Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y5 Gynae & Obstetrics > Obstetric Emergencies > Flashcards

Obstetric Emergencies Flashcards

1
Q

What are causes of acute maternal collapse?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What position myst you put a an unwell pregnant woman?

A

Left lateral tilt (at 15 degrees) to minimise aorto-caval compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are RF for sepsis?

A

Ruptured membranes

Infection - UTI, PID, STD, Group B strep, amniocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What score do you use for onset of sepsis?

A

By looking at MEOWS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the sepsis 6?

A 
3 in (fluids, high flow oxygen, antibiotics)
3 out (blood culture, lactate, urine output)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do you give before, antibiotics or blood cultures?

A

BLOOD CULTIRES FIRST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are common organisms involved in puerperal sepsis?

A

lance field group A beta haemolytic step

E coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is APH?

A

Bleeding from or into the genital tract from 24 weeks to delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are causes of APH?

A

Placental:

  • placenta abrupta
  • placenta previa

Foetal:
- vasa previa.

Maternal:

  • Vaginal trauma
  • Cervical ectropion.
  • Cervical carcinoma
  • Vaginal infection
  • Cervicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is placental abruption?

A

Premature separation. of. the placenta from the uterine w all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are. the two types of placenta abruption

A

Complete (need to deliver)

Marginal (resolves spontaneously, due to a partial abruption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the other two types of placental abruption

A

Revealed

Concealed (bleeding remains in uterus, forming retroplacental clot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you recognise a concealed abruption

A

You don’t
All you see is that there is foetal distress
So you deliver immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are RF for placental abruption

A
  • prior abruption
  • HTN and PET
  • smoking, maternal age, BMI, cocaine
  • Trauma to maternal abdomen
  • Polyhydramnios
  • Multiple preg
  • FGR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the pathophysiology of placental abruption

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is classical presentation of placental abruption

A

PAINFUL bleeding with WOODY abdomen

SUDDEN foetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you diagnose placental abruption

A

Transabdominal USS

  • can confirm if it is!
  • but not always specific (may give false negatives > does not rule it out!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations can you do for placental abruption

A 
Abdo exam, speculum, 
Obs
FBC 
Clotting (low platelets due to. intrauterine clotting) 
G&S, X match 
USS 
CTG. assess for foetal distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is management of marginal abruption

A 
Conservative 
Give steroids (if 24-34 weeks)
Discharge after 24 h of no more bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is managaemtn of severe placental abruption

A

IMMEDIATE DELIVERY
usually via C sec
+ give Anti D if lady is negative (+ Kleihauer test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is placenta previa?

A

A placenta covering / enriching the cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a low lying placenta?

A

A placenta near the cervical os but not covering it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are symptoms of. placenta previa?

A

Painless bleeding

May be spontaneous / triggered by trauma (e.g. sex, speculum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are RF for PP?

A 
Prior PP 
Iatrogenic: CS, curettage to endometrium, uterine surgery
Uterine structural abnormality 
Assisted conception
smoking, advanced maternal age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is PP diagnosed?

A

Via TVUSS

26
Q

How do you manage PP with so symptoms?

A

C section at 38 weeks

27
Q

What is vasa previa?

A

Foetal vessels transversing the foetal membrane over the cervical os, not covered. in Wharton Jelly

28
Q

Why does vasa previa usually occur?

A

As the vessels from the umbilical cord go into the foetal membranes and THEN into the placenta, instead of directly to the placenta
This means the vessels are not protected by Wharton Jelly within the cord
This makes Vasa Previa more likely to rupture

29
Q

What is the BIG danger of VP?

A 
Foetal mortality (doe to foetal exsangiuation) 
Vasa previa are likely to rupture when foetal membranes rupture during labour
30
Q

How do you manage VP/PP?

A

Deliver baby via C section

31
Q

What is a PP haemorrhage?

A

Blood loss >500 ml following vaginal or >1000 ml following C sec

32
Q

What are categories of PPH?

A

Primary: <24h post partum
Secondary: >24h post partum

33
Q

What are the four causes of PPH?

A

Tone (uterine atony)
Tissue (retained placenta)
Trauma (episiotomy/damage during C sec)
Thrombin 8coag defect)

34
Q

What are causes of uterine atony’

A
  • Retained placental tissue
  • Repeated uterine distension (multiple prig, overstitching from twins, grand multiparty)
  • Muscle fatigue during delivery (induction of labour, prolonged labour)
    _ Unable to empty bladder (pushes onto uterus, interferes with contractions)
  • Obstetric medications (e.g. anaesthetics)
35
Q

What are causes of trauma=

A

From C section surgery

36
Q

How do you ensure that there is no tissue left in vagina after

A

Ensure that placenta has come out intact

Sweep the uterus with your hand for any fragments

37
Q

Which two very dangerous events is eclampsia associated with?=

A

Cerebral haemorrhage

Stroke

38
Q

How do you treat eclampsia?

A

Magnesium sulphate
Start with 4mg IV loading dose
Maintainance infusion of 1g/h for 24h after delivery

39
Q

What must you be aware of with magnesium sulphate?

A

Narrow therapeutic range

40
Q

What does overdose from mg sulphate cause?

A

Overdose causes resp depression, cardiac arrest

41
Q

What is the antidote to mg sulphate?

A

10ml 10% calcium clucoronarte

42
Q

What are sx of amniotic fluid embolus?

A

same as PE

43
Q

HOw do you treat amniotic fluid embolus?

A

You can’t
Supportive tx in ITU
High mortality rate

44
Q

What is umbilical cord prolapse?

A

The descent of the umbilical cord through the cervix with / before the presenting part of the foetus

45
Q

Why is umbilical cord prolapse dangerous?

A

It causes foetal hypoxia

46
Q

How does umbilical cord prolapse cause foetal hypoxia

A
  • Occuylusion: presenting part of foetus compresses umbilical cord, blocking blood flow
  • arterial vasospasm: due to exposure to cold air
47
Q

How do you prevent umbilical cord prolapse

A

Schedule elective C section for transverse/oblique lie

48
Q

How do you manage umbilical cord prolapse

A

Speculum + vaginal exam
Sumon senior help
Prep operating theatre
deal with the cord (prevent further compression by elevating the presenting part of foetus, and try to not touch the cord as it causes spasm)

DELIVER VIA C SEC

49
Q

How do you place the mother in umbilical cord prolapse

A

Knee to chest

Left lateral position

50
Q

What is shoulder dystocia

A

vaginal delivery resulting in unsuccessful delivering of the shoulders with gentle traction
Requires additional obstetric maneuvres

51
Q

What actually occurs in shoulder dystocia

A

Anterior shoulder is stuck on pubic symphisis

Posterior shoulder stuck on sacral promontory

52
Q

What are two key dangers in shoulder dystocia

A

Foetal distress / hypoxia

Damage to foetus (brachial plexus) if you pull

53
Q

What are two signs that you see with shoulder dystocia

A

Failure of restitution (head remains in OA, does not become transverse again)

Turtle neck sign( head retracts back into pelvis, neck no longer visible)

54
Q

How do you manage shoulder dystocia ?

A 
Tell mother to STOP pushing 
Use only axial traction, avoid downward traction on foetal head (increased risk of brachial plexus injury) 
Maneuvres: 
- McRoberts (hyperflex maternal hips) 
- Suprapubic pressure

Consider episiotomy to increase space for manoeuvres

55
Q

What are maternal complications form shoulder dystocia

A
  • increased perineal trauma (OASI)
  • PPH
  • psychological trauma
56
Q

What are foetal complications from shoulder dystocia

A
  • brachial plexus injury
  • fractured clavicle
  • hypoxic brain injury
57
Q

How do you prevent VTE in pregnant patients?

A

TED stockings

LMWH (clean - enoxaparin)

58
Q

How do you investigate suspected PE in pregnant patients

A

V/Q scan

59
Q

What is uterine ruprute?

A

Full thickness rupture of uterus

60
Q

What are RF for uterine rupture?

A
  • VBAC
  • Prior uterine surgery
  • <12 months from last C sec
  • IOL, oxytocin use
61
Q

How does uterine rupture present during labour’

A

Maternal shock
Foetal distress /loss of foetal heart on CTG
Unable to palpate any presenting part
Sudden severe abdo pain

62
Q

How do you manage uterine rupture=

A

Vaginal exam to confirm
Foetus delivered asap whichever way is fastest
Urgent laparotomy

Y5 Gynae & Obstetrics (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions