Obstetric Emergency

Question 1

What do you do if you have a emergency delivery?

Answer 1

Call gynae reg/obstetrician
Get emergency delivery box
Get oxytocin from fridge
Prepare resuscitate
Inform paeds

Question 2

For patients who are pregnant and are being treated as a trauma patient, is it the baby or mother who received the initial treatment priority?

Answer 2

The mother

Question 3

What happens to the bowel as the uterus enlarges?

Answer 3

It is pushed upwards so that it lies in the upper abdomen

Question 4

What can an abrupt decrease in maternal intravascular volume result in?

Answer 4

Profound increase in uterine resistance, reducing foetal oxygenation despite normal maternal vital signs

Question 5

What is maximally dilated throughout gestation and is exceptionally sensitive to catecholamine stimulation?

Answer 5

The placental vasculature

Question 6

At what week of gestation does the increasing plasma blood volume plateaus?

Answer 6

34 weeks

Question 7

What does an increase of red blood cells cause?

Answer 7

Decreased hematocrit

Question 8

In a healthy pregnant patient how much blood loss can she have prior to any symptoms of hypovolemia being exhibited?

Answer 8

1.2-1.51 blood loss

Question 9

What clotting factors increase during pregnancy?

Answer 9

White blood cells count and serum fibrinogen

Question 10

After what week of pregnancy does cardiac output increase by 1-1.5L/min because of the increase in plasma volume and decrease in vascular resistance of the uterus and placenta?

Answer 10

10 weeks

Question 11

During which trimester of pregnancy dose the placenta receives 10% of cardiac output?

Answer 11

Third

Question 12

What is common in late pregnancy?

Answer 12

Hypocapnia

Question 13

Why is it important to maintain adequate arterial oxygenation during resuscitation for pregnant patients?

Answer 13

Oxygen consumption increases during pregnancy

Question 14

What acts as a buffer to direct foetal injury from blunt trauma?

Answer 14

Abdominal wall, uterine myometrium and amniotic fluid

Question 15

How does indirect injury to the foetus occur?

Answer 15

From rapid compression, deceleration, the contrecoup effect or a shearing force resulting in abruptio placenta

Question 16

In early pregnancy, what can absorb a significant amount of energy from penetrating objects, decreasing their velocity and lowering the risk of injury to other viscera?

Answer 16

Dense uterine musculature

Question 17

What can help slow a penetrating object in a pregnant patient?

Answer 17

Amniotic fluid and the foetus

Question 18

What is the foetal outcome when there is penetrating trauma to the uterus?

Answer 18

Generally poor

Question 19

What can you do to relieve uterine compression of the vena cava to stop reduced venous return to the heart, decreased cardiac output and aggravate shock?

Answer 19

Manually displace the uterus to the left side

Question 20

Why can pregnant patients lose a significant volume of blood prior to signs of hypovolemia causing the foetus to become distressed and placenta deprived of oxygen?

Answer 20

Increased intravascular volume

Question 21

What should be used as a last resort in restoring maternal blood pressure because they further reduce uterine blood flow which results in foetal hypoxia?

Answer 21

Vasopressors

Question 22

Why is abdominal examination following trauma in pregnancy critically important?

Answer 22

To quickly identify serious maternal injuries as well as establishing foetal well being

Question 23

What are the 2 leading causes of foetal death?

Answer 23

Maternal shock and death
Placenta abruption

Question 24

When would you suspect abruptio placentae in a pregnant trauma patient?

Answer 24

Vaginal bleeding
Uterine tenderness
Guarding
Rigidity or rebound tenderness

Question 25

What is the most likely diagnosis in the presence of profound shock following blunt trauma in pregnancy?

Answer 25

Placental abruption

Question 26

Can you X-ray or CT a pregnant patient?

Answer 26

Yes, as long as the benefits out weigh the risks