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Obs & Gyn > Emergencies in O&G > Flashcards

Emergencies in O&G Flashcards

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1
Q

main obstetric causes of emergencies 3

A

PPH

APH

eclampsia

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2
Q

main incidental cuases of emregnecies in obsteics 4

A

massive VTE

ruptured aneuryms

ruptured spleen/liver

MI

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3
Q

emergenceis in gynaecologyy 3

A

ectopic pregnacy

miscarriage

post-op/intra-abdominal bleeding

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4
Q

define postpartum haemorrhage

A

any bleeding from or in to the genital tract following delivery of the infant

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5
Q

define primary post-partum haemorrhage

A

occuring within 24hours of delivery

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6
Q

define secondary postpartum haemorrhage

A

occuring betweeen 24hrs and 12 weeks postnatally

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7
Q

define the values assocateid with quantiy of blood loss in types of post partum haemorrhage

A

Postpartum haemorrhage (PPH) is defined as blood loss of > 500 ml after a vaginal delivery and may be primary or secondary.

minor- loss of 500-1000ml

moderate loss of 1000-2000ml
severe- loss of >2000ml
(BOTH DEFINED AS MAJOR BLEEDS)

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8
Q

define acute blood loss in postpartum haemorrhage

A

500ml/min
-acute loss of large blood volume

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9
Q

causes of primary postpartum haemorrhage 4

A

thrombin

tissue

tone

trauma

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10
Q

types of thrombin disorders causing primary postpartum haemorrhage 3

A

pre-exisitng

pregnancy induced

iatrogenic

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11
Q

antenatal risk factors for postpartum haemorrhage 8

A

suspected or proven placental abruption

known placenta praevia

multiple pregnancy

pre-eampsia/ HT

previous PPH

asian

BMI >35

anaemia

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12
Q

intrapartum risks associated with postpartum haemorrhage 7

A

C section

induced labour

retained placenta

episiotomy

prolonged labour

big baby

age >40

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13
Q

4 components of immediate postpartum haemorrhage managemnt

A

communcation

resusciation

monitoring and investigations

arresting the bleeding

ALL SIMULTANEOUSLY

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14
Q

aspcts of immediate postpartum haemorrhage immediate action and resus 5

A

blood loss>1000ml

call for help- senior midwife, obesterician, aneathetics, blood transfusion

resus
-ABC
-O2
-fluid
-blood products
-keep patient warm

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15
Q

aspects of minitoring and investgiaons in postpartum haemorrhage management 6

A

2 cannula

FBC, coag, U&Es, LFTs

cross match

ECG

foley ceehte

weigh all swabs and estimate blood loss

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16
Q

medical treatment of postpartum haemorrhage managemnt 2
-what drugs can be used

A

bimanual uterine compression

empty bladder

-oxytocin
-ergometrine
-carboprost
-misoprostol

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17
Q

define bimanual uterine compression compression

A

the clinician places one hand on the abdomen and the other hand inside the vagina then compresses the uterus between the two hands. These techniques cause the uterus to contract, which treats atony and assists with expulsion of retained placenta or clots.

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18
Q

what medications can be used to promote uterine contractility 4

A

syntocinon- injection and infusion

ergometrine- injection

carboprost IM

misoprostol

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19
Q

what immediate tecniqures can be considered in theatre for postpartum haemorrhage 2

A

intrauterine balloon tamponade

brace suture

?interventional radiology

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20
Q

what surgery can be used for postpartum haemorrhage 4

A

bilateral uterine artery ligation

bilateral internal iliac ligation

hysterectomy

uterine artery embolisation

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21
Q

steps in manual removal of placenta (just pictures)

A

[25,26,27]

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22
Q

balloon tamponate for postpartum haemorrhage (picture)

A

[28]

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23
Q

b-lynch suture for tamponade for postpartum haemorrhage (picture)

A

[29]

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24
Q

importance of uterine inversion (picture)

A

[30]

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25
what is secondary postpartum haemorrhage usually associated with
infection (endometritis) ± retained tissue
26
managemnt of secodnary postpartum haemorrhage
treat infection consider removal of tissue -postnatal surgical evacuation risks consider balloon tamponade
27
how does bleeding in ectopic vs miscarriage differ
ectopic- most likely concealed miscarriage- most likely visulaised vaginally
28
important point with ectopic
can become unstable very quickly
29
important point with miscarriage
remeber cervical shock if products of conception or clot in cervical os
30
immediate Managemnt of miscarriage and ecotpic
if haemodynamically unstable- EMERGENCY -ABC resus -early senior involvement prepare for theatre
31
define maternal collapse
acute event involving cardiorespiraroty systeem ± brain resulting in reduced or absent conscious level (and potentially death)
32
when can maternal collapse happen
any stage of prengnacy and up to six weeks after delivery
33
incidence of maternal collapse
estimate between 0.14-6/1000 births
34
how does preganncy impact on resusication procedure
have reduced oxygen carrying capcacity therefore: -increasd CPR circulation demands potential rapid massive haemorage blood can sequester during CPR decreased BP reserve
35
how can prengnacy impact respiratory system if in maternal collapse
decreased buffering capacity- acidosis more likely -hypoxia may develop more quickly -can have difficult intubation
36
other resuscitaion considerations for pregant woemn
increased risk of aspriation large nbreasts may interfere w intubation and make ventilation more difficult
37
when is a premortem C section performed
if no response to CPR after 4 minutes and uterus appox 20 week size -aim for delivery by 5 minutes
38
aim of premortem C section
save mothers life -increase venous return -imrpove ease of ventilation allow CPR in supine posiotn reduced O2 requirements
39
causes of collapse (resus collapse) in all patients (including O&G)
4 Hs , 4 Ts Hypoxia hypovolaemia hypo/hyperkalaemia Hypothermia Thromboembolism Toxic Tamponade Tension pneumothorax
40
pregnancy specific resusitation collapse causes 4
eclampsia (incld magneussim toxicitiy) amniotic fluid embolism splecic artery ruptue antepartum/post partum haemorrhae
41
incidence of preeclampsia in pregnancy
affects approx 3% of pregnnacies
42
largest cause of death from pre-eclampsia
intracranial haemorrage secodnary to uncontrolled hypertension indicating a failure in antihypertensive therapy
43
what blood pressure value should be treated as a medical emergency in pre-eclampsia
>160mmHG
44
maternal complications of pre-eclampsia 7
intracranial haemorrhage placental abruption and DIC eclampsia HELLP syndrome renal failure pulmonary oedema acute respiratory arrest
45
define HELLP syndrome
severe form of eclampsia Haemolysis, elevated liver enzymes, low platelets
46
fetal complicatiosn fo pre-eclampsia 5
intrauterine growth restriction oligohydramnios hypoxia from placental insufficiency placental abruption premature delivery
47
managemnt of moderatee pre-eclapmsia
oral labetaol if systolic BP reaches 150-160mmHg
48
how is severe pre-eclampsia defined
systolic BP >180mmHg
49
manamegant of severe preeclampsia (>180mmHg) 3
oral/IV labetalol oral nifedipine IV hydralazine usually oral labetolor or nifedipine -repeat oral if unsuccessful -maintenance oral ehrapy or IV therapy ± infusion of labetoalol or hydrazline
50
what is the aim of antihypertensivee meds in pre-eclapmisa 1
lower systolic BP to <150mmHG
51
observations for motheres with severe pre-eclampsia
IV access, urine output BP check -15 mins if on treatemtn -30 mins when stabilised reviewed 4hrly by obstetrician if not delivered-> continuous CTG
52
fluid balance managemnt in preeclampsia
input 1ml/kg/hr or 80ml/hr -unless ongoing fluid loss (haemorrhage) hourly urine output measurements ->100ml/4hr if oral intake is adequate do not need IV do not preload w IV fluids if epidural neeeded
53
define eclampsia
one or more convulsions in assocation with pre-eclampsia -HOWEVER- MOST women in UK will not have established hypertension or proteinuria prior to seizure
54
when does eclampsia happen in pregnacy by percentage
44% postpartum 38% antepartum 18% intrapartum 5-30% recurrent seizure
55
management of pre-eclapmisa seizures
drug of choice magneisum sulphate -fewer recurrent seziures than diazepam or phenytoin DO NOT use diazepam, phenytoin or lytic cocktails as alternative to MgSO4
56
management of pre-eclapmisa seizures
drug of choice magneisum sulphate -fewer recurrent seziures than diazepam or phenytoin DO NOT use diazepam, phenytoin or lytic cocktails as alternative to MgSO4i
57
how does MgSo4 work for eclampsia
acts primarl by reducing cerebral vasospasm can also prevent eclampsia
58
when should MgSO4 be considered for eclampsia management 2 *how long should it be used for
primary prophylaics -women with severe-preeclampsia where birht is planned within next 24 hours secondary prophylaxis -after eclamptic fit *-given for 24hours form time of commencement or for 24 hours after delivery
59
immediate managemnt of elampsia
call for help-> ABC control seizures-> MgSO4 loading dose-> maintenance dose_> recurrent seziures?->MgSO4 bolus then follow severe pre-eclpamisa guidelines
60
magnesium sulphate observations 3
hourly urine measurements -MgSO4 exreted by kidnyes therefore risk of toxicity is higher with oliguria hourly deep tendon reflexes hourly RR
61
signs of MgSO4 toxicity 4
loss of deep tendon reflexes respriaoty depression respriaitoy arrest cardiac arrest
62
what can cuase MgSO4 toxicitiy 2
if oliguria or renal impairment
63
emergency managemnt of MgSO4 toxicity 5
call for help stop MgSO4 start BLS give IV calcium gluconate (1g (10ml of10%) intubate early and ventilate until respiration resumes
64
long term implciations of pre-eclampsia/eclampisa 2
increased risk of preeclampsia in future prectnacies increased risk of hypertension adn its complications later in life
65
which syxs antenatallly is pre-eclampsia until otherrwise
Headache of sufficient severity to seek medical advice is pre-eclampsia until proven otherwise Epigastric pain ≥ 20/40 is pre-eclampsia until proven otherwise
66
what should be measured to check for preeclampsia 2
BP urinalysis
67
what should be used in the third stage of labour if concerns over BP
syntocinon
68
what additional maneuver cna be required for resuscitaiton of a pregnant women
manual left lateral uterine displacemtn [31]
69
define amniotic fludi embolus
catastophic complcation of pregnancy -amniotic fluid, fetal cells, hair or other debris enters maternal pulmonary circulation and causes cardiovascular collapse

Obs & Gyn (23 decks)

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