obstetric emergencies Flashcards
Mx sepsis
High flow O2
IV Abx
Fluid challenge (crystalloid) if no response give vasopressors
Blood cultures
Lactate
Urine output
What is the definition of sepsis
Temp >38 or <36
HR >100bpm
RR>20
WCC >17x10^9 or <4x10^9 with > 10% immature band forms
key organisms in peurperial strep
Lancefield group a haemolytic strep, E.coli
RF for placental abruption
polyhydramnios multiple pregnancy trauma increased BP Smoking coke
Why is placenta praevia so dangerous
mother bleeds from her circulation
RF for placenta praevia
Multiple pregancy
c section scars
assisted conception
uterine abnormalities
Mx of placenta praevia
Asymtpomatic low-lying or placenta praevia (see at 20 wk scan):
avoid scan
rescan at 32 weeks, if still low-lying scan at 36, if still low lying elective C-section at 38 weeks
Symptomatic placenta praevia (painless bleeding)
Admit til bleeding has stopped and then for another 48 hours
ABCDE
anti-D if appropriate
if haemodynamically unstable and foetal distress expedite delivery
if mum is stable and no foetal distress give steroids and admit til bleeding stops
re scan at 36, if still low lying c-section
Kleihauer test if mum RhD -ve + anti-D
Steroids <35 weeks
mx vasa praevia
immediate c section
RF for uterine atony
Prolonged labour macrosomia induction w/ oxytocin placenta accreta polyhdramnios previous c-section
signs of uterine atony
symptoms of blood loss
rising fundus
narrow pulse pressure
peritonism
Mx of uterine atony
Initiate obstetric haemorrhage protocol Uterine compression IV access FBC + X-match empty bladder remove clots from vagina start uterotonic agents (oxytocine, carboprost) If bleed ongoing think DIC and replace clotting factors Operate
warning signs of eclampsia
epigastric pain Increased ICP signs Focal neuro signs uncontrolled HTN poor urine output
Mx of eclampsia
- call senior
- ABCDE
- MgSO4. 4g loading dose and 1g/24 hours
Side effects of MgSO4
cardiac arrest and resp depression
antidote: 10ml 10% calcium glauconate
Mx of amniotic fluid embolus
ABCDE
Support in ITU
Poor survival (you get DIC)
RF for cord prolapse
polhydramnios
multiple pregnancy
transverse/oblique lie
balloon catheter induction
Mx cord prolapse
Call senior immediate speculum and digital exam (don't touch cord as it might spasm) elevate presenting part Mother: knee to chest, left lateral Ultimately deliver by ECS
Complications of shoulder dystocia
Maternal: 3rd/4th deg tears PPH Foetal brachial plexus injury clavicle fracture hypoxic brain damage
Mx shoulder dystocia
call for help tell woman to lie flat and stop pushing external manoeuvres: McRoberts position, suprapubic pressure internal manoeuvres: Wood's screw manoeuvre Rubin II manoeuvre Change position to all fours Symphysiotomy
Mx of uterine inversion
Manual replacement
hydrostatic replacement
surgical replacement
Mx uterine rupture
Call senior ABCDE 2x large bore cannula urgent bloods transfusion ASAP expedite delivery urgent laparotomy to examine uters
Mx of abruption
ABCDE
anti-D in RhD negative
deliver if mum is haemodynamically unstable and foetal distress
If >37 weeks and stable IOL
If <37 weeks and stable admit + give steroids til bleeding settles, serial growth scans
how to minimise risk of PPH
Prophylactic uterotonics in 3rd stage
if vaginal - IM oxytocin
if C-section - IV oxytocin
Mx minor PPH (500-1000)
ABCDE
HR, RR, BP every 15 mins
Mx major PPH >1L
call for senior help and initiate obstetric haemorrhage protocol ABCDE Remove placenta and check it's all there Massage uterus to stimulate contractions then: 1. IV syntocin (or something similar) 2. IM carboprost 3. intrauterine balloon tamponade 4. surgery
