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Reproductive System > Obstetric Emergencies > Flashcards

Obstetric Emergencies Flashcards

1
Q

What is shoulder dystocia?

A

When the anterior fetal shoulder becomes impacted behind the maternal pubic symphysis after delivery of the fetal head

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2
Q

How is shoulder dystocia managed?

A

A series of manoeuvres are used to dislodge the fetal shoulder

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3
Q

Why is shoulder dystocia an emergency?

A

As fetal oxygen levels can drop steeply during the management of shoulder dystocia, effective teamwork and a well-rehearsed approach to management is essential

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4
Q

Who is involved in the MDT managing shoulder dystocia?

A

A senior obstetrician, a paediatrician to attend to baby immediately after the birth, a scribe to keep a note of timings which can help decide on what manoeuvre to try next

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5
Q

What is HELPERR?

A
  • H – Call for Help
  • E – Evaluate for Episiotomy - creates space to allow the internal manoeuvres to be attempted
  • L – Legs (McRoberts Position) - flexing the hips ~60 degrees to open up the pelvis
  • P – Suprapubic Pressure
  • E – Enter Manouvers (Internal Rotation)
  • R – Remove the Posterior Arm
  • R – Roll the Patient (Onto all Fours)
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6
Q

How many women are affect by postpartum haemorrhage?

A

8/100

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7
Q

What are the 5 main caused of post party haemorrhage?

A
  • Thrombin
  • Tissue
  • Tone
  • Trauma
  • Other
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8
Q

How can thrombin cause PPH?

A
  • Pre-eclampsia
  • Placental disruption
  • Pyrexia in labour
  • Bleeding disorders: haemophilia, anticoagulation, vonWillebrand disease
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9
Q

How can tissue cause PPH?

A
  • Retained placenta
  • Placenta accreta - placenta grows too deeply into the uterine wall
  • Retained products of conception
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10
Q

How can tone cause PPH?

A
  • Placenta praaevia

* Ove distension of

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11
Q

How can tone cause PPH?

A
  • Placenta praaevia - placenta partially or totally covering the cervix
  • Over distension of the uterus: multiple pregnancy, polyhydramnios (excessive accumulation of amniotic fluid), macrosomia (>4kg baby)
  • Uterine relaxants
  • Previous PPH
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12
Q

How can trauma cause?

A
  • Caesarean section
  • Episiotomy (incision in the periosteum)
  • Macrosomia
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13
Q

What are the other causes of PPH?

A
  • Asian ethnicity
  • Anaemia
  • Induction
  • BMI>35
  • Prolonged labour
  • Age
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14
Q

What is a primary PPH?

A
  • In first 24 hours after delivery
  • > 500ml blood (common 1/20 women)
  • Severe Haemorrhage >2000ml (rare 6/1000)
  • 99% of all PPH
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15
Q

What is a secondary PPH?

A

•>24 hours to up to 6 weeks post delivery

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16
Q

What is a secondary PPH?

A

•>24 hours to up to 6 weeks post delivery

17
Q

What is cord prolapse?

A

The descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membrane

18
Q

What is the incidence of cord prolapse?

A
  • Overall incidence of cord prolapse ranges from 0.1–0.6%

* In the case of breech presentation, the incidence is higher at 1%

19
Q

Why is cord prolapse an emergency?

A

When the umbilical cord prolapses below the presenting part of the fetus it is highly likely to become compressed and thus reduce oxygen supply to the foetus

20
Q

What are the general risk factors for cord prolapse?

A
  • Multiparity
  • Low birthweight (<2.5kg)
  • Preterm labour
  • Foetal congenital abnormalities
  • Breech presentation
  • Transverse, oblique and unstable lie
  • Second twin
  • Polyhydramnios
  • Unengaged presenting part
  • Low-lying placenta
21
Q

How is cord prolapse managed?

A
  • Call for Help!
  • Replace cord into vagina (not uterus) - reduces chance of the cord becoming compressed or of the vessels going into spasm due to low temp outside the body
  • Perform digital elevation of the presenting part
  • Catheterise and fill bladder to elevate presenting part - if no immediate access to C-section
  • Encourage mother to adopt knee-chest or left lateral position with raised hips
  • Consider tocolysis (anti-contraction medication)
  • Arrange for a Category 1 C-Section
22
Q

How is a PPH managed initially?

A
  • Call for help!
  • ABCDE
  • Empty Bladder
  • Rub up uterine fundus by massaging above the umbilicus
  • Medications
  • Surgery
  • Manage on clinical signs not just EBL (estimate blood loss)
  • Fluid Replacement +/- Blood Products
23
Q

How is a PPH managed with medication?

A
  • Oxytocin 5iu (1 unit) slow iv injection
  • Ergometrine 0.5mg slow iv injection (not if high BP)
  • Oxytocin infusion
  • Tranexamic acid 1g IV
  • Carboprost 0.25mg im (max 8 doses
  • Misoprostol 800 micrograms)
24
Q

How is a PPH managed surgically?

A
  • Intrauterine Balloon tamponade
  • Interventional Radiology
  • B-Lynch Suture
  • Hysterectomy

Reproductive System (31 decks)

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