Match each acute obstetric emergency vignette to the most appropriate immediate next step in management.
- A 34-year-old multipara develops sudden-onset hypoxia, cyanosis, and profound hypotension shortly after delivery of the placenta, rapidly followed by oozing from her intravenous catheter site.Initiate cardiopulmonary resuscitation, intubation, and massive transfusion protocol
- A 26-year-old primipara experiences a massive gush of blood following excessive umbilical cord traction. Pelvic examination reveals a purple-red mass at the introitus; the uterine fundus is impalpable transabdominally.Cease uterotonic agents and perform manual uterine replacement
- A 31-year-old multipara undergoes amniotomy at 38 weeks gestation. She immediately develops painless vaginal bleeding, and the fetal heart tracing demonstrates abrupt, prolonged bradycardia.Proceed immediately to emergent cesarean delivery
- A 38-year-old gravida 4 is pushing in the second stage of labor. The fetal head delivers but immediately retracts tightly against the maternal perineum. Gentle downward traction is ineffective.Perform the McRoberts maneuver and apply suprapubic pressure
Cevap
The correct pairings match each classic obstetric emergency presentation with its definitive acute management: Amniotic fluid embolism requires aggressive supportive care with CPR and blood products; Uterine inversion requires immediate manual replacement without uterotonics; Ruptured vasa previa necessitates emergent cesarean delivery; and Shoulder dystocia is managed initially with the McRoberts maneuver.
Each correct pairing links a life-threatening obstetric complication directly to its recognized, evidence-based initial intervention. Recognizing the pathognomonic clinical signs (e.g., turtle sign, absent fundus, post-amniotomy bleeding) is the key to selecting the correct pathway.
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Anahtar Kavram
Immediate triage and definitive management of acute intrapartum and postpartum obstetric emergencies.