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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
how is umbilical cord prolapse managed ? (5)
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
What is shoulder dystocia ? anatomy of baby stuck where ?
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
what I shoulder dystocia often caused by ? what condition
marcosomia secondary to GDM
28
shoulder dysotica presentation ?
- Difficulty delivery sign face + head - Obstruciotn to delivering shoulders - Failure of restitution - Turtle neck sign
29
describe what failure of restitution is and what condition it is associated with ?
head remain facing downward OA (instead of facing medial thigh) - associated with shoulder dystocia
30
what is turtle neck sign ? what condition is this associated with ?
- head is delivered and then retracts back into vagina - associated with shoulder dystocia
31
How is shoulder dystocia managed ? (3) most common manoeuvre ?
obs emergency - epiostomy: enlarge vaginal opening + reduce risk of perineal tears (more space for manoeuvres) - McRoberts manœuvre - pressure to anterior shoulder
32
complications of shoulder dystocia ? (4)
- Fetal hypoxia (=> CP) - brachial plexus injury (herbs palsy) - perineal tears - PPH
33
What are 2 pregnancy related causes of maternal sepsis ?
- Chorioamnionitis - UTI
34
What is Chorioamnionitis ?
it is infection of the chorioamniotic membranes + amniotic fluid 9usually caused by bacteria)
35
how might Chorioamnionitis related sepsis present ? (3)
like normal sepsis + - abdo pain - Uterine tenderness - vaginal discharge
36
management of maternal sepsis ?
continuous maternal + fetal monitoring - Sepsis 6
37
What is amniotic fluid embolism ?
rare but serious condition where amniotic fluid passes into mothers blood (during the time of labour + delivery)
38
describe amniotic fluid embolism pathophysiology ?
amniotic fluid contains fetal tissue => maternal immune response => systemic illness
39
amniotic fluid embolism RF ?
- increasing maternal age - IOL - CS - Multiple pregnancy
40
amniotic fluid embolism presentation ? when does it happen ?
usually at the time of labour but can be post partum - similar to sepsis, PE, anaphylaxis - sob, hypoxia, hypertension, haemorrhage, seizures, cardiac arrest
41
amniotic fluid embolism management ?
medical emergency - supportive - ABCDE approach (can't really be prevented or predicted)
42
What is uterine rupture ?
it is a complication of labour where myometrium (muscle layer) ruptures - High morbidity + mortality to mother and baby
43
Uterine rupture main RF ? other ? (3)
prev CS (VBAC) - obesity, increased parity, use oxytocin
43
Uterine rupture presentation ? what kind of shock associated with it ?
acutely unwell mother + abnormal CTG - Abdo pain, vaginal bleeding, ceasing of uterine contractions - Signs of hypovolaemic shock (low BP, high HR)
44
uterine rupture management ?
obs emergency - Resuscitation, transfusion - Surgical management: CS, uterine rupture/hysterectomy
45
What is eclampsia
it is one or more convulsions in a pre-eclamptic woman (in the absence of any other neurological or metabolic causes - obs emergency
46
when is eclampsia most common
intrapartum or within first 48 hrs post partum
47
ecclampsia RF ?
Same as pre-eclmapsia - Chronic hypertension - Prev pre/eclampsia - DM - CKD
48
clinical features of eclampsia ?
new onset tonic clonic seizure in presence of pre-eclampsia
49
eclampsia complications (5)
- HELLP syndrome - DIC - AKI - RDS - Death
50
eclampsia management ? 5 principles ?
(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
when is appropriate for delivery of the baby in eclampsia ?
only when mother stabilised - regardless of fetal compromise
52
what is defined as hypoactive uterus ? how often contractions ?
two contractions or fewer in 10 minutes, each lasting less than 40 seconds

3a (43 decks)

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