Tag: obstetrics

The Emergency Delivery – Obstetrics

Thanks to Dr Lauren de Luca and Franki McMahon from the Obstetrics and Midwifery department for their excellent presentation at Regional teaching on the 5th of September. Review their presentation on the emergency delivery – (has been broken up into 3 parts):


Part 1: the normal delivery




Part 2: post partum haemorrhage




Part 3: Difficult deliveries – shoulder dystocia and breech presentation



Shoulder dystocia

Shoulder dystocia is a relatively uncommon obstetric emergency. Despite this, care providers, particularly at Sunshine Hospital, must still be aware of the steps to take to address dystocia in the event obstetric support is unavailable.

Shoulder Dystocia guideline (WH – last review 2013)


Watch a short video filmed by Dr Neil Long FACEM, in collaboration with the midwifery education team of Sunshine hospital (5min)



Mechanically, shoulder dystocia occurs due to a mismatch between the antero-posterior width of the baby’s shoulders relative to the mother’s pelvis, causing obstructed labour. All techniques seek to manipulate these dimensions and correct this mismatch.

Key points:

  1. call for help early (obstetric as a given but remember paediatric/neonatal support and anaesthetic support)
  2. manipulate (widen) pelvis: McRoberts position (hips flexed)
  3. manipulate (relatively reduce) shoulders: suprapubic pressure / shoulder rotation / deliver arms
  4. consider episiotomy
  5. try on all fours position if safe
  6. consider salvage manuevers


Additional resources

watch: longer video also describing salvage techniques (10min)


watch: a dramatisation, solely to stimulate your adrenaline response (4min)


Obstetrics and gynaecology in ED: 2017

Thanks to Dr Althea Askern for her presentation. Review it here:


O&G for the ED 2017


Key points:

  1. Two registrars on duty for ED calls with two consultants on call until 1730hrs – so escalate where delays are anticipated
    1. 875 – obstetrics
    2. 885 – gynaecology
  2. EPAS (early pregnancy assessment service) is now running
  3. BHCG only useful in unsited pregnancies
  4. miscarriage is common and staff should have a familiarity with the clinical and emotional needs of these cases
  5. Consider PID and ovarian torsion in differentials for pelvic pain
  6. PV / Speculum exam is not to be feared and as utility particularly in the assessment of heavier bleeding and cervical shock
  7. management of collapse of the obstetric patient requires an appreciation of the altered physiology in pregnancy
  8. pregnant patients may represent a particularly vulnerable group in our socio-economic setting

Review also: Dr Aekta Neel’s presentation in 2016

Consider also: LACTMED – a resource for the use of medications in lactation


Yuen’s Yap 1/3/17 – O+G, stroke, neonatal resus

Summary of teaching 1/3/17 – for DEMT Terence Yuen

Obstetrics and gynaecology

Gynaecology registrar Dr Althea Askern presented on common and not-to-miss gynaecology and obstetric issues. Review her talk.

She also provided detail on the return of the Early Pregnancy Assessment Service (EPAS). Inclusion / exclusion criteria and contact details can be found on OzeMedicine but in short:

  • inclusion: pain OR vaginal bleeding in pregnant patients <16/40 gestation
  • stable (from pain / bleeding perspective)
  • EPAS appointments made via iPM (clerk) or direct call to EPAS RN during business hours who will subsequently contact patient with appointment time


Stroke update

Dr Tissa Wijeratne presented an update on stroke trials. See the current list of ongoing stroke trials at Western health.


Neonatal resuscitation

Paediatric Emergency physician Dr Bindu Bali provided a session on neonatal resuscitation focusing on good ventilation and familiarity with the neonatal resuscitaire. Review the neonatal resuscitation guideline:



Simulation Olympics 2016

UPDATED 9/3/17 – See Dr Neil Long’s additional notes regarding the stations below

On the 14th December ED Consultant Dr David Alexander and simulation registrar Dr Neil Long staged the annual simulation olympics with this year’s event  – “the Pentathlon” – featuring resuscitation stations such as “the swimmer”, “the runner”, “the fencer”, “the shooter” and “the rider”.

Congratulations to registrars Gordon Carter and Mark Daley representing “the Republic of Ireland” who stormed home for the gold medal.


Thanks to all the registrars who came and participated.

[L-R: Sze-Chi + Jess, Son + Kiri, Sheri + Jamie, Rob + Annie, Emily + Maddy, Heather + Ben]

Thanks to Dr Luigi Marino, Dr Raj Patel, Dr Sam Robertson and the simulation centre staff for their help running the morning.




Wolff-Parkinson-White Syndrome with Atrial Fibrillation

• Very rapid irregularly irregular tachycardia (rates may approach 300 beats/min) with wide QRS complexes that vary in morphology
• Often misdiagnosed as SVT, VT or atrial fibrillation with BBB
• Misdiagnosis and treatment with AVN blockers can be deadly!
• Treat with procainamide, flecainide (?), or preferably electrical cardioversion
• Key Point: Avoid all AV Nodal blockers
• Adenosine
• Beta-blockers
• Calcium channel blockers
• Digoxin
• Amiodarone
Pitfall: Treatment with Amiodarone results in patient decompensation (see references)
Take Home Points:
WPW + Atrial Fibrillation
• Irregularly irregular tachycardia
• Complexes vary in shape and width
• May approach 250-300 bpm or higher
• Avoid all AV nodal blockers…including Amiodarone!
• Use Procainamide, Flecainide (?),or electrical cardioversion

Traumatic Cardiac Arrest Algorithm from the European Resuscitation Council

Main changes:
  1. don’t do CPR
  2. control catastrophic haemorrhage
  3. control the airway
  4. bilateral chest decompressions
  5. relieve cardiac tamponade
  6. consider prox aortic compression
  7. MTP
  8. CPR can commence once the chest procedures have been completed but in the context of trauma and hemorrhagic loss your CPR will be useless if you don’t correct the underlying cause.

Heat Stroke

Heat Stroke


Shoulder dystocia

Video coming soon