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CP2 Obs & Gynae > Peripartum care and Obstetric emergencies > Flashcards

Peripartum care and Obstetric emergencies Flashcards

1
Q

Immediate management of intrauterine fetal death?

A

Immediate delivery to avoid sepsis/DIC
- IOL with mifepristone (antiprogestrogen)
- 48h later give misoprostol (prostaglandin analogue)
- adequate analgesia is essential
pt can go home temporarily after mifepristone to avoid stress of being on antenatal/postnatal ward :(
see bereavement midwife asap to discuss loss and burial/cremation plans

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2
Q

Possible maternal causes of intrauterine death?

A
  • diabetes
  • infection e.g. parvovirus, listeria
  • thrombophilia
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3
Q

Possible fetal causes of intrauterine death?

A
  • chromosomal abnormality
  • other genetic abnormality
  • haemolytic disease
  • cord incident
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4
Q

Possible placental causes of intrauterine death?

A
  • placental abruption
  • uteroplacental insufficiency (e.g. secondary to pre-eclampsia)
  • postmaturity
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5
Q

Fetal investigations after intrauterine death?

A
  • swabs for mc&s from fetus and placenta
  • skin biopsy for karotype :(
  • post mortem if agreed by parents
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6
Q

Define a “late deceleration”

A

A reduction in fetal heart rate from baseline of at least 15 beats for at least 15s

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7
Q

Resuscitation plan for mother after suspected amniotic fluid embolism?

A
  • insertion of 2 large-bore IV cannulae
  • request FBC, U&E, clotting profile, fibrin-degradation products
  • crossmatch 6 units of blood and have platelets and fresh-frozen plasma available
  • 100% oxygen by bag and mask initially with intubation by anaesthetist asap
  • volume expansion with colloid fluids
  • transfer to ITU asap
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8
Q

When does secondary PPH occur?

A

Occurs between 24h and 6 weeks following delivery

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9
Q

Common causes of PPH?

A
  • retained placental tissue
  • vaginal trauma
  • endometrial infection
  • uterine atony
  • coagulopathy e.g. following placental abruption
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10
Q

Features of uterine rupture?

A
  • constant apin
  • vaginal bleeding
  • sudden loss of contractions
  • change in CTG
  • easy palpation of fetal parts
  • haematuria
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11
Q

Causes of fetal bradycardia?

A
  • placental abruption
  • uterine rupture
  • maternal hypotension (post epidural insertion)
  • bleeding vaso praevia
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12
Q

Maternal risk factors for premature labour?

A
  • hx of premature delivery
  • young maternal age
  • illegal drug use and smoking
  • chorioamnionitis
  • pre-eclampsia
  • polyhydramnios
  • sepsis
  • previous cervical surgery/ cervical incompetence
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13
Q

Fetal risk factors for premature labour?

A
  • IUGR
  • congenital abnormality
  • multiple pregnancy
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14
Q

Name a tocolytic drug?

A

nifedipine, atosiban

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15
Q

What are tocolytic drugs used for in pregnancy?

A

Delay labour

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16
Q

Risk factors for shoulder dystocia?

A
  • estimated fetal weight >4.5kg
  • previous big baby >4kg
  • previous shoulder dystocia
  • slow progress in the first and/or second stage of labour
  • post dates delivery
17
Q

Complications of shoulder dystocia?

A
  • perinatal mortality
  • hypoxic encephalopathy
  • brachial plexus injury (Erb’s palsy)
  • maternal PPH
  • 3rd or 4th degree tear
18
Q

Prevalence of shoulder dystocia?

A

1 in 200 deliveries

19
Q

Causes and risk factors for PPH:

A
  • uterine atony (multiple pregnancy, grand multiparity, polyhydramnios, prolonged labour)
  • APH
  • uterine sepsis - chorioamnionitis
  • retained placenta
  • lower genital tract trauma - perineal or cervical tears
  • coagulopathy - heparin treatment, inherited bleeding disorders
  • previous PPH
20
Q

How much should the cervix dilate per hour once labour is established?

A

1cm/h

21
Q

What monitoring do you do in low-risk labour?

A
  • hourly BP
  • hourly HR
  • 4 hourly examinations for cervical dilatation
  • assessment for meconium
22
Q

How often do you assess the fetus during labour?

A

Auscultate for 1 min after a contraction at least every 15 min in first stage of labour
Auscultate for 1 min after a contraction every 5 min in the second stage of labour

23
Q

What results would you see in investigations for disseminated intravascular coagulopathy (DIC)?

A
  • increased INR
  • decreased platelets
  • positive D-dimer test
24
Q

Initial basic procedures to resuscitate the mother during APH?

A
  • insert 2 large bore venous cannulae
  • crossmatch 6 units of blood
  • request fresh frozen plasma and platelets
  • initial fluid resuscitation with IV fluids - colloid
  • insert urinary catheter to monitor UO
25
Q

Why do you keep women on a syntocinon infusion post delivery?

A

To prevent PPH secondary to uterine atony

26
Q

Risk factors of 3rd degree tears?

A
  • birthweight >4kg
  • persistent OP position
  • nulliparity
  • induction of labour
  • epidural
  • second stage of labour lasting more than 1h
  • episiotomy
  • forceps delivery
27
Q

How long should anticoagulation be continued post-natally?

A

6 weeks - 3 months

28
Q

Risk factors for cord prolapse

A
  • polyhydramnios
  • preterm delivery
  • malpresentation
  • unstable presentation
  • multiple pregnancy

CP2 Obs & Gynae (6 decks)

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