Obstetrical Emergencies

Question 1

Umbilical Cord Prolapse

Answer 1

When the umbilical cord passes through the birth canal and into the vagina in front of the presenting part
Occurs after the membranes have ruptured

Question 2

in relation to the membranes, when can an umbilical cord prolapse happen?

Answer 2

occurs after the membranes have ruptures

Question 3

Risk factors for cord prolapse

Answer 3

• Polyhydramnios
• Premature rupture of membranes

• Fetal malpresentation (footling breech,
transverse/oblique lie) •

Multiparity

• Multiple gestation (second twin)
• Prematurity
• Low birthweight
• Abnormal placentation
• Long umbilical cord

Question 4

management of obstetrical emergencies

Answer 4

Avoid vasospasm - tuck cord in vagina, minimize handling of cord Elevate presenting part of fetus off the cord
• With hand
• Knee chest position
• Hands and knees STAT cesarean section

Question 5

Management of shoulder dystocia

Answer 5

HELPERR
H: call for Help, Head of bed flat
E: Establish authority

L: Legs (McRobert’s maneuver)

P: Suprapubic Pressure

E: Episiotomy, Enter maneuvers

R: Remove posterior arm

R: Roll patient to all fours (or Maneuvers of last Resort)

Question 6

definition of post partum hemorrhage

Answer 6

Definitions
Quantitative: Estimated blood loss > 500 mL after a vaginal birth >1,000 mL after a cesarean birth

Clinical: Excessive bleeding that results in signs and symptoms of hypovolemia

Timing: Primary/Early (within 24 hours) or secondary/delayed (24 hours to 12 weeks postpartum)

Question 7

4 T’s of post partum hemorrhage

Answer 7

Tone: overdistension (macrosomia, multiples, polyhydramnios), high parity, uterine infection, uterine Fatigue (augmentation with oxytocin), retained placenta.

Trauma: lacerations, incisions, uterine rupture

Tissue: retained placenta or placental fragment

Thrombin: acquired or inherited bleeding disorder

Question 8

causes of secondary pph

Answer 8

subinvolution of the placental site

retained products of conception

infection

inherited coagulation defect

Question 9

management of PPH

Answer 9

think about 4 T’’s

Tone: can do uterine massage

T:trauma: repair lacerations

Management of PPH: IV access, extra nursing support, monitor vitals and include foley for urine output, uterine massage to increase tone

Labs: CBC< TandS, PT, PTT, fibrinogen, determine and treat the underlying cause

Medical: oxytocin, carbetocin, methylergonovine, misoprostol, tranexamic acid, tamponade balloon in the uterine cavity→ inserted for 8-48 hours and then gradually deflated, radiologic embolization (not available to all center), compression sutures→ sutures are tied down to maintain uterine compression and control further bleeding, artery ligation.

Surgical: Peripartum Hysterectomy

Most commonly indicated with placenta accreta, uterine atony.

Question 10

medical management of PPH

Answer 10

misoprostol

oxytocin

cyklokapron: transexamic acid

Question 11

Sudden onset of cardiorespiratory arrest, hypotension, respiratory compromise and DIC

what is going on

Answer 11

amniotic fluid embolism