Obstetric emergencies Flashcards
What is the definition of shoulder dystocia?
Additional manouevres required after normal downward traction has failed to deliver the shoulders.
What are the risk factors for shoulder dystocia?
Big baby! But only half occur in babies >4kg.
Previous dystocia.
Maternal high BMI.
Induced labour.
Low height.
Maternal DM.
Instrumental delivery.
How do you manage shoulder dystocia?
Excessive traction is useless - causes erb’s palsy.
McRobert’s manouevre helps (hyperflex maternal legs, apply suprapubic pressure and gentle downwards pressure applied to fetus).
If this fails, internal manouevres requiring episiotomy are tried (woods screw manouevre).
What are the consequences of cord prolapse?
Cord compression or spasm causing rapid hypoxia.
What are the risk factors for cord prolapse?
Preterm labour.
Breech presentation.
Polyhydramnios.
Abnormal lie.
Twin pregnancy.
Amniotomy.
How do you manage cord prolapse?
Prevent the presenting part from compressing the cord (push the part out of the way or use tocolytics).
Put PT on all fours and prepare for C-S (unless fully dilated and head presenting - then you can use instrumental.
How does amniotic fluid embolism present?
Sudden dyspnoea, hypoxia and hypotension. +- Seizures and cardiac arrest.
If she survives 30mins, she will develop DIC, pulmonary oedema and ARDS.
How do you manage amniotic fluid embolism?
ITU for resuscitation and support.
Blood products essential.
What is the incidence of rupture in VBAC?
0.7%.
What are the risk factors for uterine rupture?
Previous classical caesarian or deep myomectomy.
Previous LSCS is lower risk.
Neglected obstructed labour (not usually in the western world).
Congenital uterine abnormalities occasionally cause rupture.
How do you manage a uterine rupture?
Maternal resuscitation with fluids and blood.
Urgent laparotomy for delivery and cessation of maternal bleeding.
