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3a Women's health > Obstetrics emergencies > Flashcards

Obstetrics emergencies Flashcards

1
Q

What is antepartum haemorrhage

A

bleeding from anywhere within the genital tract after 24 weeks of pregnancy, prior to delivery of the fetus

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2
Q

Give 3 common causes of antepartum haemorrhage

A
  • placenta praevia
  • placental abruption
  • vasa praevia
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3
Q

Give 3 extra placental causes of antepartum haemorrhage

A
  • cervical polyp
  • varicose vein
  • local trauma
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4
Q

What is placenta praevia

A

when part of the placenta has implanted into the lower portion of the uterus

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5
Q

How is low-lying placenta different to placenta praevia

A
  • low-lying - used when the placenta is within 20mm of the internal cervical os
  • (major/partial) placenta praevia - used only when the placenta is over the internal cervical os
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6
Q

Give 3 RFs for placenta praevia

A
  • previous C section
  • older maternal age
  • smoking
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7
Q

How may placenta praevia present

A

painless vaginal bleeding around 2nd/3rd trimester

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8
Q

How is placenta praevia diagnosed

A
  • usually picked up on 20 week anomaly ultrasound scan
  • rpt transvaginal USS at 32w to determine placenta position
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9
Q

How is placenta praevia managed

A
  • safety netting - pain/bleeding
  • avoid sex if bleeding
  • if recurrent bleeding - admit till delivery
  • elective lower segment C section around 37/40
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10
Q

What should be done if a woman with known placenta praevia goes into labour before her elective caesarean section?

A

An emergency caesarean section should be performed due to the risk of postpartum haemorrhage

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11
Q

What is vasa praevia

A

where the fetal vessels are coursing through the fetal membranes over the internal cervical os and below the fetal presenting part, unprotected by placental tissue or the umbilical cord

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12
Q

Give 3 RFs for vasa praevia

A
  • placenta praevia
  • IVF pregnancy
  • multiple pregnancy
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13
Q

What is the risk of vasa praevia

A

if the membranes rupture, there is a risk of major fetal haemorrhage with a high mortality

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14
Q

How is vasa praevia managed

A
  • steroids from 32w (mature fetal lungs)
  • elective LSCS 34-37w
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15
Q

What is placental abruption

A

premature separation of the placenta from the uterine wall during pregnancy

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16
Q

Describe the 2 types of placental abruption

A
  • concealed - bleeding remains within the uterine cavity (behind placenta)
  • revealed - blood escapes through the vagina
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17
Q

Give 4 RFs for placental abruption

A
  • pre-eclampsia/ chronic HTN
  • smoking
  • trauma
  • cocaine
  • increasing maternal age
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18
Q

Give 5 ways placental abruption may present

A
  • Woody-hard abdo on palpation
  • maternal shock disproportionate to blood loss
  • fetal distress
  • vaginal bleeding
  • continuous abdo pain
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19
Q

How is placental abruption managed

A
  • unstable fetus/ mum - emergency C section
  • no fetal distress & <36w : admit and give steroids between 24-34 weeks gestation
  • no fetal distress & >36w: deliver vaginally
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20
Q

3 fetal complications of placental abruption

A
  • intrauterine growth retardation
  • hypoxia
  • death
21
Q

Give 3 maternal complications of placental abruption

A
  • shock
  • renal failure
  • disseminated intravascular coagulation
22
Q

What is cord prolapse

A

when the umbilical cord descends below the presenting part of the fetus into the vagina, after rupture of the fetal membranes

23
Q

What is the risk of cord prolapse

A

exposure of the cord leads to vasospasm and can cause increased risk of fetal morbidity and mortality from hypoxia

24
Q

Give 4 RFs for cord prolapse

A
  • polyhydramnios
  • long umbilical cord
  • fetal malpresentation - eg breech
  • multiple pregnancy
25
Q

How is cord prolapse managed

A
  • emergency c section
  • alleviate pressure on the cord - push presenting part back into uterus
  • constant fetal monitoring
  • Trendelenburg position (feet higher than head) or knee-to-chest
  • tocolytics - reduce uterine contractions
26
Q

When do approximately 50% of cord prolapses occur during labor?

A

after artificial rupture of the membranes.

27
Q

What is pre-eclampsia

A

hypertension in pregnancy usually with proteinuria

28
Q

When does pre-eclampsia typically occur

A

after 20 weeks gestation

29
Q

Give 7 RFs of pre-eclampsia

A
  • previous pre-eclampsia / FHx
  • nulliparity
  • diabetes
  • chronic HTN/ CKD
  • BMI >35
  • maternal age >40
  • FHx
  • autoimmune disease (eg antiphospholipid Ab syndrome)
30
Q

Give 5 ways pre-eclampsia may present

A
  • severe headache
  • visual disturbances
  • epigastric pain
  • oedema
  • clonus
31
Q

How is pre-eclampsia diagnosed

A
  • new onset high BP: >140/90 mmHg
    Plus any of:
  • Urinalysis - proteinuria
  • Organ dysfunction - thrombocytopenia, elevated LFTs and creatinine
  • Placental dysfunction - fetal growth restriction
32
Q

How is pre-eclampsia managed

A
  • arrange emergency secondary care assessments
  • if bp >160/110mmHg consider admission and obs
  • Stabilise bp:
  • 1st labetalol
  • 2nd nifedipine
33
Q

Give 4 complication of pre-eclampsia

A
  • eclampsia
  • intrauterine growth retardation and prematurity
  • haemorrhage
  • cardiac failure
34
Q

What is used for prophylaxis against the development of pre-eclampsia. When is this given

A
  • Aspirin 75-150mg if at mod/high risk
  • given from 12w gestation until birth
35
Q

What is eclampsia

A

onset of seizure in a woman with pre-eclampsia

36
Q

How is eclampsia managed

A
  • IV magnesium sulfate 4mg over 5 mins
  • 1g/hr infusion of magnesium sulfate for 24h
  • treat HTN
37
Q

What are the key characteristic of HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelets

38
Q

What is shoulder dystocia

A

failure of the anterior shoulder to pass under the pubic symphysis after delivery of the foetal head

39
Q

Give 5 RFs for shoulder dystocia

A
  • macrosomia (large baby > 8 pounds 13 ounces)
  • maternal DM
  • disproportion between mother and fetus
  • maternal obesity
  • previous shoulder dystocia
40
Q

How is shoulder dystocia managed (8)

A

HELPERRR
* call for help
* elevate for episiotomy
* legs into McRoberts
* Suprapubic Pressure
* Enter pelvis
* rotational maneuvers (rubin & wood’s screw
* remove posterior arm
* roll patient to hands and knees

41
Q

Give 3 complications of shoulder dystocia to the mother

A
  • postpartum haemorrhage
  • 3rd/4th degree perineal tears
  • psychological distress
42
Q

Give 3 complications of shoulder dystocia to the baby

A
  • hypoxia and subsequent cerebral palsy
  • injury to brachial plexus
  • fits
43
Q

What is postpartum haemorrhage

A

blood loss of >500mls after delivery (>1000ml if C-section)

44
Q

Define primary and secondary postpartum haemorrhage

A
  • primary - bleeding within 24h of delivery
  • secondary - bleeding from 24h to 12 weeks after birth
45
Q

Define minor and major postpartum haemorrhage

A
  • minor: 500-1000mls blood loss
  • major: >1000mls blood loss
46
Q

Give 4 causes of postpartum haemorrhage

A

4 Ts
* Tone - (uterine atony) mc
* Trauma - perineal tears
* Tissue - retained placenta
* Thrombin - abnormal clotting

47
Q

GIve 5 RFs for a postpartum haemorrhage

A
  • previous PPH
  • multiple pregnancy
  • prolonged labour
  • large baby (LGA)
  • instrumental delivery
48
Q

How is postpartum haemorrhage managed

A
  • IV fluids
  • uterine massage
  • uterine atony: IV oxytocin, IM ergometrine, IM carboprost
  • lay woman flat and catheterise
  • tranexamic acid to reduce bleeding
  • treat underlying cause
  • surgery: intrauterine balloon tamponade

3a Women's health (12 decks)

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