Obstetric Emergencies Flashcards
Which obstetric emergencies should oxygen be given for?
- Anaphylaxis
- Haemorrhage
- Eclampsia
What position should the mother be put in for anaphylaxis?
AN = L lateral, tilt head down PN = flat, elevate legs
Which obstetric emergencies should fluids be given for?
- Anaphylaxis
- Haemorrhage
- Eclampsia
What drugs are often given for anaphylaxis?
- Adrenaline
- Chlorphenamine (antihistamine)
- Hydrocortisone
How can the airway be assessed to diagnose anaphylaxis?
- Hoarse
- Stridor
- Swelling
How can breathing be assessed to diagnose anaphylaxis?
- High RR
- Wheeze
- Cyanosis
- Fatigue
- Sats <95%
How can circulation be assessed to diagnose anaphylaxis?
- Low BP
- Feeling faint
What skin changes might occur during anaphylaxis?
- Rash
- Clammy
- Pale
What are the initial steps in a cardiac arrest?
- 2222 - cardiac arrest
- Lay bed flat
- Open airway (chin lift/ jaw thrust)
- Left uterine displacement
How should CPR be performed on adults?
30:2
What drug is often given during a cardiac arrest?
Adrenaline
What are the 4 reversible causes of cardiac arrest?
- Hypovolemia
- Hypo/hyper metabolic
- Hypoxia
- Hypothermia
How can hypovolemia be managed during cardiac arrest?
- Fluids
- Blood transfusion
How can hypo/hyper metabolic be managed during cardiac arrest?
- Calcium gluconate (hyperkalaemia/ magnesaemia/ calcaemia)
- Glucose (hypoglycaemia)
How can hypoxia be managed during cardiac arrest?
Effective airway management
How can hypothermia be managed during cardiac arrest?
- Warm IV fluids
- Blankets
What are the sepsis 6?
- High flow oxygen
- IV access and bloods
- Catheterise
- Fluid resuscitation
- Blood cultures
- Broad-spectrum abx
What bloods are taken for sepsis?
- Serum lactate
- FBC, G+S, Us&Es, LFTs, clotting, ABG
What are the clinical signs of sepsis?
- RR >24
- Sys BP <90
- HR >100
- Temp >38 or <36
- Sats <95%
- Rash
- Capillary refill <2 secs
What other tests should be done for a patient with suspected sepsis?
- Swabs (nose, throat, wound, HVS/LVS, coronavirus)
- Urinalysis
- Chest/ abdominal x-ray
When should extreme care be taken with fluid resuscitation?
Patients with PET
When does a serum lactate level indicate possible sepsis?
> 4mmol/l
What are the first 2 steps of shoulder dystocia management?
- Call for help
- Discourage pushing, lie bed flat, move bottom to edge of bed
What are the first 2 maneouvres to try in a shoulder dystocia?
- McRoberts
- Suprapubic pressure (continuous or rocking)
If the first 2 maneouvres don’t work, what should be considered next in a shoulder dystocia?
- Consider episiotomy
- Deliver posterior arm
- If not possible, internal rotation of shoulders
If no maneouvres work, what is the next step for a shoulder dystocia?
- Inform consultant obstetrician and anaesthetist
- Repeat each step + change position if possible
What additional management might be considered for shoulder dystocia?
- Zavanelli’s maneouvre (push head up + CS)
- Cleidotomy (separate clavicle)
- Symphysiotomy (separate symphysis pubis)
What are the 4 possible ways to relieve pressure on the cord during a cord prolapse?
- Manually elevate PP
- Exaggerated sims position
- Bladder filling
- Tocolysis
What is the exaggerated sims position?
L lateral with head tilted down
What drug is commonly used for tocolysis?
Terbutaline
What should be done after every obstetric emergency?
- DDDD
2. Cord gases (if NN emergency)
What position should a woman be in if she has a uterine inversion?
Lie flat
What should be attempted first for uterine inversion?
Manual replacement of the uterus
What else should be done for a uterine inversion?
- Call for help
- Oxygen
- Observations
- IV access and bloods
- Fluids
- Transfer to theatre
