Peripartum care and Obstetric emergencies Flashcards
Immediate management of intrauterine fetal death?
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
Possible maternal causes of intrauterine death?
- diabetes
- infection e.g. parvovirus, listeria
- thrombophilia
Possible fetal causes of intrauterine death?
- chromosomal abnormality
- other genetic abnormality
- haemolytic disease
- cord incident
Possible placental causes of intrauterine death?
- placental abruption
- uteroplacental insufficiency (e.g. secondary to pre-eclampsia)
- postmaturity
Fetal investigations after intrauterine death?
- swabs for mc&s from fetus and placenta
- skin biopsy for karotype :(
- post mortem if agreed by parents
Define a “late deceleration”
A reduction in fetal heart rate from baseline of at least 15 beats for at least 15s
Resuscitation plan for mother after suspected amniotic fluid embolism?
- 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
When does secondary PPH occur?
Occurs between 24h and 6 weeks following delivery
Common causes of PPH?
- retained placental tissue
- vaginal trauma
- endometrial infection
- uterine atony
- coagulopathy e.g. following placental abruption
Features of uterine rupture?
- constant apin
- vaginal bleeding
- sudden loss of contractions
- change in CTG
- easy palpation of fetal parts
- haematuria
Causes of fetal bradycardia?
- placental abruption
- uterine rupture
- maternal hypotension (post epidural insertion)
- bleeding vaso praevia
Maternal risk factors for premature labour?
- hx of premature delivery
- young maternal age
- illegal drug use and smoking
- chorioamnionitis
- pre-eclampsia
- polyhydramnios
- sepsis
- previous cervical surgery/ cervical incompetence
Fetal risk factors for premature labour?
- IUGR
- congenital abnormality
- multiple pregnancy
Name a tocolytic drug?
nifedipine, atosiban
What are tocolytic drugs used for in pregnancy?
Delay labour
Risk factors for shoulder dystocia?
- 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
Complications of shoulder dystocia?
- perinatal mortality
- hypoxic encephalopathy
- brachial plexus injury (Erb’s palsy)
- maternal PPH
- 3rd or 4th degree tear
Prevalence of shoulder dystocia?
1 in 200 deliveries
Causes and risk factors for PPH:
- 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
How much should the cervix dilate per hour once labour is established?
1cm/h
What monitoring do you do in low-risk labour?
- hourly BP
- hourly HR
- 4 hourly examinations for cervical dilatation
- assessment for meconium
How often do you assess the fetus during labour?
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
What results would you see in investigations for disseminated intravascular coagulopathy (DIC)?
- increased INR
- decreased platelets
- positive D-dimer test
Initial basic procedures to resuscitate the mother during APH?
- 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
