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obstetric emergencies Flashcards

(96 cards)

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1
Q

what is HELLP syndrome

A

complication of pregnancy with: haemolysis, elevated liver enzymes and low platelets

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2
Q

when does HELLP syndrome usually present

A

during the 3rd trimester

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3
Q

clinical presentation of HELLP syndrome

A

headache, N+V, epigastric pain, RUQ pain (due to liver distension), blurred vision and peripheral oedema

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4
Q

definitive management of HELLP syndrome

A

delivery !!

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5
Q

what can be used for seizure prophylaxis during pregnancy

A

magnesium sulphate

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6
Q

what is the most common cause of iatrogenic prematurity

A

pre-eclampsia

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7
Q

name some risk factors for developing pre-eclampsia

A

first pregnancy, age > 40, high BMI, FHx, hypertension, CKD, multiple pregnancy

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8
Q

what is pre-eclampsia

A

new onset hypertension after 20 weeks of pregnancy associated with organ damage (proteinuria)

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9
Q

classic presentation of pre-eclampsia

A

hypertension, proteinuria and oedema

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10
Q

name some symptoms associated with pre-eclampsia

A

headache, visual disturbance, N+V, abdo tenderness (epigastric/RUQ)

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11
Q

prophylaxis for pregnancies that are high risk of pre-eclampsia

A

aspirin 75mg daily from 12 weeks gestation until birth

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12
Q

how do we screen for pre-eclampsia

A

urinalysis and blood pressure monitoring at every antenatal visit

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13
Q

curative management of pre-eclampsia

A

delivery

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14
Q

what is eclampsia

A

severe complication of pre-eclampsia, characterised by generalised tonic-clonic seizures

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15
Q

who is eclampsia more common in

A

teenage pregnancies

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16
Q

antihypertensives used in pregnancy

A

labetalol, hydralazine

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17
Q

acute seizure control in eclampsia

A

IV magnesium sulphate first line
diazepam or lorazepam if persistence

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18
Q

name some risk factors for sepsis in pregnancy

A

pre-natal invasive diagnostic procedures e.g. amniocentesis
cervical suture
prolonged rupture of membranes
operative delivery
immunosuppression

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19
Q

name 3 antenatal/intrapartum sources of infection

A

chorioamnionitis
resp: influenza, pneumonia, covid
genitoutery infections incl. HSV

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20
Q

name some post-natal causes of sepsis

A

caesarean, episiotomy, mastitis, UTI, endometritis, retained products of conception

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21
Q

why are pregnant women at risk of sepsis

A

pregnancy causes immunosuppression due to shift from cell-mediated to humoral immunity

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22
Q

steps of the sepsis 6

A

Blood cultures
Urine output
Fluids
Antibiotics
Lactate
Oxygen

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23
Q

management of sepsis in pregnancy (+also in penicillin allergic patients)

A

IV co-amoxiclav +/- gentamicin + clindamycin if sore throat
penicillin allergic: clindamycin + gentamicin

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24
Q

management of septic shock in pregnancy

A

tazocin, clindamycin and gentamicin

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25
what causes aortocaval compression in pregnancy
gravid uterus compresses the maternal abdominal aorta and inferior vena cava
26
what can aortocaval compression cause
supine hypotensive syndrome - sudden drop in BP when pregnant women lie down
27
how to manage aortocaval compression
left manual uterine displacement OR 30 degree tilt if on theatre table
28
what is amniotic fluid embolism
when amniotic fluid enters the maternal circulation
29
clinical presentation of an amniotic fluid embolism
sudden onset: hypoxia, hypotension, profound foetal distress
30
when is a perimortem c-section indicated
no response to CPR in 4 minutes
31
what are the shockable causes of cardiac arrest
ventricular fibrillation and pulseless ventricular tachycardia
32
what are the non-shockable rhythms
asystole and pulseless electrical activity
33
how do we manage non-shockable rhythms in cardiac arrest
start CPR and adrenaline 1mg IV adrenaline 1mg every 3-5 mins (every 2nd cycle)
34
what can be an alternate route of admission of drugs in emergency settings if IV access is unaccessable
interosseous
35
how do we manage shockable rhythms in cardiac arrest
start CPR, administer shocks as advised 3rd shock: adrenaline 1mg + amiodarone 300mg give adrenaline every 3-5 mins there after consider a second dose of amiodarone (150mg) after shock 5
36
what are the 4H's and 4T's of reversible causes of cardiac arrest
hypovolaemia, hypoxia, hypo/hypermetabolic, hypothermia thrombosis, tamponade, toxins, tension pneumothorax
37
what are 2 other reversible causes of cardiac arrest in pregnant women
pre-eclampsia or amniotic fluid embolism
38
why are pregnant women more at risk of VTE
pregnancy is a hypercoagulable state
39
what is a dural venous sinus thrombosis
occlusion of a dural venous sinuses in the cranial cavity
40
classic presentation of a dural venous sinus thrombosis
headache
41
investigation for a dural venous sinus thrombosis
MR venogram
42
management of dural venous sinus thrombosis in pregnancy
anticoagulation with LMWH
43
investigation for suspected PE
CTPA or V/Q scanning
44
management of PE in pregnancy
fixed dose LMWH based on early pregnancy body weight
45
name some risk factors for VTE in pregnant women
parity > 3, prolonged labour, postpartum haemorrhage >100oml, stillbirth, preterm birth, immobility
46
prophylaxis for VTE in pregnancy and postpartum
low molecular weight heparin
47
name some things that cord prolapse are associated with
abnormal lie, multiple pregnancy, high foetal head at delivery, low birth weight/prematurity
48
how might we detect cord prolapse and what would be a positive result
vaginal exam !! CTG - variable or prolonged decelerations
49
what can be administered in cord prolapse to prevent further cord prolapse
tocolytics: nifedipine, atosiban, terbutaline to stop uterine contractions
50
what is shoulder dystocia
bony impaction of foetal anterior shoulder on the maternal symphysis
51
name some antenatal risk factors for shoulder dystocia
maternal gestational diabetes, macrosomia, advanced maternal age, small pelvis, post-dates
52
name some intrapartum risk factors for shoulder dystocia
prolonged 1st and 2nd stage induction of labour instrumental delivery
53
name 2 clinical signs that indicate shoulder dystocia
turtle neck sign head bobbing
54
what is turtle neck sign
delivered head becomes tightly pulled back against the perineum and there is difficulty delivering the head
55
what is head bobbing
jerking movement of the head between contractions as it tries to move forward but gets stuck
56
management of shoulder dystocia
HELPERR call for **H**elp **E**valuate for episiotomy **L**egs (McRoberts' manoeuvre) External **P**ressure (suprapubic) **E**nter (rotational manoeuvre) **R**emove the posterior arm **R**oll the patient onto her hands and knees
57
name some foetal complications of shoulder dystocia
hypoxia brachial plexus injury fracture of clavicle/humerus if needed
58
name some maternal complications of shoulder dystocia
PPH, genital tract trauma, pelvic injury
59
what is antepartum haemorrhage
bleeding from the genital tract after 24 weeks of gestation and before the end of the second stage of labour
60
what are the 2 most common causes of antepartum haemorrhage
placental abruption and placenta praevia
61
how do we quantify APH
spotting: staining, streaking, wiping minor < 50 ml major 50-1000 ml with no signs of shock massive > 1000 ml OR signs of shock
62
first line medical management of antepartum haemorrhage
tranexamic acid
63
what is placental abruption
premature separation of the placenta from the uterine wall during pregnancy
64
name some risk factors for placental abruption
pre-eclampsia, trauma, smoking/drugs, multiple pregnancies, increased maternal age
65
'woody' uterus
PLACENTAL ABRUPTION!!
66
clinical presentation of placental abruption
severe abdominal pain, bleeding, foetal distress
67
management of placental abruption
delivery is the only way to 'fix' the problem
68
prophylaxis given to women with antiphospholipid syndrome during pregnancy
LMWH and low dose aspirin
69
what is placenta previa
placenta is lying directly over the internal os
70
what is a low lying placenta
when the placental edge is less than 2 cm from the internal os on ultrasound
71
name some risk factors for placenta previa
previous caesarean or TOP, increased maternal age, multiparity, assisted conception
72
classic presentation of placenta previa
bright red vaginal bleeding which is painless later than 24 weeks
73
name something that might trigger bleeding associated with placenta previa
sex
74
what should be avoided in patients with suspected placenta previa
digital vaginal exam
75
gold standard investigation for diagnosis of placenta previa
TVUS
76
what should be avoided in women with placenta previa
sex
77
what is placenta acreta
abnormally adherent placenta to the uterine wall (myometrium)
78
what is placenta increta
placenta invades the myometrium
79
what is placenta percreta
placenta invades through the uterine walls and attaches to the intra-abdominal organs (usually bladder)
80
name some risk factors for placenta accreta
previous TOP or caesarean, placenta previa, ashermans
81
what is ashermans syndrome
build-up of scar tissue in the uterus
82
how can placenta accreta be identified
often asymptomatic - found on ultrasound
83
definitive management of placenta accreta
elective caesarean hysterectomy
84
what is uterine rupture - and how does this differ to dehiscence
full thickness opening of the uterus - including serosa if serosa is intact - uterine dehiscence
85
name some risk factors for uterine rupture
previous uterine surgery incl. caesarean, multiparity, use of prostaglandins, obstructed labour
86
what is vasa praevia
foetal vessels run over the cervix without protection
87
what is the risk associated with vasa praevia
vessels are prone to rupture during the rupture of the membranes - can result in foetal haemorrhage
88
name some risk factors for vasa praevia
assisted reproduction, abnormal placental conditions
89
classic presentation of vasa praevia
painless vaginal bleeding, rupture of membranes, foetal bradycardia
90
primary management for vasa praevia
elective caesarean prior to the rupture of membranes
91
what is chorioamnionitis
intra-amniotic infection that affects the membranes surrounding the foetus and the placenta
92
risk factors for chorioamnionitis
invasive pre-natal diagnostics, pre-term rupture of membranes, prolonged labour, meconium stained liquour
93
name some organisms commonly associated with chorioamnionitis
group B strep, e.coli, anaerobes
94
clinical presentation of chorioamnionitis
fever, abdo pain, cervical tenderness, smelly vaginal discharge
95
management of chorioamnionitis
hospital admission and delivery
96
what should be avoided in post partum for patients who had chorioamnionitis
post-partum intra-uterine contraception

reproduction and sexual health (18 decks)

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