Obstetric Emergencies Flashcards Preview

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Flashcards in Obstetric Emergencies Deck (28):

Supine Hypotension Syndrome

Aortalcaval compression - compression of inferior vena cava and aorta by the gravid uterus
Risk factors: late pregnancy, supine



Widespread vascular endothelial malfunction and vasospasm occuring after 20 weeks gestation
Caused by mismatch of placental and vascular endothelial growth factors



New onset of tonic clonic seizure or coma during pregnancy
Includes: seizure, headache, hyperactive reflexes, marked proteinuria, generalised oedema, visual disturbances, RUQ or epigastric pain


Ectopic Pregnancy

The embryo attaches outside the uterus


Signs and Symptoms of Ectopic Pregnancy

abdo pain, vaginal bleeding, sharp dull or crampy pain, pain may spread to shoulder, severe bleeding may cause fast HR, fainting and shock


Risk factors of Ectopic Pregnancy

PID, tobacco smoking, assisted reproductive technology, previous ectopic


Vaginal Bleeding causes

implantation bleeding, cervical lesions, abortion, ectopic pregnancy, incompetent cervix



expulsion of products of conception from the uterus via the birth canal before 20 weeks
Foetal causes: foetal abnormality, poor implantation, abruption of the ovum
Trauma: MCA, direct blow, criminal interference, abdo surgery
Maternal causes: diseases, ABO incompatibility, drugs, psychological, retroverted uterus, myomas


Spontaneous abortion

period of unease prior to onset of symptoms
vaginal bleeding, pain in centre lower abdo, intermittent backache


Missed abortion

foetus has died and is retained with placenta in uterus
pain and bleeding stops, followed by brown discharge


Threatened abortion

pain, vaginal bleeding, cervical as closed, membranes intact


Inevitable abortion

free vaginal bleeding, ruptured membranes
amniotic fluid seen, more acute abdo pain
rhythmic, foetal sac and content protruding through dilating cervical os


Incomplete abortion

usually before 2nd trimester
foetus expelled but part of placenta retained
profuse bleeding, abdo pain, backache may cease


Septic Abortion

infection resulting from abortion
unwell, headache, nausea, sweating and shivering, flushed skin, increased temp


Incompetent Cervix

cervix dilates painlessly, feotus is expelled complete with placenta and membranes
due to weakness of retaining sphincter mechanism at the function of the uterus and cervix
most frequently at 16 weeks


Cervical Shock

cervix goes into shock spasm due to foreign body being caught in neck of cervix
Stimulation/irritation of cervix leads to PNS hyperactivity leads to bradycardia and hypotension


Antepartum Haemorrhage

after 20 weeks gestation and before onset of labour
If bleeding severe, increased risk of death to foetus and mother
If not severe, foetus may be subject to hypoxia
Causes: placenta praevia, placental abruption, vasa praevia, other


Placental Praevia

Placenta is partially or wholly implanted in the lower uterine segment
Type 1 - majority of placenta in upper segment
Type 2 - partially located into the lower segment near the internal os
Type 3 - placenta loated over internal os but not centrally
Type 4 - placenta located centrally over os


Causes of Placenta Praevia

delay implantation, multiparity, uterine scarring


Presentation of Placenta Praevia

painless bleeding from vagina, may be mild mod or severe, blood will be bright red, premature labour, shock


Placental Abruption

Premature separation of a normally situated placenta occurring after 20 weeks
Bleeding from maternal venous sinuses into placenta bed leads to further separation of placenta leads to blood retained in placenta therefore infiltrates myometrium leads to extravasations causing marked damage such as bruising and oedema


Causes of Placental Abruption

pre-eclampsia, sudden reduction in size of uterus, direct trauma to abdo, domestic violence


Cord Prolapse

umbilical cord lies in front or beside presenting part in presence of ruptured membranes
Predisposing factors: high presenting part of uterus, woman whos had more than 5 babies, prematurity, multiple pregnancy, polyhydraminos - excessive fluid volume, malpresentation - breech


Shoulder dystocia

failure of shoulders to traverse the pelvis spontaneously after delivering the head
Warning signs: head advanced slowly, chin has difficulty, once head delivered, may seem like it wants to go back in, alternately prolonged head to body delivery time, do not restitute baby's head


Risk factors for shoulder dystocia

mother over 35
maternal weight greater than 90kg
large baby
maternal diabetes
platypelloid pelvis


Post-partum haemorrhage

excessive bleeding from woman's genital tract or anytime following baby's birth up to 6 weeks after
caused by atonic uterus which fails to contract


Causes of post-partum haemorrhage

incomplete placental separation, retained cotyledons, precipate labour, prolonged labour, polydraminos or multiple pregnancy, placenta praevia, infection, general anaesthesia, mismanagement of 3rd stage labour


Risk factors of post-partum haemorrhage

previous history, high parity, uterine fibroids, anaemia