Obs emergencies

Question 1

6 important energencies

Answer 1

1. antepartum hemm
2. uterine rupture
3. uterine inversion
4. shoulder dystocia
5. cord prolapse
6. amniotic fluid embolism

Question 2

5 causes of antepartum hemmorage

Answer 2

1. placenta previa - PAINLESS vag. bleed
2. abruptio placenta - premature separation or normally implanted placenta - bleed and PAIN
3. Vasa previa - FETAL vessels that cross membranes located in lower uterine segment in advance of fetal part - not protected
4. LUTS lesions
5. unclassified

Question 3

what to always give in hemmorage

Answer 3

Rh Ig if Rh neg.

Question 4

findings in uterine rupture

Answer 4

• fetal brady
• severe abdo pain
• vaginal bleed
• loss of presenting part
• intraabdo hemmorage
• hypovolemic shock

Question 5

causes of rupture

Answer 5

• uterine scar
• excessive contradindications
• trauma
• spontaneous

Question 6

mgmt of rupture

Answer 6

1. stabilize mom
2. treat hypovolemia
3. call for help
4. emerg. laparotomy

Question 7

def. uterine inversion

Answer 7

fundus below os

Question 8

3 causes of inversion

Answer 8

1. excessive cord traction
2. fundal pressure
3. placenta accreta

Question 9

mgmt of inversion

Answer 9

• uterine punch
• stabilize mom
• call for help

Question 10

def. shoulder dystocia

Answer 10

impaction of anterior shoulder above symphysis in the AP diameter to remainder of body cannot be delivered in normal manner

Question 11

risks for shoulder dystocia

Answer 11

• port term
• mat. obesity
• fetal macrosomia
• previous dystocia
• operative vag. deliv.
• prolonged labor
• poorly controlled DM - fat shoulder

Question 12

maternal and fetal complications of dystocia

Answer 12

maternal - hemmorhage
fetal - 
- birth trauma
- fractures
- brachial plexus palsy
- hypoxic ischemia
- death

Question 13

what to do in dystocia

Answer 13

(ALARMER)
A-ask for help
L - lift, hyperflex legs
A - anterior shoulder disimpaction
R -rotation of post. shoulder
M -manual delivery of post. arm
E- episiotimy
R - roll over on all fours

Question 14

3 options if nothing works

Answer 14

1. fratcure clavicle
2. symphysiotomy
3. zavanelli - push head back in and CS

Question 15

4 things NOT to do

Answer 15

1. pull on head
2. push on fundus
3. panic
4. pivot

Question 16

how to assess viability in cord prolapse

Answer 16

feel for pulsations - if none- not viable

Question 17

what to do for cord prolapse

Answer 17

push back into vagina and elevate pressure on it

Question 18

risks for cord prolapse

Answer 18

• malpresentation
• premat.
• multipreg
• polyhydram
• premature membrane rupture
• placenta previa
• high presenting part

Question 19

what is perinatal mortality assoc. with amnitoic fluid embolism

Answer 19

9-44%

Question 20

def. AFE

Answer 20

presence of amniotic debris in maternal lungs

Question 21

risks for AFE

Answer 21

• old mom
• CS
• assissted deliv.
• placenta previa
• placental abruptions
• eclampsia
• fetal distress
• polyhydramnio
• cervical laceration

Question 22

impact of AFE in dev. counties

Answer 22

5-15% of all mat. deaths

Question 23

what is patho of AFE

Answer 23

breach of the barrier between maternal and fetal compatments with a pressure gradient

Question 24

3 most common presenting sign of AFE

Answer 24

1. profound hypotension
2. cyanosis, dyspnea, resp arrest
3. hemm. /DIC

Question 25

commonly reported Sx in women with AFE

Answer 25

1. breathlessness 2. chest pain 3. coldness 4. light headed 5. panic 6/ N/V

Question 26

3 basic directives of obs. emergencies

Answer 26

1. rapid init. and continuation of o2 2. circ. support 3. correct coagulopathy