Obstetric Emergencies

Question 1

What does a delay in delivery and excessive traction of shoulder dystocia cause?

Answer 1

1. Asphyxia, brain injury or death.

2. Erb’s palsy (permanent in 10%)

Question 2

What are the risk factors for shoulder dystocia?

Answer 2

Large baby, maternal diabetes, maternal BMI >30, prolonged labour

Question 3

How should you manage shoulder dystocia?

Answer 3

1. Call for help

2. Place mum in McRoberts position and apply suprapubic pressure (works in 90%)

Question 4

What is cord prolpase?

Answer 4

After membranes have ruptured, cord descends below presenting part, untreated can become compressed causing foetal hypoxia.

Question 5

How is cord prolapse diagnosed?

Answer 5

1. On vaginal exam after identification of foetal distress

2. CTG - foetal bradycardia, variable heart decelerations

Question 6

When do the majority of cord prolapses occur?

Answer 6

At artificial rupture of membranes

Question 7

How should you manage cord prolapse?

Answer 7

1. Stop presenting part compressing cord, push presenting part towards mothers head on contraction.
2. DO NOT PUSH CORD BACK UP IF OUTSIDE VAGINA
3. If cord outside, keep warm and moist
4. Tocolysis such as Terbutaline may help
5. Mum on all fours
6. C-section first line

Question 8

What is amniotic fluid embolism?

Answer 8

When liquor enters maternal circulation, causing anaphylaxis, sudden dyspnoea, hypoxia, and hypotension. Accompanied by seizures and cardiac arrest.

Question 9

What do almost all patients with amniotic fluid embolism develop afterwards?

Answer 9

DIC and ARDS

Question 10

When does amniotic fluid embolism most frequently occur?

Answer 10

With rupture of membranes, also associated with C-section and delivery.

Question 11

What is the cause of uterine rupture?

Answer 11

Majority are due to an old scar rupturing (CS > LSCS)

Question 12

What are the risk factors for uterine rupture?

Answer 12

1. Labour with a scarred uterus
2. Obstructed labour in multiparous
3. Oxytocin use in previous C-section

Question 13

What is this a presentation of and how should it be managed?
Woman in labour, variable pain, unexplained maternal tachycardia, sudden maternal shock, cessation of contractions, disappearance of presenting part, foetal distress.

Answer 13

1. Uterine rupture

2. Emergency C-section

Question 14

What is uterine inversion?

Answer 14

Fundus of uterus inverts into uterine cavity, usually following traction on the placenta.

Question 15

What are the presenting features of uterine inversion?

Answer 15

Haemorrhage, pain, and profound shock (increased vagal tone).

Question 16

How is uterine inversion managed?

Answer 16

1. Immediate replacement - push fundus up with hand through cervix
2. If this fails, bloods for cross-match, theatre for replacement with balloon into vagina.