Obstetric Emergencies Flashcards
What are causes of acute maternal collapse?
Think top to bottom
- Eclampsia (seizure)
- Amniotic fluid embolism
- Major Obstetric Haemorrhage (4Ts)
- VTE, PE
- Shoulder dystocia
- Sepsis
OR HEPARINS: Hemorrhage Eclampsia Pulmonary embolism Amniotic fluid embolism Regional anaethetic complications Infarction (MI) Neurogenic shock Septic shock
What position myst you put a an unwell pregnant woman?
Left lateral tilt (at 15 degrees) to minimise aorto-caval compression
What are RF for sepsis?
Ruptured membranes
Infection - UTI, PID, STD, Group B strep, amniocentesis
What score do you use for onset of sepsis?
By looking at MEOWS
What are the sepsis 6?
3 in (fluids, high flow oxygen, antibiotics) 3 out (blood culture, lactate, urine output)
What do you give before, antibiotics or blood cultures?
BLOOD CULTIRES FIRST
What are common organisms involved in puerperal sepsis?
lance field group A beta haemolytic step
E coli
What is APH?
Bleeding from or into the genital tract from 24 weeks to delivery
What are causes of APH?
Placental:
- placenta abrupta
- placenta previa
Foetal:
- vasa previa.
Maternal:
- Vaginal trauma
- Cervical ectropion.
- Cervical carcinoma
- Vaginal infection
- Cervicitis
What is placental abruption?
Premature separation. of. the placenta from the uterine w all
What are. the two types of placenta abruption
Complete (need to deliver)
Marginal (resolves spontaneously, due to a partial abruption)
What are the other two types of placental abruption
Revealed
Concealed (bleeding remains in uterus, forming retroplacental clot)
How do you recognise a concealed abruption
You don’t
All you see is that there is foetal distress
So you deliver immediately
What are RF for placental abruption
- prior abruption
- HTN and PET
- smoking, maternal age, BMI, cocaine
- Trauma to maternal abdomen
- Polyhydramnios
- Multiple preg
- FGR
What is the pathophysiology of placental abruption
Rupture of the maternal vessels in the basal layer of the endometrium
Blood accumulates and splits the placental attachment
The detached portion of the placenta does not function, causing rapid foetal compromise
What is classical presentation of placental abruption
PAINFUL bleeding with WOODY abdomen
SUDDEN foetal distress
How do you diagnose placental abruption
Transabdominal USS
- can confirm if it is!
- but not always specific (may give false negatives > does not rule it out!
What investigations can you do for placental abruption
Abdo exam, speculum, Obs FBC Clotting (low platelets due to. intrauterine clotting) G&S, X match USS CTG. assess for foetal distress
What is management of marginal abruption
Conservative Give steroids (if 24-34 weeks) Discharge after 24 h of no more bleeding
What is managaemtn of severe placental abruption
IMMEDIATE DELIVERY
usually via C sec
+ give Anti D if lady is negative (+ Kleihauer test)
What is placenta previa?
A placenta covering / enriching the cervical os
What is a low lying placenta?
A placenta near the cervical os but not covering it
What are symptoms of. placenta previa?
Painless bleeding
May be spontaneous / triggered by trauma (e.g. sex, speculum)
What are RF for PP?
Prior PP Iatrogenic: CS, curettage to endometrium, uterine surgery Uterine structural abnormality Assisted conception smoking, advanced maternal age