Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year Three - Reproductive System > Obstetric Emergencies > Flashcards

Obstetric Emergencies Flashcards

(71 cards)

Start Studying
1
Q

What is shoulder dystocia?

A

It occurs when, after delivery of the head, the anterior shoulder of the fetus becomes impacted on the maternal pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the pathophysiology of shoulder dystocia

A

In normal labour, the fetal head is delivered via extension out of the pelvic outlet

This is followed by restitution of the fetal head, so it lies in a neutral position in relation to its spine

This means that the fetal shoulders now lie in an anterior-posterior position

Shoulder dystocia occurs when there is impaction of the anterior fetal shoulder behind the maternal pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Between which two cardinal movements does shoulder dystocia occur?

A

Extension and restitution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three risk factors of shoulder dystocia?

A

Macrosomia

Gestational Diabetes

Previous Shoulder Dystocia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is macrosomia?

A

It is defined a as a fetal weight larger than average

This is generally a fetal weight above 4.5kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does gestational diabetes increase the risk of shoulder dystocia?

A

This is due to the fact that the baby’s weight distribution is disproportionately bigger in the abdomen region compared to the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the three clinical features of shoulder dystocia?

A

Fetal Head Delivery Difficulty

Restitution Failure

Turtleneck Sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is restitution failure?

A

It occurs when the fetal head remains in the occipital anterior position after delivery by extension and therefore doesn’t turn sideways as expected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the turtleneck sign?

A

It is is when the fetal head retracts slightly back into the pelvis, so that the neck is no longer visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the six management options for shoulder dystocia?

A

Episiotomy

McRoberts Manoeuvre

Suprapubic Pressure

Posterior Arm

Corkscrew Manoeuvre

Zavenelli Manoeuvre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an episiotomy?

A

It is a surgical cut made at the opening of the vagina during childbirth

This can enlarge the vaginal opening and can make access easier for manoeuvres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a McRoberts manouevre? How is it used to manage shoulder dystocia?

A

It involves the mother lying supine with both hips fully flexed and abducted

This widens the pelvic outlet by lifting the pubic symphysis up and out of the way and increasing the lumbosacral angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the first line management option?

A

McRoberts manouevre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is suprapubic pressure? How is it used to manage shoulder dystocia?

A

It involves pressing on the suprapubic region of the abdomen

This puts press pressure on the posterior aspect of the baby’s anterior shoulder, to encourage it down and under the pubic symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the posterior arm manoeuvre?

A

It involves inserting a hand posteriorly and grasping the posterior arm to deliver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the corkscrew manoeuvre?

A

It involves reaching into the vagina to put pressure in the posterior aspect of the baby’s anterior shoulder

The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder

This is used to move the baby into an oblique position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Zavenelli manoeuvre?

A

It involves pushing the baby’s head back into the vagina so that the baby can be delivered by an emergency c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do we do if all the manoeuvres fail?

A

We roll the patient onto all fours and repeat

This may widen the pelvic outlet as the legs are abducted and flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the four complications of shoulder dystocia?

A

Fetal Brachial Plexus Injury

Fetal Hypoxic Brain Injury

Perineal Tears

Postpartum Haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What postpartum haemorrhage (PPH)?

A

It refers to bleeding after delivery of the baby and placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What blood loss after a vaginal delivery is classified as postpartum haemorrhage?

A

500ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What blood loss after a c-section is classified as postpartum haemorrhage?

A

1000ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two classifications of postpartum haemorrhage?

A

Primary Postpartum Haemorrhage

Secondary Postpartum Haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is primary postpartum haemorrhage?

A

It is defined as bleeding within 24 hours of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is secondary postpartum haemorrhage?
It is defined as bleeding from 24 hours to 6 weeks after delivery
26
What are the four categories of postpartum causes?
Thrombin Tissue Tone Trauma
27
What are the four thrombin causes of postpartum haemorrhage?
Pre-Eclampsia Placenta Abruption Bleeding Disorders Endometritis
28
What are the two tissue causes of postpartum haemorrhage?
Retained Placenta Retained Products of Conception
29
What are the four tone causes of postpartum haemorrhage?
Uterine Atony Multiple Pregnancy Placenta Praevia Previous PPH
30
What is the most common cause of PPH?
Uterine atony
31
What are the four trauma causes of postpartum haemorrhage?
Perineal Tear C-Section Macrosomia Episiotomy
32
What are the seven immediate management options for postpartum haemorrhage?
Call for help ABCDE Check uterine tone, trauma and tissue O2 therapy Further IV access Fluid replacement Bloods
33
What six blood tests do we conduct in postpartum haemorrhage patients?
FBC U&Es LFTs Group & cross match Clotting tests Lactate
34
What are the two conservative management options for postpartum haemorrhage? Describe how
Uterus Massage - By massaging the uterus through the abdomen, a uterine contraction is stimulated. This can help stop the bleeding. Catheterisation - A catheter can be placed into the bladder to empty it. This can help stop bleeding as bladder distention prevents uterus contractions.
35
What five pharmacological treatments for postpartum haemorrhage?
Oxytocin Ergometrine Carboprost Misoprostol Tranexamic Acid
36
What is the function of oxytocin?
It stimulates uterine contraction
37
What is the function of ergometrine?
It stimulates smooth muscle contraction
38
When is ergometrine contraindicated?
Hypertension
39
What class of drug is carboprost? What is its functions?
A prostaglandin analogue It stimulates uterine contraction
40
When should we take caution when prescribing carboprost to patients?
If they have asthma
41
What class of drug is misoprostol? What is its functions?
Prostaglandin analogue It stimulates uterine contraction
42
What class of drug is tranexamic acid? What is its functions?
Antifibrinolytic It reduces bleeding
43
What are the four surgical treatments for PPH?
Intrauterine Balloon Tamponade B-Lynch Suture Uterine Artery Ligation Hysterectomy
44
What is intrauterine balloon tamponade?
It is a surgical procedure that involves inserting an inflatable balloon into the uterus to press against the bleeding
45
What is B-lynch suture?
It involves placing a suture around the uterus to compress it
46
What is uterine artery ligation?
It involves ligation of one or more of the arteries supplying the uterus to reduce the blood flow
47
What is hysterectomy?
It is a surgical procedure to remove the uterus
48
What is lochia?
It is vaginal discharge for three to four weeks after birth, however it should be like a period or less with the absence of large clots
49
In what five ways can we prevent postpartum haemorrhage?
Optimise antenatal haemoblogin levels IV access Active management of the 3rd labour stage Tranexamic acid Oxytocin infusion in high risk patients
50
What is umbilical cord prolapse?
It is when the cord descends through the cervix, with or before the presenting part of the fetus
51
What are the two classifications of umbilical cord prolapse?
Occult Cord Prolapse Overt Cord Prolapse
52
What is another name for occult cord prolapse?
Incomplete cord prolapse
53
What is occult cord prolapse?
It occurs when the umbilical cord descends alongside the presenting part, but not beyond it
54
What is another name for overt cord prolapse?
Complete cord prolapse
55
What is overt cord prolapse?
It occurs when the umbilical cord descends past the presenting part and is lower than the presenting part in the pelvis
56
What are the four risk factors of umbilical cord prolapse?
Breech Presentation Unstable Lie Polyhydramnios Amniotomy
57
How is a breech presentation a risk factor for umbilical cord prolapse?
It means that the cord can easily slip between and past the fetal feet and into the pelvis.
58
What is the an unstable lie?
It is when the presentation of the fetus changes between transverse, oblique and breech
59
What is the most significant risk factor for umbilical cord prolapse?
Unstable lie, especially after 37 weeks’ gestation
60
What is polyhydraminos?
Excessive amniotic fluid around the fetus
61
What is amniotomy?
The artificial rupture of membranes
62
What two investigations are used to diagnose umbilical cord prolapse?
CTG Vaginal examination
63
What is the sign of umbilical cord prolapse on a CTG?
There are signs of fetal distress Subtle signs = decelerations with contractions Obvious signs = fetal bradycardia
64
What is the main complication of umbilical cord prolapse?
Fetal hyopxia
65
What are the two mechanisms in which umbilical cord prolapse can result in hypoxia?
Occlusion of the umbilical cord can occur when the presenting part of the fetus presses upon it. This occludes blood flow to the fetus. Arterial vasospasm occurs when the exposure of the umbilical cord to the cold atmosphere results in a spasm, thus reducing blood flow to the fetus.
66
What are the two conservative managements for umbilical cord prolapse?
We manually push the presenting part of the foetus back into the vagina. This is to prevent compression of the umbilical cord and therefore hypoxia. We ask the mother to go on all fours, on knees and elbows
67
What is the pharmacological management for umbilical cord prolapse?
Terbutaline
68
How does terbutaline treat umbilical cord prolapse?
It used to relax the uterus, minimise contractions and relieve pressure off the cord
69
When is terbutaline used to treat umbilical cord prolapse?
It is prescribed to patients whilst waiting for delivery by c-section
70
What is the surgical management for umbilical cord prolapse?
Emergency c-section
71
What category c-section does umbilical cord prolapse require?
Category one

Year Three - Reproductive System (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions