UMEM Educational Pearls - Obstetrics & Gynecology

Title: Placental Abruption

Category: Obstetrics & Gynecology

Keywords: Placenta, Abruption, Vaginal Bleed, Third Trimester (PubMed Search)

Posted: 10/20/2007 by Michael Bond, MD (Updated: 4/6/2025)
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Placental Abruption

Leading cause of fetal death (1-80 pregnancy)
Evaluation
- Ultrasound has very poor sensitivity

Can check D-Dimer, Coags, Fibrinogen and Fibrin Split Products

For a stable patient MRI can make diagnosis.

Fetal monitoring (minimum four hours) where fetal distress and uterine contractions are seen.

Risk factors for Placental Abruption
- Hypertension
- Pre-eclampsia
- Diabetes
- Trauma
- Smoking
- Cocaine
- Advanced maternal age
Treatment
- C-Section

Title: Imminent Delivery

Category: Obstetrics & Gynecology

Keywords: Delivery, Imminent, Dystocia (PubMed Search)

Posted: 7/10/2007 by Michael Bond, MD (Updated: 4/6/2025)
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If you are facing the imminent delivery of a newborn with shoulder dystocia remember the mnemonic HELPERR. * Help. Call for it. * Episiotomy. o Necessary only to make more room if rotation maneuvers are required. * Legs (the McRoberts maneuver) o This procedure involves flexing and abducting the maternal hips, positioning the maternal thighs up onto the maternal abdomen. * Pressure, Suprapubic o The hand of an assistant should be placed suprapubically over the fetal anterior shoulder, applying pressure in a cardiopulmonary resuscitation style with a downward and lateral motion on the posterior aspect of the fetal shoulder. This maneuver should be attempted while continuing downward traction. * Enter maneuvers (internal rotation) o Attempt to manipulate the fetus to rotate the anterior shoulder into an oblique plane and under the maternal symphysis. * Remove o Remove the posterior arm. * Roll the patient. o Rolling the patient on all-fours will often dislodge the shoulder, and the position change allows gravity to aid in the disimpaction of shoulder. Baxley EG, Gobbo RW. Shoulder Dystocia, Am FamPhysician. 2004;69(7):1709-1714.

Title: OB Pearls

Category: Obstetrics & Gynecology

Keywords: Pre-eclampsia, eclampsia, HELLP (PubMed Search)

Posted: 7/12/2007 by Michael Bond, MD (Updated: 4/6/2025)
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The best known peripartum complications are pre-eclampsia and eclampsia. However, do not forget about HELLP syndrome which occurs in approximately 0.2 to 0.6 percent of all pregnancies. HELLP is an acronym for: Hemolysis Elevated Liver Enzymes Low Platelet Treatment consists: 1. Seizure prophylaxis with magnesium 2. Blood pressure control 3. Corticosteriods and plasmapheresis may be helpful in severe causes 4. Supportive care. 5. Early delivery of child.

Title: Shoulder Dystocia Legal Pearl

Category: Obstetrics & Gynecology

Keywords: Erb's Palsy, Dystocia, Legal (PubMed Search)

Posted: 7/14/2007 by Michael Bond, MD (Updated: 4/6/2025)
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In follow up to my Shoulder Dystocia Pearl

Dr. DePriest Whye has some legal pearls for us:

Erbs Palsy( Brachial Plexus Injury) is a known complication of shoulder dystocia and is due to traction on the arm that causes stretching of the brachial plexus.

Should an Erb's Palsy result as a consequence of a shoulder dystocia, a medical malpractice suit is inevitable.
The medical record documentation is particularly critical in defending the medical care rendered.
The medical record should reflect timely recognition of the shoulder dystocia.
It is important that appropriate implementation of the maneuvers described last week are done in a timely fashion.
Vital documentation should describe the amount of traction placed if any.
Terms such as minimal or mild or light traction should be used.
Terms such as strong, forceful, significant traction should be avoided.
Never state in the record that uterine pressure was used as opposed to suprapubic pressure.
Uterine pressure is contraindicated.

Erb's Palsy cases are difficult to defend. They are impossible to defend with improper documentation.