Cord prolapse is often associated with abnormal fetal heart rate tracings due to the compression of the umbilical cord. They can present with fetal heart rate changes, such as variable decelerations with contractions that return to baseline, prolonged or severe decelerations. High suspicion of cord prolapse, with non-reassuring fetal heart…
Definition Cord prolapse is a relatively rare obstetrical emergency, but is associated with neonatal morbidity and mortality. This occurs when the umbilical cord can be felt or seen in or outside the vagina. It can be either between the fetal presenting part and the cervix or alongside the presenting part….
Immediate management Initial management of uterine rupture with hemodynamic instability should involve fluid resuscitation and stabilization and then urgent delivery (cesarean delivery/exploratory laparotomy). Bedside U/S may be utilized to see if there is a large amount of free fluid/blood in the abdomen, but should not delay management if there is…
Early identification of uterine rupture and immediate intervention is key to reducing morbidity and mortality related to uterine rupture. The following are signs/symptoms that may suggest uterine rupture: Maternal signs/symptoms Unstable vitals – Hypotension, tachycardia, decreased LOC Pain– intense abdominal pain that persists between contractions (this may be masked by…
Definition Uterine rupture, the complete separation of all three layers of the uterus (endometrium, myometrium, parametrium) is a life-threatening surgical emergency for both mother and fetus. Most cases of uterine rupture occur in a scarred uterus (i.e previous cesarean section or gynecologic surgical procedures involving entering the myometrium), but can…
Postpartum hemorrhage (PPH): Diagnosis and management.Module by: Margaret Burnett. Learning objectives Recognize the most common causes and list the four “T’s” in the differential diagnosis of acute PPH. Outline a systematic approach to emergency treatment of PPH. List commonly available options for pharmacological management. Perform simple procedural and surgical management. Outline…
Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY. Williams Obstetrics, 25e; 2018. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=1918§ionid=150960110. Leeman L, Spearman M, Rogers R. Repair of Obstetric Perineal Lacerations. Available at: https://calgaryfamilymedicine.ca/residency/dox/container/OBS-RepairOfPerinealLacerations-CurriculumResourcePrereading.pdf. Netter’s Anatomy. Obstetric Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. SOGC Clinical Practice Guideline…
Post-operative care of higher order tears Prophylactic single dose intravenous antibiotics (2nd generation cephalosporin, e.g., cefotetan or cefoxitin) should be administered for the reduction of perineal wound complications following the repair of obstetrical anal sphincter injury. Laxatives (e.g., lactulose) should be prescribed following the primary repair of obstetrical anal sphincter…
Deep vaginal tears Lacerations involving the middle or upper third of the vaginal vault are usually accompanied by injuries to the perineum or cervix and are sometimes missed without a thorough inspection Should prompt you to inspect for cervical lacerations, peritoneal perforation and retroperitoneal hemorrhage Tears extending upward are usually…
Umbilical cord prolapse.Module by: Abigail Lee. Learning objectives Identify the risk factors for umbilical cord prolapse. Recognize the clinical presentation of cord prolapse. Be familiar with the immediate and surgical management of cord prolapse. Topics 2.4.1 Cord prolapse – definition and risk factors 2.4.2 Clinical presentation 2.4.3 Immediate and surgical…