Obstetric emergencies Flashcards
What are the risk factors for cord prolapse?
Preterm labour
Artificial rupture of membranes
- the head may not be fully engaged when this is done
Polyhydramnios
Placenta previa
List some interventions that can be done whilst waiting for help to arrive in a cord prolapse:
Tilt the bed back
Apply pressure to presenting part to relieve pressure off cord
Catheterise and inject saline into bladder to push presenting part back
Place mother on all fours or modified sims position
What is the advised delivery method for the fetus in a cord prolapse?
C-section
In a vaginal delivery what are the definitions of a PPH?
> 500ml
Major PPH is >1000ml
List some antenatal and intrapartum risk factors for PPH:
Antenatal:
- previous PPH
- pre-eclampsia
- placenta previa/ abruption
- multiple pregnancy
intra-partum:
- large baby
- multiple pregnancy
- prolonged labour
- pyrexia in labour
Placenta previa carries the highest risk for PPH
In a Major PPH what bloods do you want to take and how will you monitor the mother?
Bloods:
- FBC
- Coagulation studies
- Cross match (if not already done)
- U&Es
- LFTs
Monitor:
- vitals
- blood loss measurements
- urine output
*document on Obstetric Early Warning Score Chart/ OEWS
Why should any retained products be removed off the cervix immediate?
This can stimulate vagal tone reducing the blood pressure
What blood can be salvaged and reused for the patient?
Blood from laparotomy or C-section.
*note from the vagina due to the blood being contaminated.
When there is maternal collapse, how long should CPR be going on for when Emergancy C-section should be done?
4 minutes.
After 4 mins there should an Emergancy C-section
There are a set of factors which make CPR more challenging in a female, what are they?
Laryngeal oedema
Increased weight in the abdomen
Decreased residue capacity of the lungs
In a >24 week year old female who collapses and has no respiratory effort - who should be called?
Cardiac arrest team
Obstetric team
Neonatal team
What are some risk factors for shoulder dystocia?
Macrosomia
Induction of labour
Previous shoulder dystocia
Pre-longed labour
What are the complications of shoulder dystocia?
Maternal:
- perineal tears
- PPH
Fetus:
- HIE
- Brachial plexus injury
- Fractured clavicle
What is the preventative options for shoulder dystocia?
Estimated fetal weight of:
>4.5kg in a diabetic
or
>5kg
= C-section
What is the definition of retained placenta and what are some aetiologies?
definition:
- Active management - no placenta after 30mins
- Physiological management - no placenta after 60mins
Causes:
- uterine atony
- Trapped placenta (cervix closes to quickly)
- Placenta acreta/ percreta
What is the pathology behind uterine prolapse?
Neurogenic shock
What are the degrees of a tear?
1st degree: Vaginal tissue only/ skin
2nd degree: Perineum tissue but not anal sphincets
3rd grade a: <50% of sphincter complex
3rd grade b: >50% of sphincter complex
3rd grade c: both external and internal are torn
4th degree: Involvement of anorectal mucosa
What is needed following a perineal tear repair?
Analgesia
Laxatives to prevent too much pressure
Physiotherapy appointment
*sphincter tone should be measured
Following an ectopic with a salpingoectomy - what contraception should be avoided?
IUD
- increases the risk of ectopic pregnancy
Which bacterial infection are pregnant females at risk of developing causing meningitis and list an obstetric complications of this:
Listeria monocytogenes
- gram positive
Premature labour or Septic abortion
Outline the Classifications of urgent C-sections:
Grade 1: Immediate - life threatening to mother and child
Grade 2: Not immediately life threatening but compromise
Grade 3: Requires early deliver
Grade 4: Elective
Give some reasons for a grade 1 emergency C -section:
Fetal distress
- Abnormal CTG - 10min bradycardia
- Abnormal FBS suggesting acidosis
Cord prolapse
Severe maternal compromise (Haemorrhage)
Following a C-section how many sutures closures are done?
2 to uterus
1 to rectus shealth
1 to skin
What are the short term and long risks of a C section:
Short term:
- haemorrhage
- Anaesthetic risks
- Pain
- Surgicla injuries to bladder/ bowel
Long term:
- increased risk of sub-fertility from scars
- increased risk of uterine rupture
- placenta previa
What are the layers transected through on a C-section?
Skin Sub-cut tissue Camper fascia Scarpa facia Anterior rectus sheath Rectus abdominins muscle Transverse fascia Parietal peritonieum Visceral peritonium Uterus
What level is the spinal given before C-section?
L3/4
What are the major risks for VBAC? what percentage are successful?
Uterine rupture
20% require emergency C-section
Fetal death
- increased with VBAC
Prognosis:
- 75% are successful
**should be done in an obstetric unit
**TOLAC - trial of labour after C-section is the term for trying
How long is the second stage of labour when fully dilated allowed to go on for before interventions?
4 hours
What are some contraindications to instrumental delivery?
Forceps:
- not fully dilated
- Bleeding disorders of baby
- Malprsentation
- Anything that contraindicated a vaginal birth (placenta previa)
Ventous:
- face presenting
- <34 weeks due to risk of cephlahaematoma
Indications for instrumental delivery:
Prolonged labour
Fetal distress
Maternal fatigue
What surgical procedure usually has to be done during an instrumental delivery and list some complications of an instrumental delivery:
Episiostomy
- usually always has to be done
Complications to mother:
- PPH
- Perineal tear
Fetal complications:
- Subgaleal haemorrhage (extra-cranial haematoma which can be fetal)
- Cephlahaematoma
- Facial palsy
- Injuries
What are the risk factors for a molar pregnancy?
<16 years old pregnancy
> 45 years old pregnancy
Previous molar pregnancy
When is a molar pregnancy officially diagnosed and what are the two main types?
Partial molar pregnancy:
- 69 chromosomes
Completely molar pregnancy
- 46 chromosomes
*only officially diagnosed after tissue is removed and histological analysis is done
Compare and contrast complete and partial molar pregnancies:
Complete:
- 46 chromosomes
- Bunch of grapes
- Diffuse trophoblast hyperplasia
Incomplete:
- 69 chromosomes
- Focal trophoblastic hyperplasia
What is the management of shoulder dystocia?
HELPERR-Z
- Help - shout for help
- Episiotomy
- Legs - McRoberts manoeuvre
- Pressure - suprapubic
- Enter into vagina for intra-vaginal manoeuvres
- Release posterior shoulder
- Roll mother over onto all fours
- Zavanelli - pushed back up and C-section
Some of the parameters for sepsis change during labour due to the extreme physiological demands placed on the mother, what are some of the changes?
Temperature: >37.5
HR: >110 - whilst in labour
RR: >22 - whilst in labour
WCC - >20 whilst in labour
