Obstetrics emergencies Flashcards
Why is there a risk of Hypoxia during pregnancy?
Tidal volume increases by up to 50%
Residual capacity is reduced by 25%
Oxygen demand is increased by 20%
There is a reduced ability and reserve to compensate for illness or injury
Red flags for pregnant patients that are breathless
Sudden onset of breathlessness
Orthopnoea
With chest pain/syncope
RR >20
SpO2 <94%
Breathlessness with tachycardia
What are the changes in the cardiovascular system in pregnancy?
Cardiac output increase by 40%
15% increase in pulse
35% increase in stroke volume
Reduction in peripheral resistance
Drop in systolic BP
What happens when laying supine in pregnancy?
Compression of the aorta and inferior vena cava
=
Reduced venous return
Reduced cardiac output
Reduced BP
Risk of hypotension
Why lay on left side in pregnancy?
So you compress the aorta rather than the inferior vena cava
Aorta is stronger and can withstand more pressure than the inferior vena cava
What causes haemodilation in pregnancy
The plasma and haemoglobin and haemotocrit do not increase by the same level - causing relating haemodilation
What are the effects on the coagulation system during pregnancy?
Platelet count calls
Thrombocytopenia
Increased clotting factors
Rise of firbinogel levels by 50%
Decreased anticoags
Decreased venous flow
What is the first stage of labour?
Begins when labour starts and ends with full cervical dilation to 10cm
What is the second stage of labour?
Commences with complete cervical dilation to 10cm and ends with the birth to the baby
What is the third stage of labour?
After the birth of the baby and ends with the delivery of the placenta and birth
What is the ideal contraction time and how long should they last?
2-3 mins intervals
60-90 seconds
When specifically should you encoring the woman to pant during labour?
From the point of crowning to the delivery of the rest of the head.
This encourages the slow delivery of the baby.
What is antepartum haemorrhage (APH)?
Any bleeding from the genital tract after 24 weeks gestation prior to the birth of the baby
What is primary postpartum haemorrhage?
Occurs within first 24 hours of birth following delivery >500ml blood loss after vaginal delivery
What is secondary postpartum haemorrhage?
Abnormal bleeding from genital tract between 24 hours and 12 weeks postnatally.
What are the causes of antepartum haemorrhage (APH)?
Placenta praaevia
Placental abruption
Bleeding from genital tract
Abnormally invasive placenta
Vasa praaevia
Unexplained
What are the causes of postpartum haemorrhage (PPH)?
Tone
Trauma
Tissue
Thrombin
What is vasa praaevia?
Vasa praaevia is when the blood vessels that connect your baby to the placenta do not grow properly and can tear before or during labour. It is a serious but rare pregnancy complication.
What is antepartum haemorrhage management?
Position patient in left lateral position to stop aorta compression
Oxygen
IV fluids
Measure blood loss
Transfer to nearest obstetric unit
What is management for postpartum haemorrhage?
Measure blood loss
Uterine massage (for atony)
Give Uterotonics
Give TXA
IV Fluids
Apply pressure to trauma
Bimanual Uterine Compression
What are the symptoms of pre eclampsia?
Headaches
Visual disturbances
N&V
Epigastric pain
Oliguria
Signs of clonus
Progressive deterioration in laboratory blood tests
Foetal growth restriction
What are the complications of preeclampsia?
Risk of stroke due to HTN
Hepatic issues (renal failure)
Renal (AKI, endothelial swelling)
Haematological (endothelial damage, capillary leakage, clotting disorders)
CNS (ceebreal oedema, CVA)
Increased risk of pulmonary oedema
How long should a perimortem resuscitative caesarean section be performed in?
Only in pts over 23 weeks pregnant
No later 4 minutes after time of mother cardiac arrest.
How long does a healthy term baby usually take to take its first breath?
Within 60-90 seconds
What stimulated a baby to take its first breath?
The physical stimulation of being handled at birth
The exposure to environment
Hypoxia from obstruction of the umbilical cord during clamping
