

A

Umbilical cord entrapment
Inability of child’s chest to expand properly
Severe brain damage or death due to hypoxia or acidosis if delay in delivery
Brachial plexus damage

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4
Q

What does the anterior shoulder usually get stuck on in shoulder dystocia?

A

Pubic symphysis

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5
Q

What is the management for shoulder dystocia?

A 
HELPERR
H: call for help
E: evaluate for episiotomy
L: legs (McRoberts position)
P: suprapubic pressure
E: enter manoeuvres (internal rotation)
R: remove posterior arm
R: roll the patient (onto all fours)
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6
Q

What are the risk factors for shoulder dystocia?

A

Big baby
High maternal BMI
Induced labour
Prolonged first or second stage of labour
Assisted vaginal delivery
Previous big baby
Most happen in women with no risk factors

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7
Q

What are indications for C-section?

A

Previous shoulder dystocia

Diabetic mother

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8
Q

What happens in McRonerts position?

A

Mother brings legs above abdomen to straighten up sacrum

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9
Q

What is PPH?

A

Post-partum haemorrhage refers to abnormal bleeding after pregnancy

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10
Q

What are the four T causes of PPH?

A

Thrombin
Tone
Trauma
Tissue

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11
Q

How does thrombin cause PPH?

A

Coagulopathy - either pre-existing condition or acquired

  • Pre-eclampsia
  • Placental abruption
  • Pyrexia in labour
  • Bleeding disorders
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12
Q

How does tissue cause PPH?

A

Retained placenta
Placenta accreta
Retained products of conception (RPOC)

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13
Q

What is placenta accreta?

A

Pregnancy condition that occurs when theplacentagrows too deeply into the uterine wall. Typically, theplacentadetaches from the uterine wall after childbirth. Withplacenta accreta, part or all of theplacentaremains attached.

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14
Q

How can tone cause PPH?

A

Placenta praevia
Over distention of uterus: multiple pregnancy, polyhydramnios, macrosomia
Uterine relaxants
Previous PPH

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15
Q

What trauma can cause PPH?

A

C-section
Episiotomy
Macrosomia

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16
Q

What is the birth weight of a baby with macrosomia?

A

> 4000g

17
Q

Apart from the 4Ts what else is a risk factor for PPH?

A 
Asian ethnicity
Anaemia
Induction
BMI >35
Prolonged labour
Age
18
Q

What are the 2 types of PPH?

A

Primary: first 24hrs after delivery
Secondary: >24hrs-6wks post delivery

19
Q

How much blood to be PPH?

A

> 500ml

20
Q

How much blood is severe PPH?

A

> 2000ml

21
Q

What is the management for PPH?

A

ABCDE
Empty bladder
Bimanual massage of the uterus will stimulate contraction
Drugs: oxytocin, ergometrine, carboprost, misoprostol
Surgery: intrauterine balloon tamponade, interventional radiology, B-lynch suture, hysterectomy
Fluid replacement +/- blood products

22
Q

What is cord prolapse?

A

Descent of the umbilical cord through cervix alongside or past presenting part in the presence of ruptured membrane

23
Q

What are the risk factors for cord prolapse?

A 
Multiparity
Low birth weight
Preterm labour
Fetal congenital anomalies
Breech presentation
Transverse, oblique and unstable lie
Second twin
Polyhydramnious
24
Q

What is the management for cord prolapse?

A

Call for help
Replace cord into vagina
Perform digital elevation of presenting part
Catheterise and fill bladder to elevate presenting part
Knee-chest or left lateral position with raised hips
Consider tocolysis
Arrange c-section

25
Q

What is tocolysis?

A

Medications to suppress premature labour

Reproductive (20 decks)

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