Obstetric Emergencies

Question 1

What are the risk factors for amniotic fluid embolism?

Answer 1

Mutli preg
Increasing age
IOL
Uterine rupture
PP
PA 
Eclampsia
Polyhydramnios

Question 2

How does amniotic fluid embolism present?

Answer 2

Acute onset hypoxia, hypotension and confusion
Seizures
Shock
DIC

Question 3

How is amniotic fluid embolism investigated?

Answer 3

FBC
ECG
CXR

Question 4

How is amniotic fluid embolism managed??

Answer 4

ABCDE

Get senior help

Question 5

What is shoulder dystocia?

Answer 5

One of the shoulders of the foetus gets stuck (usually on a bony prominence)

Question 6

Which structure may shoulder dystocia result in damage of?

Answer 6

Brachial plexus

Question 7

What are the pre-labour risk factors for shoulder dystocia?

Answer 7

Prev event
Macrosomia
Diabetes
Maternal BMI >30
IOL

Question 8

What are the intrapartum risk factors for shoulder dystocia?

Answer 8

Prolonged stage 1 or 2
Secondary arrest
Oxytocin
Operative delivery

Question 9

What is the “turtle neck” sign in shoulder dystocia?

Answer 9

Foetal head retracts in towards the pelvis

Question 10

How is shoulder dystocia managed?

Answer 10

Senior help
Stop pushing
Avoid downwards traction
Episiotomy

Question 11

What examination is recommended after albour with shoulder dystocia?

Answer 11

PR

Question 12

What is an umbilical cord prolapse?

Answer 12

When cord comes through the cervix before/with the infant

Question 13

What is occult complete cord prolapse?

Answer 13

Descends alongside presenting part of foetus, but not in front of it

Question 14

What is overt incomplete cord prolapse?

Answer 14

Cord comes out first and is beyond the presenting part of the feotus

Question 15

By which two mechanisms does foetal hypoxia occur with cord prolapse?

Answer 15

Occlusion - presenting part presses on the cord and stops blood flow

Arterial vasospasm - exposure of umbilical cord to cold atmosphere causes vasospasm

Question 16

What are the main risk factors for cord prolapse?

Answer 16

Breech 
Unstable lie
Artificial rupture of membranes
Polyhydramnios
Prematurity

Question 17

How is umbilical cord prolapse managed?

Answer 17

Senior help
Don't touch cord
Lift presenting part
C-section
Terbutaline

Question 18

Why is terbutaline given in cord prolapse?

Answer 18

Relaxes uterus and stops contractions

Question 19

What is eclampsia?

Answer 19

TC seizure in pre-eclamptic woman with absence of neuro or metabolic explanation

Question 20

What a high risk factor for eclampsia?

Answer 20

Prev event
HTN
DM
CKD
Autoimmune

Question 21

What are mod risk factors for eclampsia?

Answer 21

>40yrs
BMI>35
FHx
Nulliparity
Preg interval >10 years
Multi preg

Question 22

What may eclampsia cause in the foetus?

Answer 22

IUGR
Premature delivery
Infant RDS
Foetal death
Placental abruption

Question 23

Why may USS be performed in eclampsia?

Answer 23

Rule out placenta abruption

Question 24

In which position should the patient be in in eclampsia?

Answer 24

Left lateral

Question 25

How are eclamptic seizures treated?

Answer 25

MgSO4

Question 26

Which anti-hypertensives can be used in pre-eclampsia and eclampsia?

Answer 26

Labetalol | Hydralazine

Question 27

What is the definitive treatment for eclampsia?

Answer 27

Deliver the baby

Question 28

What is uterine rupture?

Answer 28

Full-thickness disruption of the uterine muscle and overlying serosa

Question 29

What are the two types of uterine rupture?

Answer 29

Complete | Incomplete

Question 30

Describe an incomplete uterine rupture

Answer 30

Peritoneum over uterus in still intact

Question 31

Describe a complete uterine rupture

Answer 31

Peritoneum also torn - uterine contents can escape into peritoneal cavity

Question 32

What are the main risk factors for uterine rupture

Answer 32

``` Anything that makes the uterus weaker Prev C-sec or uterine surgery IOL obstruction Multi preg Multiparous ```

Question 33

How does uterine rupture present?

Answer 33

Severe continuous abdo pain between contractions | With/out vaginal bleeding

Question 34

What is the surgical management of uterine rupture?

Answer 34

C-sec | Uterine repair or removal