W03: Obstetric Emergencies

Question 1

Shoulder Dystocia as an emergency

Answer 1

impaction of fetal anterior shoulder behind pubic symphysis after delivering of the head

=>
umbilical cord entrapment
inability for chest expansion
brain dmg dt hypoxia or acidosis with delay
brachial plexus dmg

Question 2

Mgmt of Shoulder Dystocia

Answer 2

HELPER R

Help
Episiotomy?
Legs
Pressure (suprapubic)
Enter manouvers: internal rotation
Remove posterior arm
Roll patient (all fours)

Question 3

P.Partum Haemorrhage as an emergency: causes

Answer 3

TISSUE: retained placenta, placenta accreta, retained products of contraception

TONE:
placenta praevia
overdistension of uterus
uterine relaxants
prev. PPH

THROMBIN:
pre-eclampsia
placental abruption
pyrexia in labour
bleeds. disorders

TRAUMA:
c-sect
episiotomy
macosomia (>4kg baby)

OTHER:
asian ethnicity
anemia
induction
BMI 35+
prolonged labour

Question 4

PPH types

Answer 4

1º = 500ml+ in first 24 hours

Severe = 2000ml

2º = >24hr to up to 6weeks post delivery
* often caused by RPOContraception

Question 5

Mgmt of PPH

Answer 5

ABCDE

Empty bladder

Fundus massage

> oxytocin slow IV injection
ergometrine (CI: high BP)
oxytocin infusion
tranexamic acid
carboprost

Question 6

Sx mgmt of PPH

Answer 6

intrauterine balloon tamponade
interventional radiology
hysterectomy

*manage on clinical signs
* fluid replacement +/- blood products

Question 7

Cord prolapse as an emergency

Answer 7

Descent of u. cord through cervix alongside or PAST the presenting part

+ RUPTURED MEMBRANE

• higher incidence with breech

= compression of u. cord = reduction of o2 supply

Question 8

Cord prolapse RF

Answer 8

Breech
Spontaneous rupture of membranes
Unstable lie
Multiparity
Low birth wt.
Low-lying placenta
Polyhydramnios

Question 9

Cord prolapse types

Answer 9

OCCULT = descends alongside presenting but not beyond (incomplete)

OVERT = descends past, lower in pelvis (complete)

CORD PRES. = u. cord bresenting between fetus and cervix +/- ruptured membranes

Question 10

Mgmt of cord prolapse

Answer 10

• knee chest position
• manual elevation of presenting
  + fill uterus with saline via urinary catheter
• left lateral position = relieve pressure off cord
• TOCOLYSIS = uteral relaxation and stops contractions relieving pressure

> C-Sect delivery