Cambridge University Press 978-1-108-79093-2 — Obstetric and Intrapartum Emergencies 2Nd Edition Index More Information

Cambridge University Press 978-1-108-79093-2 — Obstetric and Intrapartum Emergencies 2nd Edition Index More Information

Index

acute hepatitis and abdominal pain, maternal collapse and, 11, 141, A,B,C (airway, breathing, CPR) – resuscitation for maternal 173 144 145 collapse, 14 acute intrapartum hypoxia, 82 morbidity and mortality, 47 abdominal pain in pregnancy acute pancreatitis and abdominal pain, second-line management acute urinary retention, 169 173 diagnosis, 49 acute polyhydramnios and abdominal reporting documentation, 49 background of, 168 – complications pain, 170 171 transfer to intensive care unit, 49 acute cholecystitis, 172 acute puerperal uterine inversion symptoms and signs, 48 aetiology, 133 anaphylaxis acute chorioamnionitis, 171 fi fi acute fatty liver of pregnancy classi cation, 134 classi cation, 247 defined, 133 clinical presentation, 247 (AFLP), 172 – acute polyhydramnios, 170–171 implications, 133 134 clinical reactions, 247 incidence of, 133 defined, 246–247 causes of, 174 – causes unrelated to pregnancy, key concepts, 137 138 pathophysiology of, 247 173 key pitfalls, 137 anaphylaxis in pregnancy key pointers for, 134 aetiology, 248 clinical investigation, 173 – HELLP syndrome, 171–172 mortality rate, 133 caesarean section delivery, 248 249 – recent developments, 137 consequences of, 249 key concepts, 173 176 ff management algorithm, 175 recurrence of, 137 di erential diagnosis, 248 placental abruption, 170 acute puerperal uterine inversion general anaesthesia, 249 management incidence of, 248 pregnancy conditions that could – cause, 172 general anaesthesia, 136 137 labour timing, 248 rectus abdominis rupture, 172 hysterectomy for, 137 management, 249 sepsis, 171 key actions, 134 maternal collapse and, 12, 141, 145 symphysis pubis diasthesis, 172 non-surgical uterus repositioning, neuraxial anaesthesia, 249 135–136 seriousness of, 247–248 topographical guide to, 174 – urinary tract infections, 172 shock management, 134 135 antepartum haemorrhage surgical uterus repositioning, 137 aetiology, 36–37 uterine scar dehiscence, 171 ’ fi uterine torsion, 171 Addison s disease de ned, 35 ectopic pregnancy and, 169 background of, 226 perinatal mortality, 35 fi clinical investigation, 226 placental abruption, 37 broids and, 170 – gastritis and, 170 key concepts, 226 227 anterior shoulder dystocia, 86 hyperemesis gravidarum, 170 management, 227 anticoagulants implications, 168 adrenal system during pregnancy, 3 implications for VTE, 17 miscarriage and, 168–169 adverse drug reactions. See also drug during lVTE VTE labour and overdose in pregnancy delivery, 23 musculoskeletal causes, 169 fi ovarian cysts and, 169 de ned, 249 VTE postnatal, 23 ovarian hyperstimulation syndrome incidence of, 250 aortocaval compression resuscitation, amniotic fluid embolism (AFE) 10 (OHSS), 170 fi ruptured rudimentary horn, 170 de ned, 47 appendicitis first-line management abdominal pain, 173 absence seizures, 207 – – acute abdomen, 168 fetus delivery, 48 49 pregnancy clinical practice, 5 7 acute adrenal insufficiency, 226 hypotension and coagulopathy arrhythmias types, 159 correction, 48 arterio-venous occlusions, 181 acute appendicitis abdominal pain, 173 – acute cholecystitis, 172 resuscitation, 48 assertiveness in obstetrics, 303 304 acute chorioamnionitis abdominal implications of, 47 asthma in pregnancy, 4 pain, 171 incidence of, 47 atony, 139 key concepts, 47–48, 50 atypical sinusoidal pattern (CTG), 80 acute fatty liver of pregnancy (AFLP), – 172 key pitfalls, 49 50 atypical variable deceleration, 81 327

Index

Bakri balloon, 137 management algorithm in upright cardiotocograph (CTG) interpretation baroreceptors (CTG), 81 position, 130 algorithm, 79, 83 blood circulation volume and maternal undiagnosed, 128–129 baseline fetal heart rate, 78–80 resuscitation, 11 predisposing factors for, 56 baseline heart rate accelerations, 80 blood gases during pregnancy, 2 types of, 56 baseline heart rate decelerations, blood pressure Burns Marshall technique, 60, 61 80–81 preeclampsia and eclampsia baseline heart rate variability, 80 measurement, 26–27 caesarean section. See also crash basics, 78 during pregnancy, 2 caesarean section contractions, 82 blood pressure control for pregnancy algorithm for degree of difficulty in fetal monitoring checklist, 84 hypertension delivery, 118 cardiovascular system in pregnancy post delivery, 31 anaphylaxis and, 248–249 blood pressure, 2 severe, 30–31 complications ECG, 2 blood transfusion bladder injury, 117 heart, 1 incidence of, 245 bleeding management, 116 cauda equina syndrome reactions bowel injury, 116, 117–119 background of, 214 early, 245–246 extension of lower segment diagnosis, 214–215 late, 246 uterine incision, 117 implications, 214 risk factors for haemorrhage, 245 fetal, 116 key pointers for, 214 blood volume during pregnancy, 1 fetal injury, 116 management blunt trauma, 252 inferior epigastric vessel key actions, 215 breathlessness in pregnancy injury, 117 low-resource center, 215 classification, 165 key concepts, 119 surgical options, 215 clinical investigation, 166 key pitfalls, 119 central serous retinopathy, 180 defined, 164 maternal, 116 chemoreceptors (CTG), 81 diagnosis, 164 medico-legal, 116 chronic intrapartum hypoxia, 83–84 implications, 164 omental vessel injury, 117 CIPHER model, 28 incidence of, 164 thrombin, 117 closed loop communication, 302 key actions, 164–165 unexpected bleeding, 116 coagulability during pregnancy, 1 key concepts, 166–167 upper abdominal bleeding, 117 communication in obstetrics key pitfalls, 166 visceral organ injury, 116 closed loop, 302 key pointers to specific conditions, defined, 107–108 importance of, 301 164, 165 incidence of, 108 SBAR tool, 301 management, 165–166 MBRRACE, 316 complicated variable deceleration, 81 types of, 164 mortality from, 109 constipation in pregnancy, 4–5 breech presentation perimortem cord prolapse in midwife-led delivery contraindications, 58 anaesthesia for, 280–281 management, 126 defined, 56 implications, 279–280 types and risk factors for, 125–126 delivery key concepts, 281 corneal changes general principles key pitfalls, 281 management, 179 for, 58–59 performing rapid, 280 vision blurring/loss in pregnancy, head, 60–61 postmortem, 280 physiological changes, 179 legs and buttocks, 59–60 cardiac arrest in pregnancy crash caesarean section; see also trunk and shoulders, 60 chest compressions for, 279 caesarean section delivery complications delivery timing, 256 benefits of, 108 caesarean section, 63 fetal assessment, 256 defined, 108 entrapped fetal head, 62 imaging modalities, 257 delivery difficulties, 113 summary of, 61–62 incidence of, 279 fetal risk factors for, 109 twins, 63 key concepts, 257 incidence of, 108 umbilical cord prolapse, 62 resuscitation of newborn, 280 key pointers for, 109 implications, 56–58 secondary survey, 256–257 low-resource center management, incidence of, 56 cardiac conditions and maternal 114–115 key concepts, 58, 63–65 collapse, 142, 145 maternal risk factors for, 108–109 key pitfalls, 63 cardiac disease and maternal collapse, MEOWS chart, 114 management options, 58, 64 11–12 perimortem, 114 in midwife-led delivery cardiotocograph (CTG) perioperative management, 110–112 key actions to improve outcomes, changes during vaginal delivery, 84 placenta delivery, 113–114 129 complexogram, 77 postnatal debrief, 114 management algorithm in fetal compromise and, 76 surgical techniques, 112–113 lithotomy position, 130 guidelines, 84 cycling (CTG), 80

328

Index

damage control resuscitation (DCR), Each Baby Counts initiative (EBC) episiotomy 254 key concepts, 318 perineal trauma and, 153 deep vein thrombosis (DVT) key findings, 317–318 repair, 155 classification, 17 reasons for, 317 Escherichia coli and sepsis, 44 confirmation of, 20 early neonatal deaths, 317 exaggerated Sim’s position, 128 defined, 17 eclampsia extended breech presentation, 56 IVC shunt, 23 accurate vital signs measurement, extended perinatal death treatment of acute, 21 26–27 defined, 317 diabetic ketoacidosis (DKA) defined, 26 rate of, 317 defined, 200 epidemiology, 26 diagnosis in pregnancy, 201–202 maternal collapse and, 12, 140, 144 Faber/Patrick’s test, 214 key pointers for, 200 in midwife-led delivery, 127–128 fetal growth restriction in pre- management prevention and treatment, 31 eclampsia, 28 fluid monitoring, 202–203 ectopic pregnancy and abdominal fetal-maternal haemorrhage infusion and blood glucose pain, 169 key pitfalls, 258 monitoring, 203–204 electrocardiogram (ECG) during occurrence of, 257–258 key pointers for, 204–206 pregnancy, 2 fetal monitoring checklist (CTG), 84 potassium and electrolytes, 203 emergency caesarean section. see crash fibrinolysis during pregnancy, 1 occurrence of, 200 caesarean section fibroids and abdominal pain, 170 pathophysiology of, 200–201 endocrine emergencies during Finkelstien’s test, 214 severe, 202 pregnancy first-line SPR manoeuvre, 87–89 symptoms and signs, 201 acute adrenal insufficiency, 226 flexed breech presentation, 56 diabetic retinopathy Addison’s disease, 226–227 flexion point principle, 102–103 non-proliferative, 181 hypopituitarism, 227 fluid overload proliferative, 181–182 lymphocytic hypophysitis, 227–228 clinical presentation, 240 dizygotic twins myxedema coma, 224–225 defined, 239 defined, 92 phaeochromocytoma, 225 incidence of, 239 incidence of, 92 Sheehan’s syndrome, 228–229 low-resource center management, drug overdose in pregnancy; see also thyroid storm, 221–224 242 adverse drug reactions endocrine system during pregnancy management, 240–241 adverse outcomes and, 191 adrenal, 3 risk factors for, 239–240 beta-blockers, 197–198 clinical practice, 4 fluid underload calcium channel blocking, 197 glucose metabolism, 3 case study, 242–243 diagnosis, 191 pituitary, 3 clinical presentation, 241 digoxin poisoning, 196–197 thyroid, 3 defined, 239 hypoglycaemia, 195 epilepsy incidence of, 241 implications, 191 clinical examination of pregnant low-resource center management, iron overdose, 198–199 woman with seizure evidence, 242 management 209 management, 241–242 aspirin, 195 clinical practice, 4 risk factors for, 241 cardiac life support, 191–193 defined, 207 focal seizures, 207 extracorporeal drug removal, 199 diagnosis, 208–209 footing breech presentation, 56 give antidote, 193–194 implications, 207–208 forceps patient assessment and incidence of, 207 breech presentation delivery, 61 stabilisation, 191 key concepts, 210–212 delivery, 101–102 recent developments, 199 key pitfalls, 210 Piper’s, 62 risk assessment, 193 management procedure, 99–100 supportive care, 199 drug treatment, 210, 212 fractures during pregnancy maternal collapse and, 12, 145 immediately after seizure, background of, 217 most common drugs, 191, 192 209–210 compartment syndrome, 217 physiological changes and, 191 low-resource center, 212–213 diagnosis, 218 reversible cause for maternal during seizure, 209 DVT, 217 collapse, 13 status epilepticus, 210 hip dislocation, 219 risk timing, 191 maternal collapse and, 12, 142, 145 key concepts, 218 suicide rates, 191 occurrence of, 207 leg cramps, 217 sulphonylureas, 194–195 risk factors for seizures, 208 management tricyclic antidepressants (TCAs), seizure types low-resource center, 219 196 absence, 207 options, 218–219 dyspnoea. See breathlessness in focal, 207 fullPIERS model for pre-eclampsia, pregnancy generalised, 207 27–28 329

Index

gall bladder in pregnancy, 4 key concepts, 161–162 indicated preterm birth, 283 gastritis and abdominal pain, 170 key pitfalls, 161 inferior vena cava shunt gastrointestinal system during key pointers for, 160 (IVC), 23 pregnancy, 2 management algorithm, 162 instrumental vaginal delivery general anaesthesia; see also intubation heart rate decelerations according to complications, 104–105 failure in general anaesthesia parasympathetic receptor defined, 98 acute puerperal uterine inversion baroreceptors, 81 diagnosis, 99–100 management, 136–137 chemoreceptors, 81 failure anaphylaxis and, 249 heart rate decelerations according to complications after, 293 generalised seizures, 207 uterine contractions defined, 292 glucose metabolism during pregnancy, early, 80 determinants of, 292 3 late, 81 emergency caesarean section after, glycosuria in pregnancy, 7 prolonged, 81 292 Golden Hour antibiotics, 45 variable, 81 implications, 292 gradually evolving intrapartum HELPERRS procedure, 123 incidence of, 292 hypoxia, 82–83 high myopia in pregnancy, 182–183 risk factors for, 292 Graves eye disease, 182 hip dislocation FID scoring, 294 diagnosis, 219 flexion point principle, 102–103 haematology changes during key concepts, 219 forceps, 292 pregnancy management, 219 forceps delivery, 101–102 blood volume, 1 human factors in obstetrics implications, 98 coagulation and fibrinolysis, 1 debrief, 298 incidence of, 98 platelets, 1 high reliability organisations, 298 key pitfalls, 105 red blood cell volume, 1 importance of, 297 key pointers for, 98–99 haemolysis, elevated liver enzymes and non-technical skills low-resource center management, low platelets (HELLP), 171–172 assertiveness, 303–304 105 haemorrhage communication, 301–302 management, 100–101 3E’s after every obstetric emergency, HALTS potential performance maternal morbidity from, 293–294 41 issues, 304 prerequisites for, 293 aetiology, 35 leadership, 302–303 training and assessment, 105–106 blood transfusion and, 245 online resources, 304–305 trial of, 294 clinical practice, 4 situational awareness, 298–301 types and classification, 98 clinical presentation, 38 stress, 303 ultrasound fetal head position defined, 35 summary of, 299 before, 104 female maternal, 257–259 tiredness and fatigue, 304 ventouse delivery, 102 key concepts, 37, 41–42 WORM classification, 297–298 intestinal obstruction and abdominal key pitfalls, 41 Huntingdon’s operation, 137 pain, 173 management hydrostatic reduction, 136 intracerebral tumours and haemostasis, 35, 36, 37 hyperemesis gravidarum and vision, 182 implications, 35–36 abdominal pain, 170 intracranial haemorrhage and key actions, 38 hyperkalaemia maternal collapse, 12 steps, 35, 36 blood transfusion and, 246 intrapartum haemorrhage maternal collapse and, 11, 142–144 reversible cause for maternal aetiology, 37 and placenta praevia, 35, 38 collapse, 13 defined, 35 risk factors for, 38 hyperpigmentation during pregnancy, 3 perinatal mortality, 35 trauma and, 254–255 hyperstimulation (CTG), 82 intrapartum hypoxia types, 35 hypopituitarism CTG interpretation, 78–82 haemostasis aetiology, 227 fetal compromise, 76 haemorrhage steps, 35, 36, 37 clinical presentation, 227 implications, 76–77 postpartum haemorrhage, 38–41 diagnosis, 227 indications for, 78 Haultain’s operation, 137 pre-existing, 228 key concepts, 84 heart changes during pregnancy, 1 hypothermia key pitfalls, 84 heart palpitations during pregnancy blood transfusion and, 246 key pointers for, 77 arrhythmias and, 159 reversible cause for maternal types background of, 159 collapse, 13 acute, 82 causes of, 159 therapeutic, 269 chronic, 83–84 clinical investigation, 160–161 hypovolaemia and maternal collapse, 13 gradually evolving, 82–83 defined, 159 hypoxia and maternal collapse, 13 subacute, 82 diagnosis, 161 hysterectomy, acute puerperal uterine intubation difficulties and maternal implications, 159–160 inversion, 137 resuscitation, 11

330

Index

intubation failure in general resuscitation for maternal collapse, thyroid storm, 221 anaesthesia; see also general 14–15 trauma, 252 anaesthesia retained placenta, 151 Mothers and Babies: Reducing Risk defined, 231 risk management in obstetrics, 326 through Audits and diagnosis, 232–233, 236 shoulder dystocia, 90 Confidential Enquiries implications, 231–232 symphysis pubis diasthesis (SPD), (MBRRACE) incidence of, 231 216–217 caesarean section and, 316 key actions, 236–237 trauma, 258, 259 key concepts, 318 key concepts, 237 twin delivery, 96 mortality rate, 2014–2016, 315–316 key pitfalls, 237 umbilical cord prolapse, 70–71 placenta praevia, 316 key pointers for, 232 VTE, 24–25 musculoskeletal system management lung function changes and maternal abdominal pain in pregnancy, 169 equipment and preparation, 234 collapse resuscitation, 10–11 cauda equina syndrome, 214–215 low-resource center, 237 lymphocytic hypophysitis, 227–228 changes during pregnancy, 214 perioperative care, 235–236 common conditions, 214 pre-medication, 234 magnesium sulphate therapy, 287 fractures during pregnancy, 217–219 Rapid sequence induction, 231 maternal collapse; see also postpartum management, 215 Mortality rate, 315–317 maternal collapse symphysis pubis diasthesis (SPD), aetiology, 11–12 215–217 knee–chest position, 128 assessment, 143 myxedema coma defined, 10 clinical tests, 225 labour analgesia and maternal collapse, epidemiology, 10 diagnosis, 225 12 physiological changes affecting incidence of, 224 labour ward fire drill resuscitation, 10–11 key concepts, 225 defined, 307 reversible causes for, 12–13 key pitfalls, 225 evaluation, 309 maternal collapse aetiology (for late management, 225 example of, 309–310 postpartum collapse) implementation, 309 cardiac conditions, 142 neonatal deaths implications, 307 central nervous system, 142 defined, 317 key concepts, 309, 310 pulmonary embolism (PE), 141 rate of, 317 key facts about, 307 sepsis, 141–142 twin delivery, 317 key pitfalls, 310 Mauriceau–Smellie–Veit (MSV) newborn resuscitation medical conditions manoeuvre, 60–61 anticipation of, 262 for, 307 McRobert’s manoeuvre, 87, 123 equipment and environment, 262 needed equipment, 309 melasma during pregnancy, 3 evaluation planning, 307–308 meningiomas and vision, 182 initial infant assessment steps, 263 late fetal losses, 316 mental state examination, 187–188 temperature management, late neonatal death, 317 midwife-led obstetric emergencies 262–263 leadership in obstetrics, 302–303 cord prolapse, 125–126 umbilical cord clamping, 262 legal medicine home-birth trends, 120 frequency of, 261 caesarean section complications, 116 postpartum haemorrhage, 120–122 guidelines, 261 implications for VTE, 18 severe preeclampsia and eclampsia, management algorithm, 264 less invasive surfactant administration 127–128 physiology of, 261–262 (LESS), 268–269 shoulder dystocia, 122–125 non-proliferative diabetic retinopathy, linea nigra during pregnancy, 3 undiagnosed breech presentation, 181 liver during pregnancy, 4 128–129 Lovset’s manoeuvre, 60 miniPIERS model, 27 obese pregnant women in clinical low-resource center management miscarriage and abdominal pain, practice, 8 cauda equina syndrome, 215 168–169 obstetric anal sphincter injuries crash caesarean section, 114–115 modified early obstetric warning score (OASIS) epilepsy, 212–213 (MEOWS), 114 perineal trauma and, 153 fractures during pregnancy, 219 monozygotic twins, 92 repair, 155–156 instrumental vaginal delivery, 105 mortality rate obstetric unit standard suggestions, 14, intubation failure in general acute puerperal uterine inversion, 242 anaesthesia, 237 133 occult umbilical cord prolapse, 66 maternal death rate, 315 intubation failure in general ovarian cysts and abdominal newborn resuscitation, 270 anaesthesia, 231 pain, 169 perineal trauma, 157 MBRRACE, 2014–2016, 315–316 ovarian hyperstimulation syndrome preterm birth diagnosis, 285 postpartum maternal collapse, 139 (OHSS), 170 psychiatric emergencies, 189 preterm birth, 283 overt umbilical cord prolapse, 66 331

Index

palmar erythema during pregnancy, 3 platelets during pregnancy, 1 epidemiology, 26 Pendleton’s rules, 309 Poole shark teeth pattern (CTG), 80 key concepts, 26 penetrating trauma, 252 positive end-expiratory pressure management peptic ulcer and abdominal pain, 173 (PEEP), 266–267 anaesthesia, 32 perimortem caesarean section posterior shoulder dystocia, 86 antenatal corticosteroids, 31 management, 114 postpartum haemorrhage blood pressure control, 30–31 resuscitation for maternal collapse, defined, 35 CIPHER model, 28 11, 14 haemostasis, 38–41 collaborative management perinatal mortality incidence of, 35 approach to, 27 defined, 317 key actions, 37, 38 fetal assessment, 28 haemorrhage and, 35 and maternal collapse fluid monitoring, 31–32 perineal trauma atony, 139 fullPIERS model, 27–28 classification, 153 causes of, 140 in midwife-led delivery, 127–128 diagnosis, 154 most common cause, 139 miniPIERS model, 27 episiotomy and, 153 thrombin, 140 mode of delivery, 30 implications, 153–154 trauma, 139–140 postnatal review, 30 key concepts, 157 in midwife-led delivery standardised care, 27 key pitfalls, 157 definition and risks, 120–121 timing of delivery, 28–29 key pointers for, 154 delivery of placenta, 121 place of care, 27 management incidence of, 120 pregnancy episiotomy repair, 155 key actions to improve outcomes, anatomical and physiological low-resource center, 157 121–122 changes, 5 OASIS repair, 155–156 tissue, 140 cardiovascular system in, 1–2 subsequent pregnancy, 156–157 postoperative care, 41 endocrine system in, 3 surgical principles, 154–155 postpartum maternal collapse; see also fluid changes, 239 OASIS injuries and, 153 maternal collapse gastrointestinal system in, 2 occurrence of, 153 aetiology haematology of, 1 prevention, 157 amniotic fluid embolism (AFE), renal system in, 2 phaeochromocytoma, 225 141 respiratory system, 2 Phalen’s test, 214 anaphylaxis, 141 skin changes during, 3 Pinard’s manoeuvre, 59 drug overdose, 141 pregnancy clinical practice Piper’s forceps delivery, 62 eclampsia, 140 appendicitis, 5–7 pituitary apoplexy, 227 postpartum haemorrhage, asthma, 4 pituitary during pregnancy, 3 139–140 constipation, 4–5 placenta accreta spectrum (PAS) timing of onset, 139 endocrine system, 4 classification, 273 uterine inversion, 141 epilepsy, 4 defined, 273 defined, 139 glycosuria, 7 diagnosis, 273–274 epidemiology, 139 haemorrhage, 4 implications, 273 management key concepts, 8 incidence of, 273 amniotic fluid embolism (AFE), key pitfalls, 8 key concepts, 277–278 144–145 liver and gall bladder, 4 key pitfalls, 277 anaphylaxis, 145 recent developments, 8 key pointers for, 273 cardiac conditions, 145 skin changes, 8 management central nervous system, 145 summary of key changes in, 6 antepartum, 274–275 drug overdose, 145 thyroid function tests, 7 conservative, 275 eclampsia, 144 preterm birth key actions, 274 haemorrhage, 142–144 aetiology, 283, 284 postoperative care, 277 intra-abdominal bleeding, 144 defined, 283 radical surgical, 275 placenta delivery, 144 diagnosis triple P procedure, 275–276 pulmonary embolism (PE), 145 biomarker tests, 285 placenta praevia mortality rate, 139 caution around, 284–285 clinical features, 38 sepsis, 145 cervical length ultrasound, 285 defined, 38 thrombin, 144 combination cervical length and haemorrhage, 35 tone, 144 ultrasound and biomarkers, management in low-resource trauma, 144 285–286 setting, 38 uterine inversion, 145 low-resource center, 285 MBRRACE, 316 preeclampsia predictive techniques, 283 placental abruption accurate vital signs measurement, tests based on gestational age, 286 abdominal pain in pregnancy, 170 26–27 incidence of, 283 and antepartum haemorrhage, 37 defined, 26, 29 mortality rate, 283

332

Index

rescue cerclage, 289–290 A, B, C (airway, breathing, CPR), 14 retrospective analysis of risk, 324 risk factors for, 283, 284 aortocaval compression, 10 reverse Wood screw manoeuvre, types of, 283 blood circulation volume, 11 124–125 preterm infants intubation difficulties, 11 risk management in obstetrics intubation versus CPAP, 268 lung function changes, 10–11 defined, 320 stopping resuscitation, 269 management in low-resource implications, 322 proactive risk, 322–323 setting, 14–15 importance of, 320–321 proliferative diabetic retinopathy, obstetric unit standard suggestions, key concepts, 325 181–182 14 key pitfalls, 325 prospective analysis of risk, 325 perimortem caesarean section, 11, key pointers for, 321–322 pseudo-sinusoidal pattern (CTG), 80 14 low-resource center, 326 psychiatric emergencies S&T (shout, safe, tilt), 13 risk event incidence, 321 defined, 185 resuscitation of newborn steps diagnosis, 185 antenatal magnesium sulphate, 269 analysis of risk event, 324–325 implications, 185 anticipation of, 262 control of risk events, 325 incidence of, 185 approach identification of risk type, key concepts, 189 airway manoeuvres, 263–266 322–324 key pitfalls, 189 algorithm, 264 treatment of risk events, 325 key pointers for, 185 breathing manoeuvres, 266–267 tools to assist, 324–325 management circulation, 267 types of risks, 321 assessment for immediate risks, drugs for, 267 risk types 185–186 documentation, 268 proactive, 322–323 de-escalation, 188–189 equipment and environment, 262 reactive, 323–324 low-resource center, 189 evaluation rotational thromboelastomy mental state examination, initial infant assessment steps, 263 (ROTEM), 255 187–188 temperature management, Rubens II manoeuvre, 124 obtain background information, 262–263 rudimentary horn rupture and 186 umbilical cord clamping, 262 abdominal pain, 170 obtain collateral information, 186 frequency of, 261 running start manoeuvre, 125 obtain history, 186–187 guidelines, 261 rapid tranquillisation, 189 hypoxic ischaemic encephalopathy, S&T (shout, safe, tilt) resuscitation, 13 restraint, 189 269 saltatory pattern (CTG), 80 risk assessment, 188 intubation versus CPAP for preterm, SBAR communication tool, 301 types of, 185 268 second-line SPR manoeuvre, 89 pulmonary embolism (PE) LISA procedure, 268–269 sepsis confirmation of, 21 low-resource center management, abdominal pain in pregnancy, 171 defined, 17 270 aetiology, 43 leading direct cause of maternal physiology of, 261–262 antimicrobial stewardship, 45–46 death, 18 post care, 268 clinical examination, 45 maternal collapse and, 141, 145 versus stabilisation for preterm defined, 43 maternal implications, 17 infants, 268 diagnosis, 44–45 pulse oximetry stopping, 269–270 Golden Hour antibiotics, 45 newborn resuscitation, 266 surfactant administration, 268 incidence of, 43 preeclampsia and eclampsia retained placenta key concepts, 46 measurement, 27 defined, 147 key facts about, 43 diagnosis, 148 key organisms, 43–44 radiology and VTE, 17 implications, 147 key pitfalls, 46 rapid sequence induction, 234–235 incidence of, 147 maternal collapse and, 12, 145 reactive risk, 323–324 key actions, 148 online resources, 46 rectus abdominis rupture, 172 key concepts, 151 risk factors for, 44 red blood cell volume during key pitfalls, 151 sepsis 6 bundle, 45 pregnancy, 1 key pointers for, 147 sepsis 6 bundle, 45 renal system during pregnancy, 2 management sepsis and postpartum maternal rescue cerclage, 289–290 3E’s, 151 collapse respiratory system during pregnancy first-line procedure, 149 genital tract, 142 anatomical changes, 2 low-resource center, 151 other body systems, 142 blood gases, 2 second-line manoeuvres, 149–151 urinary tract, 142 physiological, 2 morbidity and mortality, 147 septic shock, 43 resuscitation for AFE, 48 partial separation of, 148 serum biochemistry ranges during resuscitation for maternal collapse recent developments, 151–152 pregnancy, 4 333

Index

Sheehan’s syndrome, 227, 228–229 hypopituitarism and, 227 symptoms and signs, 221 SHEEP model, 298 maternal collapse and, 142, 145 tocolytics, 136 shoulder dystocia subacute intrapartum hypoxia, 82 transurethral resection of prostate defined, 86 symphysiotomy procedure, 90–91 (TURP), 137 diagnosis, 86 symphysis pubis diasthesis (SPD) trauma indications for, 86 and abdominal pain in pregnancy, cardiac arrest, 256–257 key concepts, 90 172 disability and neurological status, key pitfalls, 90 diagnosis, 216 256 key pointers for, 86 implications, 216 fetal maternal haemorrhage, management incidence of, 215 257–259 first-line SPR manoeuvre, 87–89 key concepts, 216 issues related to, 252–253 low-resource center, 90 key pitfalls, 216 key concepts, 253 second-line SPR manoeuvre, 89 key pointers for, 216 key pitfalls, 253 symphysiotomy procedure, 90–91 management, 216 mortality rate, 252 in mid-wife led delivery algorithm, 218 and postmortem caesarean section, algorithm for management, 126 conservative, 217 280 definition and risks, 122 low-resource center, 216–217 prevention, 258–259 key actions to improve outcomes, surgical options, 217 trauma injury mechanisms 125 blunt trauma, 252 management, 123–125 tachysystole (CTG), 82 penetrating trauma, 252 types of, 86 tamponade and maternal collapse, 13 trauma management sickle cell crisis and abdominal pain, tear film changes airway with cervical spine control, 173 management, 178–179 253–254 simulation training vision blurring/loss in pregnancy, breathing and ventilation, 254 3E’s, 312–313 physiological changes, 178 circulation and haemorrhage debrief and feedback, 312 tension pneumothorax and control, 254–255 defined, 311 resuscitation, 13 key concepts, 256 documentation, 312 three E’s key pitfalls, 256 reasons for, 311 after obstetric emergencies, 41 low-resource center management, requirements, 312 retained placenta, 151 258, 259 role in obstetrics, 311 shoulder dystocia, 89–90 point of care testing, 255 scientific outcomes from, 313 simulation training, 312–313 principles, 253 types of, 311 thromboelastography (TEG), 255 rotational thromboelastomy sinusoidal pattern (CTG), 80 thrombo-embolism (ROTEM), 255 situational awareness and SHEEP maternal collapse and, 11 thromboelastography model, 298 reversible cause for maternal (TEG), 255 skin collapse, 13 tricyclic antidepressants clinical practice, 8 thromboprophylaxis and VTE, 18 (TCA), 196 during pregnancy, 3 thyroid triple P procedure, 275–276 spontaneous preterm birth, 283 clinical practice, 4, 7 twin delivery management during pregnancy, 3 diagnosis, 93 antibiotics, 289 thyroid storm implications, 92 corticosteroid treatment, 286–287 clinical investigation, 222 key concepts, 96 magnesium sulphate therapy, 287 complications, 224 key pitfalls, 95–96 progesterone, 287–289 diagnosis, 221–222 key pointers for, 92–93 tocolysis, 287 fetal management management transfer to neonatal care unit, 289 implications, 224 delivery mode, 93 treatment summary, 288 principles, 224 delivery timing, 93 SPR manoeuvre incidence of, 221 internal podalic, 94 first-line, 87–89 indications for, 221 during labour, 93–94 second-line, 89 key concepts, 224 low-resource center, 96 STAN analyser, 77 key pitfalls, 224 third stage, 94–95 Staphylococcus and sepsis, 44 management mortality and, 317 stillbirths principles, 223 twins defined, 317 supportive care, 223 epidemiology, 92 rate of, 317 maternal management incidence of, 92 twin delivery, 317 anti-thyroid treatment, 223–224 types of, 92 Streptococcus and sepsis, 44 principles, 223 typical sinusoidal pattern striae gravidarum during pregnancy, 3 therapeutic options, 224 (CTG), 80 stroke mortality rate, 221 typical variable deceleration, 81

334

Index

umbilical cord prolapse uterine scar, 52 thromboprophylaxis defined, 66 management, 53–54 and, 18 diagnosis, 67 risk factors for, 51 treatment of acute, 21 implications, 66 uterine scar dehiscence and abdominal ventouse delivery, 102 incidence of, 66 pain, 171 vision blurring/loss in pregnancy key concepts, 66–67, 71 uterine torsion and abdominal pain, implications, 178 key pitfalls, 71 171 key concepts, 183 in low-resource center, 70–71 uterus repositioning management algorithm, 183 management general anaesthesia, 136–137 pathological changes conservative, 70 Haultain’s operation, 137 arterio-venous occlusions, 181 definitive, 67–69 Huntingdon’s operation, 137 central serous retinopathy, 180 initial, 67–69 hydrostatic reduction, 136 eclampsia, 179–180 prediction, 67 non-surgical methods, 135–136 preeclampsia, 179–180 prevention, 67 surgical methods, 137 physiological changes training, 71–74 tocolytics, 136 corneal changes, 179 types of, 66 summary of, 178 uncomplicated variable deceleration, venous thromboembolism (VTE) tear film changes, 178–179 81 anticoagulants during labour and pre-existing systemic diseases urinary retention and abdominal pain, delivery, 23 changes 169 clinical management, 18 Graves eye disease, 182 urinary tract infections, 172 defined, 17 high myopia, 182–183 uterine inversion and maternal diagnosis, 18 intracerebral tumours, 182 collapse, 141, 145 IVC shunt, 23 meningiomas, 182 uterine rupture key concepts, 24 non-proliferative diabetic defined, 51 key pitfalls, 23–24 retinopathy, 181 diagnosis, 52–53 maintenance treatment of, 23 proliferative diabetic retinopathy, implications, 52 management in low-resource 181–182 incidence of, 51 setting, 24–25 key concepts, 54 maternal implications, 17 Wood’s screw manoeuvre, 88, 124 key pitfalls, 54 patient information, 18 WORM classification (workmanship, key pointers postnatal anticoagulation, 23 omissions, relationships induction with prostaglandins or postnatal review, 23 and mentorships), 297–298 oxytocin, 51 risk identification algorithm, 19 obstetric manipulation, 51–52 risk reduction, 25 Zavanelli’s manoeuvre, 90

335