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Obstetrics & Gynaecology - Things I forget > Obstetric emergencies > Flashcards

Obstetric emergencies Flashcards

1
Q

What are the risk factors for placental abruption?

A 
Hypertension
Smoking
Trauma
Twin pregnancy
Polyhydramnios
Foetal growth restriction
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2
Q

What are the clinical features of placental abruption?

A

Painful vaginal bleeding
Tense rigid abdomen (Woody uterus)
Abdominal pain
Shock

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3
Q

What are the risk factors for placenta praevia?

A

Multiple gestations
Previous c-section
Uterine abnormalities

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4
Q

What are the clinical features of placenta praevia?

A

Painless vaginal bleeding
Bleeding may trigger preterm labour
Diagnosed via ultrasound (Low placenta is typically seen during week 20 ultrasound)

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5
Q

What are the clinical features of vasa praevia?

A

Foetal blood vessels covering the cervical os
Spontaneous rupture of membranes accompanied by painless fresh vaginal bleeding
Associated with high perinatal mortality
Hence, immediate C-Section is required

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6
Q

What is the definition of post-partum haemorrhage?

A

> 500ml blood loss following delivery

>1000ml blood loss considered major haemorrhage

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7
Q

What are the risk factors for post-partum haemorrhage?

A 
Previous PPH
Nulliparity
Praevia
Distended uterus (Polyhydramnios, Twins)
Obesity
PET
Prolonged labour
Chorioamnionitis
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8
Q

What are the causes of post-partum haemorrhage?

A

Tone (70%) - Atonic uterus
Trauma (20%) - Lacerations, episiotomy, haematoma
Tissue (10%) - Retained placenta
Thrombin (1%) - Coagulopathies

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9
Q

What is the general management of PPH?

A 
ABC approach
Obs
Correction of circulation:
 - x2 cannulas
 - Blood for diagnostic tests
 - 2L crystalloid blood
 - 500ml tranexamic acid
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10
Q

What is the management of PPH caused by atony?

A

Mechanical:
- Bimanual uterine compression to stimulate contraction

Pharmacological:

  • Syntocinon 5/10 units IV
  • Ergometrine 0.5mg IV (CI: HTN/CHD)
  • Haemabate/Carboprost IM (Synthetic prostaglandin)
  • Rectal Misoprostol

Advanced:

  • Intrauterine tamponade
    • Balloon into vagina, that forces uterus shut when inflated
  • B-Lynch suture

Last-line:
- If nothing else works, hysterectomy

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11
Q

What is the management of PPH caused by trauma?

A

Examine vagina/cervix

Urgent repair of tissues with sutures

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12
Q

What is the management of PPH caused by tissue?

A

Typically presents with bleeding 12-24 hours after delivery

Mostly managed by expectant management, medical management to induce contraction/expulsion; or surgery

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13
Q

What is the management of PPH caused by thrombin?

A

If they are still bleeding, must consider DIC

Must replace clotting agents

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14
Q

What are the sequelae of PPH?

A
  • Sheehan’s syndrome
  • Postpartum depression
  • Anaemia
  • Acute stress reaction
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15
Q

What are the clinical features of amniotic fluid embolism?

A

Caused by amniotic fluid entering the maternal circulation
Resulting in acute cardiorespiratory compromise and severe DIC

Diagnosed post-mortem

Clinical signs/symptoms:

  • Collapse
  • Tachycardia
  • Shivering
  • Chest pain
  • Cyanosis
  • SOB
  • Hypotension
  • Bronchospams

There is no treatment, just supportive management (O2, fluids, FFP, ITU admission)
10% survival

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16
Q

What is cord prolapse and what are the risk factors?

A

During rupture of membranes, the umbilical cord may descend below the presenting head, potentially leading to cord compression and hence foetal hypoxia

Risk factors:

  • Induction of labour amniotomy (Most common cause)
  • Preterm labour
  • Breech presentation
  • Polyhydramnion
  • Twins

Diagnosed on CTG abnormality and palpable cord on vaginal examination

17
Q

What is the management of cord prolapse?

A
  • Cord should be pushed upwards
  • Tocolytics (Terbutaline) given to prevent compression
  • Patient placed on all 4s
  • Immediate C-section
18
Q

What are the clinical features of uterine rupture?

A

Rupture of the uterus typically occurs de novo or due an old caesarean scar opening
Causes foetal hypoxia and massive maternal haemorrhage
Bleeds more if de novo and c-section scar is at lower abdomen and this is less vascular. Also foetus less likely to extrude out of the abdomen

Symptoms:

  • Severe abdominal pain
  • Vaginal bleeding
  • Haematuria
  • Cessation of contractions
  • Maternal tachycardia
  • Foetal compromise (bradycardia)

Women with a C-section scar need continuous monitoring and a low threshold for c-section if there are any CTG abnormalities. Induction of labour should not be conducted

19
Q

What is the management of uterine rupture?

A

Resuscitation (IV fluids and blood transfusion)
Bloods for clotting, Hb, cross-match
Urgent laparotomy for foetal delivery and repair/removal of uterus
Early c-section delivery in future pregnancies

20
Q

What is the management of shoulder dystocia?

A

Calling My Supervisor Ensures Successful Results (Rah)

Call supervisor
McRobert’s manoeuvre (Legs hyperextended onto abdomen)
Suprapubic pressure applied (Disimpact shoulder from pubic symphysis)
Episiotomy consideration if need better access to shoulder
Start manoeuvres (Rubins and Wood’s corkscrew)
Removal of posterior arm
Rotate onto all fours

21
Q

Which investigations should be performed in a patient with a suspected PE?

A

ECG
CXR
Compression duplex ultrasound (if DVT)
V/Q or CTPA

22
Q

How should a DVT/PE during pregnancy be managed?

A

Therapeutic dose LMWH given daily in two divided doses according to the patient’s weight until 6 weeks postpartum (and at least 3 months in total)

23
Q

How should VTE in a collapsed patient be managed?

A

Unfractionated heparin
Thrombolysis
Thoracotomy and surgical embolectomy

24
Q

What is the management of uterine inversion?

A

Attempt manual replacement
If unsuccessful attempt hydrostatic replacement (Tube 2-3L of warm saline into the vagina, using your hands to block the vulva)
If unsuccessful, hysterectomy

25
Q

What are risk factors for uterine inversion?

A 
Full dilatation C-section
Unsuccessful instrumental delivery
IV syntocinon prior to C-section delivery
Malpresentation
Prolonged second stage

Obstetrics & Gynaecology - Things I forget (16 decks)

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