Osky Prep

Question 1

PPH- key priorities

Answer 1

Help

mum lie down, Baby to breast

deliver placenta - uterotonic / controlled cord traction

palpate fundus - IDC + rub up fundus
view perineum for clots/ assess whether bleeding continuing/ atony continuing?

Assess mum for shock -
feeling unwell, light headed, fainting,
pallor, cold /clammy hands, goosebumps
Tachycardic/ hypotensive
assess blood loss - continuing

take bloods
(CBC, G+H, coagulation studies, order CRoss match)

Site 2 lines-
start Oxy infusion (40IU in 500ml / 4hrs)
give TXA (10mls in 100ml normal saline (600mls/ hr)

investigate cause of bleeding
- trauma
- tissue
- thrombosis issue

If need to stabilise
- more fluids (crystalloid- hartmanns)
- blood transfusion (- >2L= massive transfusion protocol)

Question 2

cord prolapse

Answer 2

Help
information sharing
kness to chest, bottom up / exagerated sim
Stop Oxytocin
EFM / FHR auscultation
digital pressure- don’t touch the cord (vasospasm)
consider bladder filling

consider mode of birth - fully dilated?

consider tocolysis if preparing for C section

Question 3

APH

Answer 3

Assess mum- Drs ABC
Palpation
Start CTG
Hx
Investigations / ongoing mangement

Question 4

Shoulder dystocia- definition

Answer 4

shoulders need additional manouvres to be releaesd, after head is born and routine axial traction has not worked.

Question 5

position- manouvres

Answer 5

mcroberts
running start
side lying
all fours

Question 6

suprapubic pressure

Answer 6

lie on side of baby’s spine
hands above pubis
continuous pressure + rocking

Question 7

per vaginum

Answer 7

delivery of poster arm
axillary traction

Question 8

signs of shoulder dystocia- what do you do?

Answer 8

face / chin slow to be birthed
face tightly applied to vulva
face retracting into perineal body (turtle neck sign)
delayed / no restitution

diagnose shoulder dystocia- routine axial traction (in line with fetal spine)

CALL for help

Question 9

risk factors of shoulder dystocia

Answer 9

pre labour
hx of shoulder dystocia
* macrosomia (>4.5kg)
* gestation
* maternal diabetes
* obesity >30
* IOL

pregnancy
* Augmentation
* rpolonged first or second stage
* secondary arrest (pause in dilation)
* assisted vaginal birth

Question 10

Post partum

Answer 10

-Risk of Resus + PPH

-NB exam- check for injury (brachial plexus, shoulder fracture, condition from hypoxia- cerebral palsy)

-maternal assessment- perineal tear, uterine / bladder rupture, joint dislocation, psychological trauma