obstetric emergencies

Question 1

what is shoulder dystocia

Answer 1

when the anterior fetal shoulder gets stuck behind the pubic symphysis
the head has been delivered

Question 2

how does shoulder dystocia present

Answer 2

signs of distress on CTG
difficulty delivering the baby
head not turning - faces OA
may have turtle neck sign - head retracts

Question 3

how do you manage shoulder dystocia

Answer 3

series of manoeuvres can be done

episiotomy is sometimes an option

Question 4

what is the McRoberts manoeuvre

Answer 4

hyperflexion at hip to provide posterior pelvic tilt

Question 5

what is the rubins manoeuvre

Answer 5

reaching into vagina to put pressure on the posterior part of the anterior shoulder

Question 6

what is the woods screw manoeuvre

Answer 6

done with the rubins manoeuvre

the other hand pus pressure on the other shoulder to try and rotate the baby

Question 7

what is the zavanelli manoeuvre

Answer 7

pushing the head back in so an emergency CS can be done

Question 8

what are complications of shoulder dystocia

Answer 8

hypoxia
brachial plexus injury
perianal tears
PPH

Question 9

what is cord prolapse

Answer 9

when the umbilical cord descends down through the cervix in front of the foetus after the membranes have ruptured

Question 10

what is dangerous about cord prolapse

Answer 10

the cord can be compressed and oxygen supply can be reduced - foetal hypoxia

Question 11

what are risk factors for cord prolapse

Answer 11

abnormal lie 
low birth weight 
preterm labour 
breech presentation 
foetal congenital abnormalities

Question 12

how can cord prolapse present

Answer 12

distress on CTG

can see cod in vaginal exam

Question 13

how could you manage cord prolapse

Answer 13

push cord back into vagina
keep cord warm and wet but try not to handle it too much
catheterise and fill bladder
get patient to have a knee to chest position (on all fours) or lateral lie to take the pressure off the cord
tocolytic medications - terbutaline

Question 14

what is primary postpartum haemorrhage

Answer 14

blood loss of >500ml in first 24hrs after birth

99% PPH are primary

Question 15

what is secondary PPH

Answer 15

blood loss of >500ml from 24hrs to 6wks after birth

Question 16

what are minor and major PPH values

Answer 16

Minor PPH – under 1000ml blood loss

Major PPH – over 1000ml blood loss

Question 17

what are risk factors for PPH

Answer 17

previous PPH
multiple pregnancy 
large baby 
obesity 
failure to progress to 2nd stage of labour 
prolonged 3rd stage 
pre-eclampsia
retained placenta 
instrumental delivery 
general anaesthesia 
perianal tear

Question 18

what are the four causes of PPH (4Ts)

Answer 18

tone
trauma
thrombin
tissue

Question 19

what are examples of tone causes of PPH

Answer 19

womb doesn’t contract enough after delivery
overdistention of uterus
general anaesthesia
failure to progress to 2nd stage

Question 20

what are examples of ‘tissue’ causes of PPH

Answer 20

retained placenta
membranes
RPOC (retained products of conception)

Question 21

what are examples of ‘trauma’ causes of PPH

Answer 21

perineal tears

macrosomia (large baby)

Question 22

what are examples of ‘thrombin’ causes of PPH

Answer 22

coagulopathy e.g. haemophilia

pre-eclampsia

Question 23

what are preventative measures for PPH

Answer 23

treat anaemia in pregnant patients
empty bladder before labour
IV tranexamic acid for CS in high risk patients

Question 24

how do you acutely manage PPH

Answer 24

ABCDE resuscitation 
keep patient lying flat and warm 
two large bore canulas 
bloods 
group and cross match 4 units 
give IV fluid and bloods 
oxygen 
fresh frozen plasma if clotting abnormalities

Question 25

what are mechanical ways of managing PPH

Answer 25

rub uterus through abdomen to stimulate contractions

empty the bladder

Question 26

what are medical ways of managing PPH

Answer 26

oxytocin 40ui 500mls 
ergometrine 0.5mg IV
carboprost 0.25mg IM
misoprostol 800micrograms 
tranexamic acid 1g IV

Question 27

what are surgical methods of managing PPH

Answer 27

intrauterine balloon tamponade
B-lynch suture
uterine artery ligation
hysterectomy as last resort