Obstetrics Emergency Procedures Quiz

Questions and Answers

Which scenario would require active management of pregnancy?

Patient in labor at 38 weeks with fetal distress (correct)

Patient is Rh positive with no concerns

Active bleeding is present with a stable mother

Gestational age is 30 weeks with no bleeding

What is a primary goal of expectant management in pregnancy?

To assess for fetal anomalies through surgery

To terminate the pregnancy

To prolong pregnancy to term without risking the mother's life (correct)

To ensure immediate caesarean section delivery

Which condition is NOT an indication for expectant management?

No active bleeding

Gestational age more than 37 weeks (correct)

Hemodynamically stable mother

Assured fetal condition

Which complication is associated with placenta previa?

Shock and major hemorrhage Signup and view all the answers

What is a characteristic of grade III or IV placenta previa?

Requires a caesarean section by a senior obstetrician Signup and view all the answers

Which factor is important in the management protocol for expectant management?

Correction of anemia through blood transfusions if necessary Signup and view all the answers

What is the primary symptom associated with placenta previa?

Painless recurrent bleeding after 24 weeks Signup and view all the answers

Which classification of placenta previa indicates that the placenta completely covers the cervical os?

Grade IV Signup and view all the answers

What initial vital signs should be assessed in a patient with severe bleeding?

Pulse rate, respiratory rate, temperature, blood pressure Signup and view all the answers

Which of the following is NOT a risk factor for placenta previa?

Consuming a high fiber diet Signup and view all the answers

What is the management step taken after first aid in a case of placenta previa?

Prepare IV fluids and blood products Signup and view all the answers

In the classification of placenta previa, which grades are considered major?

II and IV Signup and view all the answers

What type of ultrasound is preferred for localized assessment of placenta previa?

Transvaginal ultrasound Signup and view all the answers

What should be monitored to assess the severity of bleeding in a patient with placenta previa?

Pallor and general appearance Signup and view all the answers

What should be included in the maternal assessment besides blood pressure and pulse?

Assessment of uterine size and tenderness Signup and view all the answers

At what gestational age should FHR monitoring be commenced if a fetal heart is detected?

26 weeks Signup and view all the answers

Which investigation is crucial for determining the appropriate dose of anti-D in Rh negative women?

Kleihauer test Signup and view all the answers

Which sign would NOT indicate haemodynamic compromise in a maternal assessment?

Increased appetite Signup and view all the answers

What is the initial action to take if a patient presents with severe bleeding?

Consider hospital admission and resuscitation Signup and view all the answers

Which of the following is NOT a common indication for an urgent ultrasound in cases of APH?

To determine fetal heart rate Signup and view all the answers

What does a low fibrinogen level and increased D-dimer suggest in cases of severe bleeding?

Potential disseminated intravascular coagulation (DIC) Signup and view all the answers

Which condition could be ruled out if fetal presenting part is confirmed to be engaged?

Placenta previa Signup and view all the answers

Study Notes

Blood Transfusion and Monitoring

Cross-match at least 4 pints of blood before transfusion.
Monitor vital signs: pulse rate (PR), respiratory rate (RR), temperature, and blood pressure.
Record observations on patient charts.
Replace blood volume with crystalloids or colloids until blood is available.

Urgency of Care

Severe bleeding necessitates urgent delivery.
All instances of vaginal bleeding should be reported to an antenatal care provider.
Emphasis on teamwork involving senior obstetricians, anaesthetists, and neonatologists.

Placenta Previa Overview

Defined as placenta located partly or completely in the lower uterine segment.
Incidence rate: 4 in 1000 pregnancies.

Classification of Placenta Previa

Grade I: Placental edge in the lower segment, not reaching internal os.
Grade II: Placental edge reaches the os but does not cover it.
Grade III: Placenta covers the os incompletely.
Grade IV: Placenta covers the os completely.
Grades I and II are minor; Grades III and IV are major.

Risk Factors for Placenta Previa

Previous uterine surgeries (e.g., cesarean section, myomectomy, curettage).
Previous history of placenta previa.
Multiparity (having multiple births).
Increased maternal age.
Multiple pregnancy.
Smoking.
Presence of submucous fibroids.
Use of assisted reproductive techniques.

Clinical Picture of Placenta Previa

Symptoms:
- Painless, causeless vaginal bleeding after 24 weeks of gestation.
Signs:
- Pallor may indicate severity of bleeding.
- Soft, non-tender uterus; size corresponds to gestational age.
- Possible fetal malpresentation and normal fetal heart sounds.

Management of Placenta Previa

Initial first aid and assessment include IV fluids and preparation of blood.
Ultrasound for placental localization via transabdominal or transvaginal scan; avoid per vaginal examination unless in theatre.
Expectant Management:
- Goal: prolong pregnancy to term without endangering the mother's life.
- Criteria: no active bleeding, hemodynamically stable, gestational age < 37 weeks, reassuring fetal condition, no major fetal anomaly.

Active Management of Placenta Previa

Indicated when active bleeding occurs, the mother is hemodynamically unstable, gestational age > 37 weeks, or there is fetal distress.
Modes of delivery:
- Vaginal delivery can be attempted for grades I & II with minimal bleeding.
- Cesarean section necessary for grades III & IV or severe bleeding.

Complications of Placenta Previa

Maternal:
- Major hemorrhage, trauma leading to shock or death, anemia, and morbidly adherent placenta.
- Risk of RH sensitization and acute renal failure.
Fetal:
- Potential for prematurity, low birth weight, chronic and acute hypoxia, and intrauterine fetal death.

Maternal and Fetal Assessment

Maternal evaluation includes blood pressure, pulse, and signs of circulatory compromise (e.g., cyanosis).
Uterine palpation for size, tenderness, and fetal lie.
Fetal heart rate (FHR) monitoring begins if gestation is estimated at 26 weeks or beyond.

Investigations for Antepartum Hemorrhage (APH)

Complete blood count and blood group with Rh typing.
Cross-match based on estimated blood loss.
Coagulation studies if coagulopathy is suspected.
Kleihauer test for RH-negative women to determine anti-D dosage.
Continuous Cardiotocography (CTG) for fetal well-being monitoring.
Ultrasound for clarity on placental location and to rule out placenta previa.
High vaginal and cervical swabs if infection is suspected.

Management of Antepartum Hemorrhage (APH)

Conduct thorough history and assessment, followed by clinical and management strategies.
Hospital admission for monitoring and management.
Initiate resuscitation for shock or severe bleeding: maintain airways, oxygen supplementation, and circulation through IV lines.
Insert Foley catheter for urine output monitoring and sample blood for further investigations.

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Description

Test your knowledge on critical obstetrics procedures such as blood cross-matching, vital signs monitoring, and management of severe bleeding. Understand the importance of teamwork among specialists and the definitions related to complications like placenta previa. This quiz is essential for health care providers involved in antenatal care.