Obstetric emergencies Flashcards
(28 cards)
What is shoulder dystocia?
This is where the shoulders fail to deliver after the head has delivered
What are the consquences of shoulder dystocia if it is not managed properly?
It can lead to brain injury or death
Inappropraite manipulation leads to brachial pleux injuries such as erb’s palsy
What are the risk factors for shoulder dystocia?
Large babies are the main risks
Maternal diabetes doubles the risk at any birthweight
Babies over 4.5kg should have c-section considered
What is the management of shoulder dystocia?
It is managed by gentle downward traction to reduce risk of brachial plexus injury
The mcroberts manouvre is used involving flexion of the legs onto the abdomen to tilt the pelvis and open this birth canal, suprapubic pressure is used to press the anterior shoulder of the baby
If this doesnt work episiotomy allows a hand to enter the vagina and rotate the babies shoulder
Last resorts inlude symphysiotomy or replacement of head a and c section
What is cord prolapse?
This is where the membranes rupture and the cord descends below the presenting part of the baby
This can cause it to become compressed and cause fetal hypoxia
What are the risk factors for cord prolapse?
Preterm labour
Breech presentation
Polyhydramnios
Abnormal lie
What is the management of cord prolapse?
Initiallyif the cord is protruding through the cervix then it should be kept warm and moist, it should not be pushed back in
Patient is asked to go on all fours whilst prep for emergency c section is done
What is amniotic fluid embolism and what are the symptoms?
This is where liquor enters the maternal circulation causing anaphylaxis, dyspnoea, hypoxia, hypotension, seizures and cardiac arrest
If the mother survives 30 mins she will develop disseminated intravascular coagulopathy and adult respiratory distress syndrome
What are the risk factors for amniotic fluid embolism?
It usually occurs when membranes rupture but can occur in labour or at c-section
What is the management of amniotic fluid embolism?
Diagnosis often confused with eclampsia
resuscitation and supportive treatment are key
Bloods for clotting, FBC, U and E, cross match
Treatment of massive obstetric haemorrhage will be required
What is uterine rupture?
This is where the uterus tears allowing the fetus to leave the uterus
It can be de novo or through an old c section scar
The uterus then contracts down and bleeds from the rupture
This causes acute fetal hypoxia
It presents with fetal heaert rate abnormalities or a constant lower abdo pain, cessation of contractions, maternal collapse
What are the risk factors of uterine rupture?
Previously scarred uterus
Preventative measures involve avoidance of induction and cautious use of oxytocin in patients with previous c section
What is the management of uterine rupture?
Resuscitation with IV fluids and blood Bloods for clotting, FBC, cross match Arrange an immediate laparotomy Fetus will die rapidly and blood can be lost faster than it can be replaced Uterus is repaired or removed
What is the management of uterine inversion?
This can happen when there is tension on the umbilical cord
It causes haemorrhage, pain and a vasovagal response
An attempt is made to push the fundus back up via the vagina
If this fails hydrostatic pressure with saline is used under general anaesthetic
What are the causes of maternal epileptiform seizures?
Commonly caused by eclampsia and maternal epilepsy however can be caused by hypoxia
What is the management of epileptiform seizures?
A-E
Airway cleared with suction, given oxygen
Patient prevented from hurting herself but not restrained
Diazepam given however eclapsia must be considered as the cause
magnesium sulphate is only useful for eclampsia so should not be used where the diagnosis is uncertain
Why is warfarin not used in treatment of PE in preganacy?
It is teratogenic
What are some of the maternal risk factors for VTE to consider?
Previous VTE High risk thrombophilia Low risk with family history Obesity (BMI over 40) Surgical procedure Major medical comorbidity Smoking age over 35
What prophylactic measures are taken for vte in pregnancy?
Non pharma:
-Mobilisation and maintenance of hydration
-Compression stockings
Pharma:
-LMWH based on weight (40mg for 70kg person)
-In high risk antenatally
-Postpartum used more and continued for at least 10 days
What is teh definition of postpartum haemorrhage?
This is loss of more than 500mls blood less than 24 hours following pregnancy
What is the deition of massive obstetric haemorrhage?
This is more than 1500mls blood
What are the causes of postpartum haemorrhage?
Retained placenta causes blood to accumulate in the uterus
Uterine causes (80%) uterus fails to contract properly (atonic) due to retained products, more common in prolonged labour, multiparity and polyhydramnios
Vaginal causes (20%) - perineal or episiotomy, high vaginal tears
Coagulopathy - usually picked up antenatally
How can postpartum haemorrhage be prevented?
Use of oxytocin in the thrid stage of labour
What are the clinical features of postpartum haemorrhgae?
The uterus will be enlarged (above level of uterus)
