obstetric emergency
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Obstetric Emergency. Definition: Emergency is term that denotes an unex pected or sudden occurrence demanding prompt action. - PowerPoint PPT PresentationTRANSCRIPT
Obstetric Emergency
Definition:
Emergency is term that denotes an unexpected or sudden
occurrence demanding prompt action.
The list of potential and unexpected obstetric
occurrences demands prompt action is extensive.
1.Placental abruption
2.Placental praevia
3.Post-partum haemorrhage
* placenta accreta
* uterine inversion
* puerperal hematoma
4. Uterine rupture
5. Ectopic pregnancy
6. Hypovolaemia due to haemorrhage
7. Eclampcia
8. Amniotic and thromboembolism
9. Obstetric septic shock
10. Acute respiratory failure
11. Pre-Term labour
12. Shoulder dystocia
Post- Partum Haemorrhage
Definition
Increase blood loss during or following the 3rd stage of
more than 600cc.
Types-:
1. Primary post Partum haemorrhage
2. Secondary post Partum haemorrhage
Primary Post-Partum Haemorrahage
Aetiology:
A. Placental site bleeding
I. Atonic post-partum haemorrhage
A) The factors of predispoic to:
1. Prolonged labour - exhaustion
2. Antepartum haemorrhage
3. Anaemia +++
4. Fibroid in uters
5. Full Bladder or rectum
B. Trauma: Perineum, vulva, vagina and
cervix
II. Retention of placenta - partially or complete support
III. Hypofibrinogenaemia
Clinical Picture
A. General examination
B. Abdominal Examination
C. Vagincal examination
Prophylaxis
Avoid predisposing factors
A) During labour:
a. Avoid traumatic delay delivry
b. Proper Management of 3rd stage
c. Avoid traction on cord
d. Examine birth canal
e. Bladder should be empty
B) The patient should be observed 2 hours after
delivery.
C) Delivery in good hospital
Active Treatment
1. Blood Transfusion
2. Fibrinogen 4-10 gm I.V.
3. Double or triple strength plasma
4. Epsilon Amino caproic acid
Secondary Post-partum Haemorrhage
Causes:
1. Retained part of placenta
2. Infection.
3. Submucous fibroid
4.Local gynae case - erosion
5. Puerperal inversion
6. Choriocarcinoms
7. Oestrogen withdrawal
8. Choriocarcinoma
Retained Placenta
Placenta failed to be expelled.
A) Aetiology
1. Retention, separllted placenta
2. Atony of uterus
3. Contraction ring – hour glass contraction
B. Retention of non-separated placenta
1. Atony of uterus
2. Abnormal adhesion of placenta
Clinical Picture
1.Bleeding
2. Atonic uterus
3. Vaginal examination
* hour glass
* placenta accreta
* ruptu of the uterus
Treatment
A. In case of uterine atony
Ergometrine
Massage of uterus
Manual removal of placenta
B. In case of contraction ring
Deep anaesthesia
Arrange nitrate inhalation
C. In case of adherent placenta
Manual removal.
D. In case of rupture of uterus
Acute Puerperal InversionThe uterus is partially or completely turned inside out.
Aetiology
1. Usually induced
pressing fundus
traction or cord
2. Spontaneous
a. precipitation labour
b.traction of fetus on short cord
c. submucous fibroid
Degree
1st deg
2nd deg
3rd deg
Clinical Picture
Shock
Bleeding un the placenta attached
Pain
Treatment
A) Prophylaxis
B) Active Treatment
1. Anti-shock measures
2. Blood transfusion
3. Reduce invasim
Shock in Obstetrics
Types of shock
Surgical shock
Neurogenic
Idiopathic obstetric shock
Hypovolaemia shock
Emdotoxic or septic shock
Clinical Picture
1. Hypotension
2. Tachycardia
3. Pallor
4. Cyanosis
Treatment of shock
Hypofibrinegemia
Aetioiogy
1. Concealed accidental haemorrhage
2. IUFD
3. Amniotic fluid embolism
Fibrinogen 4 - 16 gm IV
Antifibrinolysin EACA 4-6 gm
Rupture of Uterus
Indication* Malpresentation
* Big size baby
* Pendulous
* Weak uterine muscle
* osteomalacia
Aetiology:Rupture during pregnancy:
Spontaneous
1. Rupture scar (upper segment ea rean section,
myomectomy perforation)
2. Severe concealed accidental haemorrhage
3. Anterior sacculation - incarcerated R.V. gravid uterus
4. Rupture rudimentary haemorrhage of bicornuate uterus
Clinical Picture
A. Rupture of uterus during pregnancy or early or in early in labour
1. Severe abdominal pain + sign and symptoms of internal haemorrhage
2. Abdominal - fetus is easly felt
- FHS not heard
3. Vaginally - may be vaginal bleeding
B. Rupture of the uterus late in labour
1. Spontaneous rupture due to obstructed labour
(1) Before actu.1 rupture - impending rupture
2. When actu.al rupture occurs:
a. Severe abdominal Pain - cessation of uterine contraction
b. shock
c. Abdominal fetus is easly felt
Site of Rupture
1. Rupture due to obstructed labour - involve lower uterine
2. Traumatic in late labour involve lower segment and
usually incomplete
3. Rupture of upper segment scar - complete
4. Rupture of lower segment scar - complete
- incomplete
Clinical Conditions allegedly associated with Utrine Rupture
Casesarean Section
Oxytocin
Multipara
Epidural anasthesia
Abruptio placenta
Mid forceps
Breech version / extraction
External trauma to the abdomen
Pertomlon of uterus - D & C
Rupture during labourI. Spontaneous
1. Obstructed labour2. Rupture of uterine scar 3. Idiopathic
II. Traumatic
1. IPV after drainage2. Destructive operdon 3. Forceps application
II. Improper use of syntoclnon drugs
Types of Rupture
1. Complete
2. Incomplete
Clinical signs and symptome associated with uterine
rupture
1. Fetal distress
2. Abdominal pain
3. Vaginal bleeding
4. Recession of presenting part
5. Uterine hypertonias
6. Altered uterine contour
TreatmentBlood transfusion Labarotomy
ComplicationsA. Maternal
1. Shock 2. Haernorrhage 3. Sepsis4. Paralytic ileus 5. Injury to the bladder