Obstetric Emergency Flashcards

1
Q

what is shoulder dystocia

A

when normal downward traction fails to deliver the shoulders after the head has been delivered

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2
Q

what are complications of shoulder dystocia

A

Erbs palsy – upper brachial plexus palsy causing arm adduction, internal rotation (pronation) and flexion – permeant in 10%

Brain injury

Death

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3
Q

what are risk factors for shoulder dystocia

A

Large baby (>4kg)

Gestational diabetes

Antenatal obesity

Previous shoulder dystocia

Instrumental delivery

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4
Q

what is the initial management for shoulder dystocia

A

Gentle downwards traction
McRoberts manoeuvre
suprapubic pressure applied

if that fails Episiotomy + internal manouvering to an oblique position
Or posterior arm is grasped and the elbow is flexed, bringing the hand down, narrowing the obstructed width by an arm

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5
Q

what is the last resort for shoulder dystocia after mcroberts and episiotomy/internal manoeuvring

A

Symphysiotomy - This is a lateral replacement of the urethra via metal catheter

Followed by the zavanelli manouvre – this is a manouvre that replicates the cardinal movemets of labour in reverse in order to get the baby back into the uterus, where the child can then be taken out via C-section

This is often high risk and the majority of the time the damage has been done

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6
Q

what is cord prolapse

A

when the membranes have been ruptured and the umbilical cord presents below the presenting part of the baby

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7
Q

what are the complications of a cord prolapse

A

there may be compression of the cord or the trauma may cause a spasm which would lead to the baby becoming rapidly hypoxic

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8
Q

what are risk factors for cord prolapse

A

Preterm labour

Breech presentation

Polyhydramnios

Abnormal lie

Twin pregnancy

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9
Q

how do you manage a cord prolapse

A

Manual reduction of the cord if still in vaginal canal

Tocolytics (terbutaline) to prevent cord compression

If the cord has fallen out of the vaginal opening do not push back inot the vagina and instead keep it warm and moist

Patient is asked to go on all fours whilst the safest delivery option is prepared

C section usually done but if the cervix is dilated and the head is low instrumental delivery is possible

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10
Q

what is an amniotic fluid embolism

A

Liquor enters the maternal circulation

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11
Q

what are the clinical features of an amniotic fluid embolism

A

dypnoea

tachycardia

hypotension

hypoxia

very sudden onset

Occasionally followed by seizures and cardiac arrest

Acute heart failure is evident

basically same as PE

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12
Q

if a woman survives the first 30 minutes of an amniotic fluid embolism, what are the further complications

A

DIC

Pulmonary Oedema

ARDS

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13
Q

what are the common triggering events for an amniotic fluid embolism

A

typically rupture of membranes

Termination

C-section

Delivery

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14
Q

whats the management for amniotic fluid embolisms

A

Resus + supportive management

Bloods

Clotting

FBC

Cross match

Electrolytes

Treatment of massive obstestric haemorrhage

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15
Q

what is more serious, a new uterine rupture of a rupture of a previous horizontal uterine scar

A

primary rupture

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16
Q

what are symptoms of a uterine rupture during labour

A

Maternal pain

foetal heart rate abnormalities

Cessation of contractions

Vaginal bleeding

Maternal collapse

17
Q

what are risk factors for uterine rupture

A

Labours with a scarred uterus

Neglected obstructed labour – requiring more force

Congenital Uterine abnormalities

18
Q

what are some prevention methods for uterine rupture

A

Avoiding induction

Careful with oxytocin in women who have had a previous c section

Always delivering via c section in women with a non-lower section scar

19
Q

what is done with a ruptured uterus post delivery of the baby

A

uterus is repaired and removed most commonly

20
Q

what is uterine invasion

A

fundus inverts into the uterine cavity

21
Q

what are some common features with uterine invasion

A

haemorrhage, pain and profound shock is common

22
Q

what are the management options for uterine invasion

A

Usually a brief initial management is to attempt to push the fundus up via the vagina

If impossible a GA is given and a replacement performed with hydrostatic pressure of several liters of warm saline

23
Q

what is the treatment for a non-eclamptic seizure in pregnancy

A

Diazepam