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3a > WH: Obstetric Emergencies > Flashcards

WH: Obstetric Emergencies Flashcards

1
Q

What is primary PPH ? vol ? timing ?

A
  • Primary post-partum haemorrhage is the loss of >500 ml of blood per-vagina within 24 hours of delivery
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2
Q

how much blood loss is required for it to be PPH for vaginal delivery ? for CS ?

A
  • vaginal: >500ml
  • CS: >1000ml
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3
Q

what is the difference between primary and secondary PPH ?

A

timing
- Primary: within 24 hrs
- secondary: 24hrs - 12 weeks

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4
Q

What can cause PPH ? (4) give example of each ? most common ?

A

4 Ts
- Tone (uterine atony) (most common)
- Trauma (perineal tear)
- Tissue (retained tissue from placenta)
- Thrombin (bleeding disorder)

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5
Q

What can cause uterine atony ? (3) what can this increase risk of ?

A

most common cause of PPH
- uterine over distension (polyhydramnios)
- Prolonged labour
- Full bladder

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6
Q

PPH RF ? (9)

A
  • Prev PPH
  • Multiple pregnancy
  • Obestiy
  • Large baby
  • Failure to progress in 2 nd stage of labour
  • Prolonged 3rd stage of labour
  • Pre-ecclmapsia
  • placenta acreta
  • Instrumental delivery
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7
Q

What preventative measures are there for PPH ?

A
  • Treating anaemia during antenatal period
  • Give brith with empty bladder
  • Actie management of 3rd stage of labour
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8
Q

how does giving birth with an empty bladder reduce risk of PPH ?

A

full bladder => decrease uterine contractions
(full bladder is RF for uterine atony)

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9
Q

what drug can be given in the active management of ht third stage of labour ?

A

oxytocin (syntocinon)

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10
Q

overall approach to primary PPH ?

A

obstetric emergency
- Resuscitation (ABCDE)
- lie flat _ keep her warm
- group + cross match 4 units
- oxytocin

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11
Q

what 3 categories of management is available for primary PPH ?

A
  • Mechanical
  • Medical
  • Surgical
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12
Q

what is the mechanical management of primary PPH ? (2)

A
  • Rubbing uterus through about to stimulate contraction
  • Urinary catheterisation => empty bladder (bladder distention preventer uterine contraction)
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13
Q

What is the medical managmetn of primary PPH ? (4) what type is each drug

A
  • Oxytocin
  • ergometrine (stimulate smooth muscle contraction)
  • Misoprostol (prostaglandin analogue)
  • tranexamic acid (anti-fibrinolytic)
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14
Q

What is the surgical mamangemt of primary PPH ?

A
  • Intrauterine balloon tamponade
  • B0lynch suture
  • uterina retro ligation
  • Hysterectomy (last resort)
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15
Q

rare complication of PPH ?

A

Sheehans sydnrome

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16
Q

What is secondary PPH usually due to ? (2)

A
  • Retained products of conception
  • Infection (endometritis)
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17
Q

labour related RF for endometritis ?

A
  • CS
  • Prematur ROM
  • Long labour
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18
Q

what investigations for secondary PPH ?

A
  • US (looking for RPC)
  • highvaginal + Endocervical swabs
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19
Q

secondary PPh managmetn ?

A

depends on underlying problem
- dilatation + curettage
- Abx

(usuallydue to retained products of conception)

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20
Q

What bloo counts as minor PPH ? major PPH ?

A

minor: <1000ml
major: >1000ml

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21
Q

What is umbilical cord prolapse ?

A

it is when the umbilical cord descends below the presenting part of fetus and thought the cervix into that vagina (after ROM)

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22
Q

what important complication can cord prolapse lead to ?

A

risk of presenting part compressing cord OR vasospasm (due to cold environment) => fetal hypoxia

23
Q

umbilical cord prolapse RF ? (1) explain a bit

A
  • Abnormal fetal lie (abnormal, transverse, oblique) => provides space for cord to prolapse
24
Q

when should you suspect umbilical cord prolapse ? how is diagnosed ?

A

should be suspected when signs of fetal distress on CTG
- diagnosed by vaginal examination

25
Q

how is umbilical cord prolapse managed ? (5)

A

emergency CS
- avoid vaginal delivery (=> cord compression => hypoxia)
- push presenting part up (off cord)
- keep cord warm and avoid handling (to avoid vasospasm)
- tocolytic medication
- encourage into left lateral position

26
Q

What is shoulder dystocia ? anatomy of baby stuck where ?

A

it occurs during delivery of the bab when the anterior shoulder of the baby becomes stuck under pubic symphysis of the pelvis (obs emergency)

27
Q

what I shoulder dystocia often caused by ? what condition

A

marcosomia secondary to GDM

28
Q

shoulder dysotica presentation ?

A
  • Difficulty delivery sign face + head
  • Obstruciotn to delivering shoulders
  • Failure of restitution
  • Turtle neck sign
29
Q

describe what failure of restitution is and what condition it is associated with ?

A

head remain facing downward OA (instead of facing medial thigh)
- associated with shoulder dystocia

30
Q

what is turtle neck sign ? what condition is this associated with ?

A
  • head is delivered and then retracts back into vagina
  • associated with shoulder dystocia
31
Q

How is shoulder dystocia managed ? (3) most common manoeuvre ?

A

obs emergency
- epiostomy: enlarge vaginal opening + reduce risk of perineal tears (more space for manoeuvres)
- McRoberts manœuvre
- pressure to anterior shoulder

32
Q

complications of shoulder dystocia ? (4)

A
  • Fetal hypoxia (=> CP)
  • brachial plexus injury (herbs palsy)
  • perineal tears
  • PPH
33
Q

What are 2 pregnancy related causes of maternal sepsis ?

A
  • Chorioamnionitis
  • UTI
34
Q

What is Chorioamnionitis ?

A

it is infection of the chorioamniotic membranes + amniotic fluid 9usually caused by bacteria)

35
Q

how might Chorioamnionitis related sepsis present ? (3)

A

like normal sepsis +
- abdo pain
- Uterine tenderness
- vaginal discharge

36
Q

management of maternal sepsis ?

A

continuous maternal + fetal monitoring
- Sepsis 6

37
Q

What is amniotic fluid embolism ?

A

rare but serious condition where amniotic fluid passes into mothers blood (during the time of labour + delivery)

38
Q

describe amniotic fluid embolism pathophysiology ?

A

amniotic fluid contains fetal tissue => maternal immune response => systemic illness

39
Q

amniotic fluid embolism RF ?

A
  • increasing maternal age
  • IOL
  • CS
  • Multiple pregnancy
40
Q

amniotic fluid embolism presentation ? when does it happen ?

A

usually at the time of labour but can be post partum
- similar to sepsis, PE, anaphylaxis
- sob, hypoxia, hypertension, haemorrhage, seizures, cardiac arrest

41
Q

amniotic fluid embolism management ?

A

medical emergency
- supportive
- ABCDE approach
(can’t really be prevented or predicted)

42
Q

What is uterine rupture ?

A

it is a complication of labour where myometrium (muscle layer) ruptures
- High morbidity + mortality to mother and baby

43
Q

Uterine rupture main RF ? other ? (3)

A

prev CS (VBAC)
- obesity, increased parity, use oxytocin

43
Q

Uterine rupture presentation ? what kind of shock associated with it ?

A

acutely unwell mother + abnormal CTG
- Abdo pain, vaginal bleeding, ceasing of uterine contractions
- Signs of hypovolaemic shock (low BP, high HR)

44
Q

uterine rupture management ?

A

obs emergency
- Resuscitation, transfusion
- Surgical management: CS, uterine rupture/hysterectomy

45
Q

What is eclampsia

A

it is one or more convulsions in a pre-eclamptic woman (in the absence of any other neurological or metabolic causes
- obs emergency

46
Q

when is eclampsia most common

A

intrapartum or within first 48 hrs post partum

47
Q

ecclampsia RF ?

A

Same as pre-eclmapsia
- Chronic hypertension
- Prev pre/eclampsia
- DM
- CKD

48
Q

clinical features of eclampsia ?

A

new onset tonic clonic seizure in presence of pre-eclampsia

49
Q

eclampsia complications (5)

A
  • HELLP syndrome
  • DIC
  • AKI
  • RDS
  • Death
50
Q

eclampsia management ? 5 principles ?

A

(continuous CTG monitoring)
1) resuscitation (+lie in L lateral position)
2) cessation of seizures (MG sulphate)
3) BP control (IV labetalol)
4) prompt delivery of baby + placenta (only definitive treatment)
5) monitoring (fluid balance)

51
Q

when is appropriate for delivery of the baby in eclampsia ?

A

only when mother stabilised
- regardless of fetal compromise

52
Q

what is defined as hypoactive uterus ? how often contractions ?

A

two contractions or fewer in 10 minutes, each lasting less than 40 seconds

3a (43 decks)

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