obstetric emergencies

Question 1

shoulder dystocia

Answer 1

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

Question 2

management of shoulder dysotica

Answer 2

call help 
episiotomy 
legs - McRobert's position 
suprapubic pressure 
internal rotation arm 
remove posterior arm 
roll pt onto all 4s

Question 3

what does episiotomy do in management shoulder dystocia

Answer 3

creates space to allow for the internal manoeuvres (internal rotation and removal of posterior arm) to be attempted

Question 4

causes post partum haemorrhage

Answer 4

thrombin - pre-eclampsia, placental abruption, bleeding disorders

tissue - retained placenta

tone - placenta praevia, uterine relaxants

trauma: CS, episiotomy
other: anaemia, asian, induction, age, BMI >35

Question 5

management of PPH

Answer 5

empty bladder
rub up uterine fundus by massage umbilicus - can cause uterus to contract
measure urine output

medications
surgery

fluid replacement +/- blood products

Question 6

management of PPH: medications

Answer 6

oxytocin 5iu slow IV injection

ergometrine 0.5mg slow IV injection (if not high BP)

oxytocin infusion

tranexamic acid 1g IV

carboprost 0.25mg im

misoprostol 800mcg

Question 7

management of PPH: surgical

Answer 7

intrauterine balloon tamponade

interventional radiology

B-lynch suture

hysterectomy

Question 8

cord prolapse

Answer 8

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

it comes out of uterus into vagina

Question 9

what is likely to happen with cord prolapsed

Answer 9

highly likely to become compressed and reduce oxygen supply to foetus

Question 10

cord prolapse risk factors

Answer 10

multiparity 
low birthweight <2.5kg
preterm labour 
fetal congenital abnormalities
breech 
transverse, oblique, unstable lie 
second twin 
polyhydramnios 
unengaged presenting part
low-lying placenta

Question 11

management of cord prolapse

Answer 11

replace cord into vagina (not uterus)
perform digital elevation of presenting part (decompress cord)
catheterise and fill bladder to elevate presenting part
encourage mother to adopt knee chest or left latera position with raised hips
category I c section

Question 12

vasa praevia

Answer 12

foetal blood vessels in presenting position, cna have foetal bleeding

–> foetal anaemia, which is fatal

Question 13

overt cord prolapse

Answer 13

cord goes past presenting part

Question 14

occult cord prolapse

Answer 14

cord goes alongside presenting part