Obstetric emergencies: Flashcards
(44 cards)
List the 4 types of Maternal Obstetric Emergencies:
- Antepartum Haemorrhage
- Postpartum Haemorrhage
- Pre-eclampsia
- Venous thromboembolism
List the 3 types of foetal Obstetric Emergencies:
- Foetal distress
- Cord prolapse
- Shoulder dystocia
What is the definition of Antepartum Haemorrhage?
Bleeding from anywhere in the genital tract after 24th week of pregnancy (uterus, cervix, vagina, vulva).
(3-5% of pregnancies)
List 4 causes of antepartum haemorrhage:
- Low lying placenta/placenta praevia (classically painless)
- Placenta accreta
- vasa praevia
- Minor/major abruption (classically painful)
What is placenta accreta?
When the placenta growth too deeply into the uterine wall. When the placenta detaches during childbirth, in placenta accreta, part of the placenta may remain attached which can lead to severe blood loss after delivery (postpartum Haemorrhage)
What is vasa praevia?
It is when blood vessels run across or near to the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.
Can occur when there is a secondary lobe to the placenta (i.e. one on either side of the cervix).
What is placental abruption?
When the placenta separates from the uterus before childbirth. This commonly occurs around the 25th week of pregnancy.
When is placenta praevia/low lying placenta picked up?
At 20 week scan
How far from the cervical OS must the placenta be? What occurs if it is not? What occurs if it is at least that distance away?
> 25mm.
Minor praevia = repeat scan at 36 weeks.
Major praevia = repeat scan at 32 weeks
If the placenta remains <25mm away from cervical OS then elective caesarean section should be performed.
Outline the management of a low lying placenta:
- Advise symptoms to watch for
- Outpatient management if asymptomatic, inpatient is recurrent bleeds
- Remember anti-D if Rhesus Negative
- Elective Caesarean at 38-39 weeks
What O/E should be performed in those with bleeding placenta praevia?
1) 15min Maternal obs:
- BP, Pulse, temp, O2 sats, urine output
2) Examination:
- General and abdo
- Vaginal (avoid digital examination)
3) Foetal monitoring - CTG +/- arrange delivery
4) Steroids <34 weeks gestation
When should steroids be given during pregnancy/what situation?
If the mother is to deliver before 34 weeks
Outline the protocols you would complete in those with a major bleed:
1) Resuscitate ABC
2) Two 14/16 G cannulas in antecubital fossa
3) Crystalloid (IV saline)
4) X-match 6 units
5) FBC, U&E, LFTs, Clotting
6) Consultant Obs + Anaesthetist
Outline the difference between placental accreta, increta and percreta:
Accreta - placental invasion deeper into the endometrium/little bit of myometrium
Increta - placental invasion in the myometrium
Percreta - placental invasion through the myometrium + serosa.
Who and when would you typically look out for low lying placenta (LLP)?
At 20 week scan in those with a previous section - look for anterior LLP.
What Ix would you perform and subsequent management in someone with placental accreta?
Ix: - USS - loss of definition between wall of uterus + abnormal vasculature - MRI Rx: - Elective C-section at 36-37 weeks
Identify 2 risks of placenta accreta:
- Haemorrhage
- Caesarean hysterectomy
In those undergoing C-sections for placenta accreta, what must you warn the patient about as a complication?
May have to undergo a hysterectomy within the same procedure.
Give 5 risk factors for placental abruption:
- Previous abruption
- Hypertension
- Multiple pregnancy
- Trauma - aminodrainage due to domestic violence
- Vasoconstrictor drugs e.g. cocaine and crack
Give 5 complications of antepartum haemorrhage:
- Premature labour/delivery
- Blood transfusion
- Acute tubular necrosis (due to hypo-perfusion of kidneys)
- DIC
- Foetal morbidity (hypoxia) and mortality
Define post partum haemorrhage:
Primary - within 24hours of delivery, blood loss >500mls
Secondary - After 24hours and up tp 12 weeks post delivery
Minor - 500-100mls
Major - >1000mls
(it is a major cause of maternal death worldwide)
List 4 causes of Postpartum haemorrhage:
The four T’s:
- Tissue - Ensure placenta is complete
- Tone - ensure uterus contracted
- Trauma - look for tears and repair
- Thrombin - check clotting
Give 4 drugs that aid with uterine contraction to Rx postpartum haemorrhage:
- Syntometrine (synthetic oxytocin)
- Syntocinon (Synthetic oxytocin)
- Ergometrine
- Haemobate (also used for abortions)
- Misoprostol (also used for abortions)
Give 5 risk factors for postpartum haemorrhage:
- Big baby
- Nulliparity + grand multiparity
- Precipitate/prolonged labour
- Maternal pyrexia
- Operative delivery
