Obstetrical Emergencies

Question 1

Clinical Features of Cord Prolapse

Answer 1

1. Ruptured membranes
2. Variable decelerations, bradycardia
3. Vag exam pulsating cord

Question 2

Management Cord Prolapse

Answer 2

1. STAT c-section
2. Elevate presenting part
3. keep cord warm and handle minimally
4. Fill bladder, knees to chest, tocolytics

Question 3

Clinical Features of Shoulder Dystocia

Answer 3

1. Turtle sign- head retracts against perineum

2. shoulder fails to deliver with gentle downward traction

Question 4

Risk factors for shoulder dystocia

Answer 4

1. Operative vaginal delivery
2. Macrosomia
3. Maternal diabetes
4. Maternal short stature
5. Postdates pregnancy

Question 5

Maneuvers for shoulder dystocia

Answer 5

1. Ask for help
2. Lift legs (McRoberts)
3. Apply suprapubic pressure
4. Rotate anterior shoulder
5. Manual Removal of posterior arm
6. Episiotomy

Question 6

Risk factors for post-partum hemorrhage

Answer 6

1. Tone- distention, drugs, long labour
2. Trauma-laceration, dystocia, rupture
3. Tissue- retained products, chorioamnionitis
4. Thrombus-HELLP, DIC

Question 7

Prevention of post-partum hemorrhage

Answer 7

1. Oxytocin with delivery of anterior shoulder
2. Prompt placental delivery
3. Make sure placenta is intact

Question 8

Management of post-partum hemorrhage

Answer 8

1. Bimanual uterine massage
2. If atony: oxytocin IV, more drugs later
3. CBC, crossmatch & screen
4. Start large bore IVs & fluid resuscitate
5. Continue to search for source
6. Balloon packing, uterine artery embolization, hysterectomy

Question 9

Medical management uterine atony during PPH

Answer 9

1. Oxytocin IV in 1L bolus
2. Hemabate q15 minx8
3. Cytotec
4. Ergot IM q 15minx5

Question 10

Placental Abruption

Answer 10

Most common cause of T3 bleeding
Risk Fx: trauma, smoking, HTN, PPROM
Sx: painful bleeding, contractions, fetal distress
Ix: screen DIC, type & screen
Tx: large bore IVs, assess vitals, deliver if unstable

Question 11

Placenta Previa

Answer 11

Abnormal location of placenta in front of fetus
Risk Fx: hx of previa, hx C-section, older, multip, multiples, smoking
Sx: Painless vaginal bleeding
Ix: NEVER DO VAG EXAM
Tx: Monitor, C-section if stable, stat if unstable

Question 12

Vasa Previa

Answer 12

Blood vessels in cord over cervix
Sx: painless vag bleeding, fetal distress, abnormal FHR
Ix: Apt test (blood source)
Tx: Admit, section if 34-36 wk or bleeding- Cannot do vag delivery

Question 13

Placenta Accreta

Answer 13

Abnormal placentation- grows too closely with myometrium
Risk fx: previous c-section, placenta previa, myomectomy
Sx: may bleed
Ix: Dx antenatally with MRI
Tx: planned c-section hysterectomy