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Flashcards in Obstetric emergencies Deck (8)
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1
Q

What is shoulder dystocia?

A

Any delivery that requires additional obs manoeuvres after gentle downward tracion on the head has failed to dliver the shoulder

1:200 pregnancies

Usually anterior shoulder is pushed against symphysis pubis due to failed internal rotation of shoulder

Rapid foetal deterioration occurs due ot cord compression and trauma

2
Q

Risk factors and comlications of shoulder dystocia

A

RF: macrosomia, prev. hx, BMI >30, instrumental delivery, DM

Foetal: hypoxia, cerebral palsy, brachial plexus palsy, clavicle/ humerus fracture, intracranial haemorrhage, cervical spine injruy, foetal death

Maternal: PPH, genital tract trauma

3
Q

Management of shoulder dystocia

A

H: call for help

E: episiotomy

L: legs to McRoberts

P: suprapubic pressure

E: enter pelvis for internal manoeuvres

R: release of posterior arm by flexing elbow, getting hold o foetal headand sweeping foetal arm across chest and face

R: roll over onto hands and knees (Gaskin manoeuvre)

80% deliver with McRoberts and pressure

Zanvanelli = pushing head back in

4
Q

What is massive obstetric haemorrhage?

A

Blood loss >1000ml +/- signs of shock

Important cause of death

Causes:

Antepartum: abruption, praevia, sepsis, retained products

Intrapartum: abruption, uterine rupture, amniotic fluid embolism, complications of CS, acreta/ increta/percreta

Postpartum: tone, trauma, tissue, low thrombin

5
Q

Discuss primary PPH

A

Within 24hrs

a) Tone: uterus feels boggy, soft, fundus above umbilicus

I: USS, bloods, coag profile

Tx: uterotonic agents e.g. oxytocin, ergot alkaloids, uterine balloon/ tamponade

b) Tears/ trauma: bleeding, uterine rupture, tears during c-section

I: inspect during c-section, USS to look for free fluid and rupture

Tx: repair trauma, pelvic artery embolisation

c) Retained tissue: placenta and membranes

I: examination under anaesthesia

Tx: manual removal

d) Coagulopathy: continued bleeding, contracted uterus

I: U&E, FBC, coagulation profile

Tx: medical: blood + clotting factors + platelets

Surgical: only if unresponsive to medication

6
Q

Discuss secondary PPH

A

24hrs - 12 weeks PP

a) Endometritis: uterine tenderness, guarding and rebound tenderness

I: high vaginal swabs, USS to rule out retained products

Tx: oral antibiotics, admit for IV if unwell

b) Pseudoaneurysm: uterine artery, mostly due to CS, result in profuse bleeding and shock

I: doppler, MRI, angiography

Tx: antibiotics if infection, uterine artery embolisation

c) Retained tissue: foul or offensive discharge, fever, tenderness

I: USS

Tx: oral or IV antibiotics/ surgery to remove tissue

7
Q

What is PPH?

A

>500ml blood loss PP

Minor haemorrhage = <50ml

Major = 50-100ml

Massive = >1000ml

70% due to uterine atony

8
Q

Methods to control or reduce risk of PPH

A

Bimanual uterine compression

Medication: syntocinon, syntometrine, misoprostol