Obstetric Emergencies

Question 1

Antepartum Haemorrhage

Definition

Answer 1

Bleeding after 20 weeks until the end of the second stage

Question 2

Antepartum Haemorrhage

Causes

Answer 2

Marginal Bleed/other (50%)
Placenta Praevia (30%)
Placental Abruption (20%)

Question 3

Antepartum Haemorrhage

Management

Answer 3

Resuscitation and delivery only if maternal/fetal compromise

Anti-D if Rh-ve

Question 4

Marginal Bleed

Answer 4

Leak in the ‘maternal lake’
Painless and non-tender
Self-limiting
Placenta not praevia on scan

Question 5

Placenta Praevia

Answer 5

Presence of placental tissue overlying or proximate to the internal cervical os
Painless, non-tender
No contractions
Well fetus unless there is severe maternal hypotension
R/F include previous C/S, parity and age
Low grade (placenta not crossing os) vs high grade (crosses os - requires C/S)

Question 6

Placental Abruption

Answer 6

Premature separation of the placenta from the uterus
Blood (usually maternal) leaks between the placenta and the uterus
Painful and tender
Contractions
Fetal compromise
Maternal effects include acute blood loss, DIC, multiple organ failure and PPH
Fetal effects include acute progressive hypoxia
Management - resuscitate, coagulate, deliver if possible (anti-D if Rh-ve)

Question 7

Placenta Accreta

Answer 7

Placenta is morbidly attached to the uterine muscle rather than the lining.
R/F include previous LUSCS and placenta praevia, and age (independent RF)

Question 8

Cord prolapse

Answer 8

Polyhydramnios on US
Made to sit in knee chest position
Theatre for Em C/S

Question 9

Shoulder dystocia

Answer 9

Head comes out and goes back in again - “turtle necking”

Question 10

Uterine rupture

Answer 10

Previous C/S for placenta praevia, constant lower abdominal pain, foetal bradycardia