Obstetric Emergencies ppt

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Questions and Answers

What is the most immediate management step for uterine inversion during the third stage of labor?

Administer oxytocin

Start prophylactic antibiotics

Push the uterus back into the abdominal cavity (correct)

Perform a hysterectomy

Which of the following is NOT a common cause of uterine inversion?

Excessive fundal pressure

Dehydration during pregnancy (correct)

Excessive traction on the umbilical cord

Uterine atony

Which laboratory test is most relevant for evaluating a patient suspected of having consumptive coagulopathy?

Liver function tests

Complete blood count

Fibrinogen level (correct)

Blood glucose level

What is the incidence of uterine inversion, and how does it relate to maternal morbidity?

1 in 20,000 deliveries; high morbidity Signup and view all the answers

What is the recommended approach for addressing rapid progressive enlargement of a hematoma?

Incision and drainage of the hematoma Signup and view all the answers

What is the significance of normal FHR variability in the context of fetal well-being?

It provides reassurance about fetal status and the absence of metabolic acidemia. Signup and view all the answers

In a Non-Stress Test, what is considered a reactive outcome?

Two accelerations in fetal heart rate within a 20-minute period. Signup and view all the answers

Which of the following conditions is NOT commonly indicated for electronic fetal monitoring?

Routine prenatal check-up Signup and view all the answers

What is the purpose of the Biophysical Profile in fetal assessment?

To assess how the fetus is doing over time and currently. Signup and view all the answers

A Biophysical Profile score of 4 or less indicates what action?

Need for further testing and consideration of labor induction or C-section. Signup and view all the answers

What does a normal response of the fetus in a Non-Stress Test suggest?

Well-functioning autonomic nervous system without impairment. Signup and view all the answers

Which of the following is NOT a component measured in the Biophysical Profile?

Fetal heart rate monitoring. Signup and view all the answers

What indicates a low score (between 6 and 8) in a Biophysical Profile?

You should repeat the test in the next 12 to 24 hours. Signup and view all the answers

What is the most common cause of postpartum hemorrhage?

Uterine atony Signup and view all the answers

Which of the following is NOT a risk factor for postpartum hemorrhage?

Low maternal age Signup and view all the answers

Which procedure involves placing direct pressure on the bleeding site during postpartum hemorrhage management?

Bakari Balloon Signup and view all the answers

What is the maximum blood loss defined for postpartum hemorrhage following a vaginal delivery?

500 mL Signup and view all the answers

Which of the following medications is contraindicated in hypertensive patients when treating uterine atony?

Methylergonovine (Methergine) Signup and view all the answers

What is the initial management step for suspected uterine atony?

Uterine Massage Signup and view all the answers

Which is a key sign of uterine atony?

Soft and boggy uterus Signup and view all the answers

In the context of postpartum hemorrhage, what do the 'Four T’s' refer to?

Tone, Tissue, Trauma, Thrombin Signup and view all the answers

Which condition is characterized by signs of labial or pelvic pressure and vital sign deterioration following delivery?

Vulvar hematoma Signup and view all the answers

What is the incidence range of postpartum hemorrhage among deliveries?

3-5% Signup and view all the answers

What is the primary concern associated with umbilical cord prolapse during delivery?

Decreased or stopped blood flow through the umbilical cord Signup and view all the answers

Which of the following maneuvers is NOT typically used to address shoulder dystocia?

Bishop score assessment Signup and view all the answers

What is a key characteristic of placenta previa?

Bleeding often subsides if labor does not begin. Signup and view all the answers

What is the recommended delivery method when vasa previa is diagnosed?

Planned emergency cesarean section Signup and view all the answers

Which of the following factors increases the risk of placental abruption?

Cocaine abuse Signup and view all the answers

What does an absence of the decidua layer indicate in cases of placenta accreta spectrum?

Abnormal trophoblast invasion Signup and view all the answers

Which symptom is NOT typically associated with uterine rupture?

Immediate delivery of the placenta Signup and view all the answers

What is the most significant fetal consequence of placental abruption?

Fetal hypoxia Signup and view all the answers

What is a common clinical presentation indicating placental abruption?

Vaginal bleeding with abdominal pain Signup and view all the answers

During which condition is hyperstimulation with oxytocin a risk factor?

Uterine rupture Signup and view all the answers

Which approach is indicated for managing a case of shoulder dystocia?

Application of suprapubic pressure Signup and view all the answers

Which factor requires the use of transvaginal ultrasound for more accuracy when diagnosing placenta previa?

Uncertain placental location Signup and view all the answers

What is the recommended management for a patient with suspected placenta accreta?

Planned cesarean delivery with possible hysterectomy Signup and view all the answers

Which symptom indicates potential fetal distress due to placental issues?

Non-reassuring fetal heart rate tracing Signup and view all the answers

What constitutes a reactive Non-Stress Test outcome in a fetus aged 32 weeks or older?

Two accelerations of 15 beats or more per minute for at least 15 seconds within 20 minutes Signup and view all the answers

Which criterion is assessed in a Biophysical Profile to evaluate the fetus's health?

Fetal breathing movements Signup and view all the answers

What is the significance of normal fetal heart rate (FHR) variability?

Provides reassurance about the absence of fetal metabolic compromise Signup and view all the answers

In the context of fetal assessments, what follow-up is indicated for a Biophysical Profile score between 6 and 8?

Repeat the test in 12 to 24 hours Signup and view all the answers

Which condition is NOT typically an indication for Electronic Fetal Monitoring (EFM)?

Routine prenatal check-up without risk factors Signup and view all the answers

Study Notes

Assessment of Fetal Well-Being

Electronic Fetal Monitoring (EFM): Used to assess fetal oxygenation.
Fetal Heart Rate (FHR) Variability: Normal variability indicates fetus is likely well-oxygenated and without metabolic acidosis.
Common Indications for EFM and Testing: Diabetes, hypertension, fetal growth restriction, multiple gestation, post-term pregnancy, decreased fetal movement, systemic lupus erythematosus, oligohydramnios/polyhydramnios, alloimmunization, prior fetal demise, preterm rupture of membranes.
Types of Testing: Fetal kick counts, serial growth sonograms (every 3-4 weeks), umbilical artery Doppler assessment, non-stress test (NST), biophysical profile (BPP), modified BPP (NST + amniotic fluid index).

Non-Stress Test (NST)

Reactive NST: Two or more FHR accelerations of 15 bpm or more above baseline for at least 15 seconds in a 20-minute period, indicating the fetus is healthy.
Non-Reactive NST: No accelerations in the 20-minute period, suggesting non-reassuring fetal status requiring additional testing.

Biophysical Profile (BPP)

Assess Fetal Well-being: Evaluates factors reflecting fetal well-being and status over time, including NST, fetal tone, fetal breathing movements, fetal body movements, and amniotic fluid.
Scoring and Interpretation:
- Normal (8-10): Healthy fetus, continue usual pregnancy care.
- Low (6-8): Repeat the test in 12-24 hours.
- Abnormal (4 or less): Indicate fetal distress, requiring further testing, possible induction, or cesarean section

Intrapartum Emergencies

Umbilical Cord Prolapse

Definition: Umbilical cord is positioned between the presenting part and cervix.
Cause: Cord compression results in decreased/absent blood flow.
Risk Factors: Premature rupture of membranes before fetal head engagement, breech presentation.

Shoulder Dystocia

Definition: Failure to deliver fetal shoulders despite downward traction on fetal head.
Causes: Obstruction of anterior shoulder by symphysis pubis, impaction of posterior shoulder on maternal sacral promontory, increased resistance between fetus and vaginal walls.
Maneuvers: Episiotomy, McRoberts maneuver (hip hyperflexion and abduction), suprapubic pressure, delivery of posterior shoulder and arm, use of Woods screw, Rubin maneuver, Gaskin maneuver, Zavanelli maneuver (if required, emergency C-section).
Risk Factors: macrosomia (large baby), diabetes

Placenta Previa

Diagnostic Timing: Routinely found by ultrasound during anatomy scan (~20 weeks); rechecked around 28 weeks, or as needed.
Characteristics: Typically painless bleeding; bleeding frequently subsides if no labor; no digital exam.
Management: Ultrasound to identify placental location (transvaginal may be more accurate) if unsure. Speculum exam to evaluate vaginal bleeding but NOT a digital cervical exam. Delivery by planned cesarean section around 36-38 weeks.

Vasa Previa

Definition: Umbilical vessels cross the internal os (opening of the cervix).
Severity: High perinatal mortality rate (50%) with vaginal delivery.
Management: Urgent planned cesarean section.

Abnormal Placental Implantation (Placenta Accreta Spectrum)

Definition: Abnormal placental trophoblast invasion into the myometrium (uterine muscle).
Types: Accreta (superficial invasion), increta (deep invasion), percreta (invasion through the uterine wall).
Risk Factors: Prior uterine surgery or curettage, placenta previa

Placental Abruption

Definition: Premature separation of placenta after 20 weeks' gestation.
Types: Total or partial.
Causes: Bleeding between uterine lining and placental maternal side.
Risk Factors: Maternal hypertension, smoking, maternal age/parity, cocaine abuse, prior placental abruption, Preeclampsia, multiple gestation, preterm premature rupture of membranes, polyhydramnios.
Fetal Consequences: Hypoxia (reduced oxygen), maternal hypotension, reduced placental surface area.
Clinical Presentation: Vaginal bleeding, abdominal pain, tachysystole (frequent contractions,), non-reassuring fetal heart rate, concealed bleeding (amount of bleeding may not reflect severity).

Uterine Rupture

Definition: Complete tear of all uterine layers.
Incidence: ~1-2% after low transverse incisions, ~3% after classical incisions.
Risk Factors: Prior cesarean section or other uterine surgery, oxytocin hyperstimulation, trauma, prior pregnancies.
Symptoms: Vaginal bleeding, abdominal tenderness, tachycardia abnormal fetal heart rate, cessation of uterine contractions, loss of fetal station, decreased/absent contractions.
Management: Emergency surgical intervention.

Postpartum Hemorrhage (PPH)

Definition: Excessive blood loss after vaginal delivery (>500 mL) or cesarean delivery (>1000 mL).
Incidence: ~3-5% of deliveries.
Types: Primary (within 24 hours), secondary (24 hours to 12 weeks postpartum).
Risk factors: Prolonged labor, chorioamnionitis, preeclampsia, uterine atony.
Causes (Four T's): Uterine atony, retained placenta/membranes, trauma, coagulopathy
Prevention: Active management of the third stage of labor, oxytocin after delivery, uterine massage, gentle cord traction.
Recognition: Estimate post-delivery blood loss (visual vs. quantitative), monitor for hypotension, tachycardia, or pain; rule out intra-abdominal blood loss.

Management of Uterine Atony

Medications: Oxytocin, Methylergonovine (Methergine), prostaglandin F2α analogue (Hemabate), Misoprostol (Cytotec), Tranexamic Acid (Lysteda)
Procedures: Bakri balloon, B-Lynch suture, uterine artery embolization.

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Description

This quiz covers key concepts related to the assessment of fetal well-being using electronic fetal monitoring (EFM) and various tests such as the non-stress test (NST) and biophysical profile (BPP). Participants will learn about fetal heart rate variability, common indications for testing, and the interpretation of test results. Ideal for medical students and healthcare professionals focused on obstetrics.