Obstetrics emergencies

Question 1

Why is there a risk of Hypoxia during pregnancy?

Answer 1

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

Question 2

Red flags for pregnant patients that are breathless

Answer 2

Sudden onset of breathlessness
Orthopnoea
With chest pain/syncope
RR >20
SpO2 <94%
Breathlessness with tachycardia

Question 3

What are the changes in the cardiovascular system in pregnancy?

Answer 3

Cardiac output increase by 40%
15% increase in pulse
35% increase in stroke volume
Reduction in peripheral resistance
Drop in systolic BP

Question 4

What happens when laying supine in pregnancy?

Answer 4

Compression of the aorta and inferior vena cava

=

Reduced venous return
Reduced cardiac output
Reduced BP
Risk of hypotension

Question 5

Why lay on left side in pregnancy?

Answer 5

So you compress the aorta rather than the inferior vena cava

Aorta is stronger and can withstand more pressure than the inferior vena cava

Question 6

What causes haemodilation in pregnancy

Answer 6

The plasma and haemoglobin and haemotocrit do not increase by the same level - causing relating haemodilation

Question 7

What are the effects on the coagulation system during pregnancy?

Answer 7

Platelet count calls
Thrombocytopenia
Increased clotting factors
Rise of firbinogel levels by 50%
Decreased anticoags
Decreased venous flow

Question 8

What is the first stage of labour?

Answer 8

Begins when labour starts and ends with full cervical dilation to 10cm

Question 9

What is the second stage of labour?

Answer 9

Commences with complete cervical dilation to 10cm and ends with the birth to the baby

Question 10

What is the third stage of labour?

Answer 10

After the birth of the baby and ends with the delivery of the placenta and birth

Question 11

What is the ideal contraction time and how long should they last?

Answer 11

2-3 mins intervals

60-90 seconds

Question 12

When specifically should you encoring the woman to pant during labour?

Answer 12

From the point of crowning to the delivery of the rest of the head.

This encourages the slow delivery of the baby.

Question 13

What is antepartum haemorrhage (APH)?

Answer 13

Any bleeding from the genital tract after 24 weeks gestation prior to the birth of the baby

Question 14

What is primary postpartum haemorrhage?

Answer 14

Occurs within first 24 hours of birth following delivery >500ml blood loss after vaginal delivery

Question 15

What is secondary postpartum haemorrhage?

Answer 15

Abnormal bleeding from genital tract between 24 hours and 12 weeks postnatally.

Question 16

What are the causes of antepartum haemorrhage (APH)?

Answer 16

Placenta praaevia
Placental abruption
Bleeding from genital tract
Abnormally invasive placenta
Vasa praaevia
Unexplained

Question 17

What are the causes of postpartum haemorrhage (PPH)?

Answer 17

Tone
Trauma
Tissue
Thrombin

Question 18

What is vasa praaevia?

Answer 18

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.

Question 19

What is antepartum haemorrhage management?

Answer 19

Position patient in left lateral position to stop aorta compression

Oxygen
IV fluids
Measure blood loss
Transfer to nearest obstetric unit

Question 20

What is management for postpartum haemorrhage?

Answer 20

Measure blood loss
Uterine massage (for atony)
Give Uterotonics
Give TXA
IV Fluids
Apply pressure to trauma
Bimanual Uterine Compression

Question 21

What are the symptoms of pre eclampsia?

Answer 21

Headaches
Visual disturbances
N&V
Epigastric pain
Oliguria
Signs of clonus
Progressive deterioration in laboratory blood tests
Foetal growth restriction

Question 22

What are the complications of preeclampsia?

Answer 22

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

Question 23

How long should a perimortem resuscitative caesarean section be performed in?

Answer 23

Only in pts over 23 weeks pregnant
No later 4 minutes after time of mother cardiac arrest.

Question 24

How long does a healthy term baby usually take to take its first breath?

Answer 24

Within 60-90 seconds

Question 25

What stimulated a baby to take its first breath?

Answer 25

The physical stimulation of being handled at birth
The exposure to environment
Hypoxia from obstruction of the umbilical cord during clamping