Obstetric Emergency Flashcards
what is shoulder dystocia
when normal downward traction fails to deliver the shoulders after the head has been delivered
what are complications of shoulder dystocia
Erbs palsy – upper brachial plexus palsy causing arm adduction, internal rotation (pronation) and flexion – permeant in 10%
Brain injury
Death
what are risk factors for shoulder dystocia
Large baby (>4kg)
Gestational diabetes
Antenatal obesity
Previous shoulder dystocia
Instrumental delivery
what is the initial management for shoulder dystocia
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
what is the last resort for shoulder dystocia after mcroberts and episiotomy/internal manoeuvring
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
what is cord prolapse
when the membranes have been ruptured and the umbilical cord presents below the presenting part of the baby
what are the complications of a cord prolapse
there may be compression of the cord or the trauma may cause a spasm which would lead to the baby becoming rapidly hypoxic
what are risk factors for cord prolapse
Preterm labour
Breech presentation
Polyhydramnios
Abnormal lie
Twin pregnancy
how do you manage a cord prolapse
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
what is an amniotic fluid embolism
Liquor enters the maternal circulation
what are the clinical features of an amniotic fluid embolism
dypnoea
tachycardia
hypotension
hypoxia
very sudden onset
Occasionally followed by seizures and cardiac arrest
Acute heart failure is evident
basically same as PE
if a woman survives the first 30 minutes of an amniotic fluid embolism, what are the further complications
DIC
Pulmonary Oedema
ARDS
what are the common triggering events for an amniotic fluid embolism
typically rupture of membranes
Termination
C-section
Delivery
whats the management for amniotic fluid embolisms
Resus + supportive management
Bloods
Clotting
FBC
Cross match
Electrolytes
Treatment of massive obstestric haemorrhage
what is more serious, a new uterine rupture of a rupture of a previous horizontal uterine scar
primary rupture