Obstetric Emergencies

Question 1

What is shoulder dystocia?

Answer 1

Is when babies anterior shoulder gets caught above mothers pubic bone after vaginal delivery of the head

Question 2

What are risk factors for shoulder dystocia?

Answer 2

• Gestational diabetes
• Previous history of condition
• Obesity

Question 3

What are possible complications of shoulder dystocia?

Answer 3

• Umbilical cord entrapment
• Inability of child’s chest to expand properly
• Severe brain damage or death
• Brachial plexus damage

Question 4

What is the management of shoulder dystocia?

Answer 4

• McRoberts manoeuvre
• Possible episiotomy

Question 5

What does PPH stand for?

Answer 5

Postpartum haemorrhage

Question 6

What is a postpartum haemorrhage?

Answer 6

Loss of more than 500ml or 1000ml of blood within the first 24 hours following childbirth

Question 7

What are the different classifications of postpartum haemorrhage?

Answer 7

• Primary
  
  • 99% of all
  • In first 24 hours after delivery
• Secondary
  
  • More than 24 hours after delivery, up to 6 weeks post

Question 8

What is primary and what is secondary postpartum haemorrhage?

Answer 8

Primary - in first 24 hours

Secondary - more than 24 hours up to 6 weeks after delivery

Question 9

What is the aetiology of postpartum haemorrhage?

Answer 9

• Remember 4 Ts: thrombin, tissue, tone, trauma
• Poor contraction of uterus
• Not all placenta removed
• Tear of uterus
• Poor blood clotting

Question 10

What are risk factors for postpartum haemorrhage?

Answer 10

• Anaemia
• More than 1 baby
• Age older than 40 years

Question 11

What is the management of postpartum haemorrhage?

Answer 11

• Fluid replacement with or without blood products
• Surgical
  
  • Intrauterine balloon tamponade
  • Interventional radiology
  • B-lynch suture
  • Hyperectromy

Question 12

What is cord prolapse?

Answer 12

The descent of umbilical cord through the cervix alongside or past the presenting part in the presence of ruptured membrane

Question 13

What is the incidence of cord prolapse?

Answer 13

0.5%

Question 14

What are risk factors for cord prolapse?

Answer 14

• Abnormal position of baby
• Prematurity
• Twin pregnancy
• Congenital abnormalities

Question 15

What is the management of cord prolapse?

Answer 15

• Replace cord into vagina – not uterus
• Perform digital elevation of presenting part
• Catheterise and fill bladder to elevate presenting part
• Arrange for a category 1 C-section