Obstetric emergency

Question 1

Causes of cardiac arrest (4H 4T)

Answer 1

Hypovolemia 2’ hemorrhage/sepsis Hypoxia Hyperkalemia Hypothermia Thromboembolism Toxity (i.e drugs anaesth) Tension pneumothorax Cardiac tamponade

Question 2

Risk factors for PPH (10)

Answer 2

[Pre-existing] Adv maternal age Primigravida Grandmultipara Fibroids Prev cesarean Bleeding disoders Obesity APH Prev PPH [Intrapartum] Prolonged labor Cesarean section Instrumental delivery Episiotomy [Fetal] Large baby Multiple pregnancy Polyhydramnion Shoulder dystocia

Question 3

Causes of PPH (4Ts)

Answer 3

Tone (atony) Tissue (retained placenta) Trauma (injury) Thrombin (clotting dx)

Question 4

Management of severe PPH- blood loss > 1500ml (10)

Answer 4

1. Ask for HELP 2. Oxygen mask 3. Secure 2 large bore cannula 4. FBC, clotting study 5. RF & LFT 6. Fluid resuscitation 7. Notify blood bank 8. CBD and fluid chart 9. Blood transfusion ** 10. CVP and arterial line 11. Investigate causes Add point: ABCDE

Question 5

Acute management in hypertensive disorder

Answer 5

1. Call for HELP 2. Prevent convulsion w magnesium sulphate 3. Control BP 4. Control fluid balance 5. Minimize organ damage 6. Control coagulopathy 7. Deliver baby HELLP syndrome a/w DIVC, coagulation, placental abruption, fetal death

Question 6

Risk factors of uterine rupture (8)

Answer 6

1. Previous Cesarean
2. Previous uterine surgery
3. Induction/augmentation of labor
4. High parity
5. Macrosomic fetus
6. Placenta percreta
7. Fetal version (breach extraction)
8. Congenital anomaly (ie bicornuate uterus)

Question 7

Risk factors for cord prolapse (7)

Answer 7

Pelvic tumor Narrow pelvis Prematurity Malpresentation Multiple pregnancy Polyhydramnion Placenta previa Large baby

Question 8

Risk factors for shoulder dystocia (10)

Answer 8

1. Diabetes
2. Short stature
3. Prev shoulder dystocia
4. Obesity
5. Macrosomic
6. Postmaturity
7. Long first stage of labor
8. Long second stage of labor
9. Instrumental delivery
10. IOL
11. Use of oxytocin

Question 9

Management of shoulder dystocia

HELPERR

Answer 9

• H- Call for help
• E- Evaluate episiotomy
• L- Legs McRoberts maneuver
• P- Pressure of suprapubic
• E- Enter; rotational maneuver (Rubin II)
• R- Remove post arm
• R- Roll patient to hand and knee (all-four)

Last resort:

1. Deliberate clavicle fracture
2. Zavanelli maneuver (upward pressure for CS)
3. Symphysiotomy

Question 10

Features of scar dehiscence/impending rupture (6)

Answer 10

1. Scar tenderness
2. Persistent lower abd pain
3. Maternal tachycardia & hypotension
4. Fetal bradycardia
5. Abnoral PV bleed
6. Delayed labor progress