Obstetric Emergencies

Question 1

what are the main maternal obs emergencies?

Answer 1

APH
PPH
VTE
pre-eclampsia

Question 2

what are the main fetal obs emergencies?

Answer 2

fetal distress
cord prolapse
shoulder distocia

Question 3

define APH

Answer 3

Bleeding from anywhere in the genital tract after 24th week of pregnancy

Question 4

what are the causes of APH?

Answer 4

placenta praevia
Placenta accreta
Vasa praevia
Minor/major abruption
Infection

Question 5

how is a placenta previa classified?

Answer 5

minor - encroaching on the os ie partial

major - covering the os

Question 6

how is placenta previa identified?

Answer 6

on anomaly scan

Question 7

what are the signs of placenta previa?

Answer 7

high presenting part, abnormal lie, painless bleed

Question 8

how would you manage non-urgent placenta previa

Answer 8

repeat transvaginal scans at 32 (minor) or 36 weeks (major)

organise elective c-section at 38-39 weeks if placenta is very close to os

advise pt to watch out for bleeds

Anti-D if rhesus negative

Question 9

how would you manage bleeding placenta previa?

Answer 9

ABCDE

cannulas
IV fluids (crystalloid)
X match 6 units
inform senior team and Paeds ASAP

Examination

• General and abdominal
• Vaginal (avoid digital examination)
• ? USS (check 20 week scan)

Fetal monitoring (CTG) +/- delivery

Steroids if < 34 weeks gestation

Question 10

what is placenta accreta

Answer 10

placenta penetrates through the decidua basalis and attaches to the myometrium

Question 11

What are the types of abnormal placental attachment

Answer 11

placenta accreta - attaches to myometrum
placenta increta - invades myometrium
placenta percreta - invades uterine serosa

Question 12

what investigations would you do for placenta accreta

Answer 12

look out for it on 20 week scan - loss of definition between wall of uterus and abnormal vasculature

MRI scan

Question 13

what is an important risk factor for placenta accreta

Answer 13

placenta previa plus previous C-section scar

Question 14

how would you manage placenta accreta

Answer 14

elective c-section at 36 to 37 weeks

interventions:
- hysterectomy
- leaving the placenta in situ
- cell salvage

HDU bed

Question 15

what is vasa previa?

Answer 15

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

typically occurs when the umbilical cord is attached to the membranes rather than the placenta (velamentous insertion)

Question 16

what are the potential consequences of vasa previa?

Answer 16

No major maternal risk, but major fetal risk
When the membranes rupture, the vessel may rupture too - leads to major fetal haemorrhage

c-section is not fast enough to save the fetus
if not detected previously

Question 17

how does vasa previa present?

Answer 17

bleeding when membranes rupture

with fetal distress

Question 18

how is vasa previa managed?

Answer 18

c-section is not fast enough to save the fetus

if detected antenatally, then can organise c-section and steroids

Question 19

what is placental abruption?

Answer 19

Premature separation of the placenta from the uterine wall

Question 20

what are the types of placental abruption?

Answer 20

concealed or revealed