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Obs and gynae > obstetric emergencies > Flashcards

obstetric emergencies Flashcards

1
Q

Mx sepsis

A

High flow O2
IV Abx
Fluid challenge (crystalloid) if no response give vasopressors

Blood cultures
Lactate
Urine output

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2
Q

What is the definition of sepsis

A

Temp >38 or <36
HR >100bpm
RR>20
WCC >17x10^9 or <4x10^9 with > 10% immature band forms

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3
Q

key organisms in peurperial strep

A

Lancefield group a haemolytic strep, E.coli

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4
Q

RF for placental abruption

A 
polyhydramnios
multiple pregnancy
trauma
increased BP 
Smoking 
coke
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5
Q

Why is placenta praevia so dangerous

A

mother bleeds from her circulation

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6
Q

RF for placenta praevia

A

Multiple pregancy
c section scars
assisted conception
uterine abnormalities

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7
Q

Mx of placenta praevia

A

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

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8
Q

mx vasa praevia

A

immediate c section

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9
Q

RF for uterine atony

A 
Prolonged labour
macrosomia
induction w/ oxytocin
placenta accreta
polyhdramnios
previous c-section
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10
Q

signs of uterine atony

A

symptoms of blood loss
rising fundus
narrow pulse pressure
peritonism

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11
Q

Mx of uterine atony

A 
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
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12
Q

warning signs of eclampsia

A 
epigastric pain
Increased ICP signs
Focal neuro signs
uncontrolled HTN
poor urine output
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13
Q

Mx of eclampsia

A
  1. call senior
  2. ABCDE
  3. MgSO4. 4g loading dose and 1g/24 hours
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14
Q

Side effects of MgSO4

A

cardiac arrest and resp depression

antidote: 10ml 10% calcium glauconate

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15
Q

Mx of amniotic fluid embolus

A

ABCDE
Support in ITU
Poor survival (you get DIC)

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16
Q

RF for cord prolapse

A

polhydramnios
multiple pregnancy
transverse/oblique lie
balloon catheter induction

17
Q

Mx cord prolapse

A 
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
18
Q

Complications of shoulder dystocia

A 
Maternal:
3rd/4th deg tears
PPH
Foetal
brachial plexus injury
clavicle fracture
hypoxic brain damage
19
Q

Mx shoulder dystocia

A 
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
20
Q

Mx of uterine inversion

A

Manual replacement
hydrostatic replacement
surgical replacement

21
Q

Mx uterine rupture

A 
Call senior
ABCDE
2x large bore cannula
urgent bloods 
transfusion ASAP
expedite delivery
urgent laparotomy to examine uters
22
Q

Mx of abruption

A

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

23
Q

how to minimise risk of PPH

A

Prophylactic uterotonics in 3rd stage
if vaginal - IM oxytocin
if C-section - IV oxytocin

24
Q

Mx minor PPH (500-1000)

A

ABCDE

HR, RR, BP every 15 mins

25
Q

Mx major PPH >1L

A 
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

Obs and gynae (23 decks)

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