Obstetrics Flashcards
(27 cards)
Where to take obstetric emergencies?
- <20 weeks nearest ED
- > 20 weeks obstetric unit
- All that have major trauma follow trauma guidelines
Types of bleeding
Spotting = staining, streaking or blood noted
Minor = blood loss less than 500mls that has settled
Major = blood loss of 50-1000mls with no clinical shock
Massive = blood loss greater than 1000ml and/or clinical shock
Antenatal haemorrhage
Late pregnancy bleeding >20 weeks
Onset of labour (bloody show)
Placenta praevia = placenta implanted in lower uterine
Placenta abruption = premature separation of the placenta from the uterus
Treatment of antenatal haemorrhage
- Position appropriate
- Consider oxygenation
- Vascular access
- Pain relief
- Anti emetic
- Transport to nearest obstetric unit in left lateral tilt
- Document duration, amount, colour, consistency and patten blood loss
Types of breech
Frank = bottom first legs up
Complete = bottom first legs tucked up
Footling= feet first
Treatment of breech presentations
- Delivery should not be attempted unless absolutely inevitable
- Do not delivery footling in prehospital setting
- Do not attempt to push or pull baby
- Position patient appropriate
- Vascular access
- Pain relief (methoxyflurane)
- Antiemetic
- Lithotomy position (on back with knees up)
- Exclude cord prolapse
- Mauriceau smellie veit manoeuvre
- Prepare for newborn support
Increased risk of erbs palsy (arm paralysis), fracture of the clavicle, humerus and femur and dislocation of hips and shoulders
Cord prolapse presentations
Funic presentation = umbilical cord lies in front of the presenting part, the membranes are intact
Overt prolapse = cord lies in front of presenting part and membranes are ruptured
Occult prolapse = cord trapped beside presenting part rather than below
If cord is visible at the vaginal opening after the membrane have ruptured. This should be considered in all women at high risk for cord prolapse
* Malpresentation
* Low birth weight
* Multiple gestation
* Multiparity
* Preterm
* Abnormally long umbilical cord
Cord prolapse treatment
- Do not touch the cord or push the cord back in
- Position appropriate (knee to chest, exaggerated sims)
- Vascular access
- Pain relief
- Antiemetic
- If birth is imminent follow birth skill
Early pregnancy bleeding
Bleeding <20 weeks
Miscarriage = spontaneous loss of pregnancy
Ectopic= extra uterine gestation usually in fallopian tube, rupture usually occurs at 6-10 weeks gestation
- Vaginal bleeding
- Abdominal pain
- Rigid abdomen
- Signs of shock
- Shoulder tip pain
Early loss cannot be prevented, bleeding does not always result in miscarriage. Ectopic should be considered in all sexually active women presenting with any associated features
Treatment of early pregnancy bleeding
- Vascular access
- Fluid therapy
- Pain relief
- Anti emetic
- Record duration, amount, colour, consistency and pattern of blood loss
Ectopic pregnancy
When zygote implants outside the uterus, typically fallopian tube. Can rupture causing major internal haemorrhage
Presentation:
* Abdominal pain
* Vaginal bleeding
* Amenorrhoea
* Palpable mass, syncope, radiating pain to shoulder and neck, non specific GI, tachycardia etc also common
Treatment
- Consider oxygen
- Liaise with obstetric units
- IV access consider wide bore cannula
- Fluid therapy with emphasis on permissive hypotension
- Analgesia
Stages of labour
Stage 1 = start of labour until cervix is fully dilated
Stage 2 = full dilation of the cervix until birth of the baby
Stage 3 = after birth of baby until placenta and membranes have been delivered
Stage 4 = few hours afterbirth
Normal birth
- Increasing frequency and severity of contractions (3-5 contractions in a 10 minute period)
- Urge to push or open bowels
- Bulging perineum/anal pouting
- Crowning/presentation of part of the baby
- Spontaneous rupture of membranes during 1st or 2nd stage of labour
Physiological process by which the fetus, placenta and membranes are expelled through the birth canal. Spontaneous onset between 37 to 42 weeks, process is within acceptable time limits.
Normal birth treatment
- Vascular access
- Pain relief (methoxyflurane)
- Anti emetic
- Do not attempt delivery of Malpresentation unless imminent
- Do not pull cord
- Prepare for newborn support
- First stage = vitals, assess for if birth is imminent
- Newborn = record time, stimulate and allow skin to skin assess APGAR, delay cord clamp
- Third stage =oxytocin, manage haemorrhage as required, transport placenta, keep everyone warm
What does APGAR stand for and what times
Appearance, Pulse, Grimace, Activity, Respiration
1,3,5,10
4 Ts of PPH
Tone
Tissue
Thrombin
Tone
PPH
Defined as >500ml blood loss after child birth, severe >1000ml
Visual estimations usually underestimated, look for clinical signs of poor perfusion
Treatment of PPH
- Keep warm
- Oxygen
- Direct pressure to external haemorrhage visualised
- Encourage skin to skin to trigger uterine contraction
- Fundus uterine massage (contraindicated with placenta still in situ)
- Oxytocin
- Txa
- Fluid resuscitation
- Aortic compression (just under bellybutton)
Pre eclampsia & Eclampsia
Hypertension occurs in 4% of all pregnancies. BP >140/90 severe >170\110. Any elevation 20 above normal may be significant to indicate hypertension/preeclampsia
Gestational hypertension = hypertension >20 weeks
Pre eclampsia = hypertension >20 weeks with one or more signs of organ involvement
Eclampsia = rare condition where hypertension results in seizure
Presentation of eclampsia
- Increasing BP
- Severe headache
- Visual disturbances
- Nausea and vomiting
- Abdominal pain
- Hyper reflexia
- Convulsions / seizures
- Increased bleeding/bruising
- Intrauterine growth restriction
Treatment of eclampsia
- High risk
- Seizures treated as per guideline (midazolam)
- Consult STORC
Pre term labour
Preterm <37 weeks
Presentation:
* Contraction
* Abdominal pain
* Vaginal loss (mucous, blood, fluid)
* Lower back pain
* Pelvic pressure
Not all will progress to actual labour and birth
Extreme prematurity <28 weeks
Treat birth as it presents (normal or breech)
Shoulder dystocia
Anterior should have baby lodges against mother pubic bone and prevents further progress through birth canal.
Presentation:
* Difficulty with birth of face and chin
* Fetal head retracts against perineum “turtle signs”
* Failure of fetal head restitute
* Failure of shoulders to descend
