Peripartum care and Obstetric emergencies Flashcards Preview

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Flashcards in Peripartum care and Obstetric emergencies Deck (28):

Immediate management of intrauterine fetal death?

Immediate delivery to avoid sepsis/DIC
- IOL with mifepristone (antiprogestrogen)
- 48h later give misoprostol (prostaglandin analogue)
- adequate analgesia is essential
pt can go home temporarily after mifepristone to avoid stress of being on antenatal/postnatal ward :(
see bereavement midwife asap to discuss loss and burial/cremation plans


Possible maternal causes of intrauterine death?

- diabetes
- infection e.g. parvovirus, listeria
- thrombophilia


Possible fetal causes of intrauterine death?

- chromosomal abnormality
- other genetic abnormality
- haemolytic disease
- cord incident


Possible placental causes of intrauterine death?

- placental abruption
- uteroplacental insufficiency (e.g. secondary to pre-eclampsia)
- postmaturity


Fetal investigations after intrauterine death?

- swabs for mc&s from fetus and placenta
- skin biopsy for karotype :(
- post mortem if agreed by parents


Define a "late deceleration"

A reduction in fetal heart rate from baseline of at least 15 beats for at least 15s


Resuscitation plan for mother after suspected amniotic fluid embolism?

- insertion of 2 large-bore IV cannulae
- request FBC, U&E, clotting profile, fibrin-degradation products
- crossmatch 6 units of blood and have platelets and fresh-frozen plasma available
- 100% oxygen by bag and mask initially with intubation by anaesthetist asap
- volume expansion with colloid fluids
- transfer to ITU asap


When does secondary PPH occur?

Occurs between 24h and 6 weeks following delivery


Common causes of PPH?

- retained placental tissue
- vaginal trauma
- endometrial infection
- uterine atony
- coagulopathy e.g. following placental abruption


Features of uterine rupture?

- constant apin
- vaginal bleeding
- sudden loss of contractions
- change in CTG
- easy palpation of fetal parts
- haematuria


Causes of fetal bradycardia?

- placental abruption
- uterine rupture
- maternal hypotension (post epidural insertion)
- bleeding vaso praevia


Maternal risk factors for premature labour?

- hx of premature delivery
- young maternal age
- illegal drug use and smoking
- chorioamnionitis
- pre-eclampsia
- polyhydramnios
- sepsis
- previous cervical surgery/ cervical incompetence


Fetal risk factors for premature labour?

- congenital abnormality
- multiple pregnancy


Name a tocolytic drug?

nifedipine, atosiban


What are tocolytic drugs used for in pregnancy?

Delay labour


Risk factors for shoulder dystocia?

- estimated fetal weight >4.5kg
- previous big baby >4kg
- previous shoulder dystocia
- slow progress in the first and/or second stage of labour
- post dates delivery


Complications of shoulder dystocia?

- perinatal mortality
- hypoxic encephalopathy
- brachial plexus injury (Erb's palsy)
- maternal PPH
- 3rd or 4th degree tear


Prevalence of shoulder dystocia?

1 in 200 deliveries


Causes and risk factors for PPH:

- uterine atony (multiple pregnancy, grand multiparity, polyhydramnios, prolonged labour)
- uterine sepsis - chorioamnionitis
- retained placenta
- lower genital tract trauma - perineal or cervical tears
- coagulopathy - heparin treatment, inherited bleeding disorders
- previous PPH


How much should the cervix dilate per hour once labour is established?



What monitoring do you do in low-risk labour?

- hourly BP
- hourly HR
- 4 hourly examinations for cervical dilatation
- assessment for meconium


How often do you assess the fetus during labour?

Auscultate for 1 min after a contraction at least every 15 min in first stage of labour
Auscultate for 1 min after a contraction every 5 min in the second stage of labour


What results would you see in investigations for disseminated intravascular coagulopathy (DIC)?

- increased INR
- decreased platelets
- positive D-dimer test


Initial basic procedures to resuscitate the mother during APH?

- insert 2 large bore venous cannulae
- crossmatch 6 units of blood
- request fresh frozen plasma and platelets
- initial fluid resuscitation with IV fluids - colloid
- insert urinary catheter to monitor UO


Why do you keep women on a syntocinon infusion post delivery?

To prevent PPH secondary to uterine atony


Risk factors of 3rd degree tears?

- birthweight >4kg
- persistent OP position
- nulliparity
- induction of labour
- epidural
- second stage of labour lasting more than 1h
- episiotomy
- forceps delivery


How long should anticoagulation be continued post-natally?

6 weeks - 3 months


Risk factors for cord prolapse

- polyhydramnios
- preterm delivery
- malpresentation
- unstable presentation
- multiple pregnancy