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Obstetric Emergency

Obstetric Emergency. Definition: Emergency is term that denotes an unex pected or sudden occurrence demanding prompt action.

phelan-mcmillan
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Obstetric Emergency

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  1. Obstetric Emergency

  2. Definition:Emergency is term that denotes an unexpected or sudden occurrence demanding prompt action.

  3. The list of potential and unexpected obstetric occurrences demands prompt action is extensive. 1.Placental abruption 2.Placental praevia3.Post-partum haemorrhage * placenta accreta * uterine inversion * puerperal hematoma

  4. 4. Uterine rupture 5. Ectopic pregnancy 6. Hypovolaemia due to haemorrhage7. Eclampcia8. Amniotic and thromboembolism9. Obstetric septic shock 10. Acute respiratory failure 11. Pre-Term labour12. Shoulder dystocia

  5. Post- Partum HaemorrhageDefinitionIncrease blood loss during or following the 3rd stage of more than 600cc.Types-: 1. Primary post Partum haemorrhage2. Secondary post Partum haemorrhage

  6. Primary Post-Partum HaemorrahageAetiology:A. Placental site bleeding I. Atonic post-partum haemorrhageA) The factors of predispoic to: 1. Prolonged labour - exhaustion 2. Antepartumhaemorrhage 3. Anaemia +++ 4. Fibroid in uters 5. Full Bladder or rectumB. Trauma: Perineum, vulva, vagina and cervix

  7. II. Retention of placenta - partially or complete support III. HypofibrinogenaemiaClinical Picture A. General examination B. Abdominal Examination C. Vagincal examination

  8. ProphylaxisAvoid 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

  9. Active Treatment1. Blood Transfusion2. Fibrinogen 4-10 gm I.V. 3. Double or triple strength plasma 4. Epsilon Amino caproic acid

  10. Secondary Post-partum HaemorrhageCauses:1. Retained part of placenta 2. Infection.3. Submucous fibroid4.Local gynae case - erosion 5. Puerperal inversion6. Choriocarcinoms7. Oestrogen withdrawal8. Choriocarcinoma

  11. Retained Placenta

  12. 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

  13. Clinical Picture 1.Bleeding 2. Atonic uterus 3. Vaginal examination * hour glass * placenta accreta * ruptu of the uterus

  14. TreatmentA.In case of uterine atonyErgometrine 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

  15. Acute Puerperal InversionThe uterus is partially or completely turned inside out. Aetiology 1. Usually induced pressing fundus traction or cord 2. Spontaneous a. precipitation labourb.traction of fetus on short cord c. submucous fibroid Degree 1st deg 2nd deg 3rd deg

  16. Clinical Picture Shock Bleeding un the placenta attached PainTreatment A) Prophylaxis B) Active Treatment 1. Anti-shock measures 2. Blood transfusion 3. Reduce invasim

  17. Shock in ObstetricsTypes of shock Surgical shockNeurogenicIdiopathic obstetric shock HypovolaemiashockEmdotoxicor septic shock

  18. Clinical Picture1. Hypotension 2. Tachycardia 3. Pallor 4. Cyanosis Treatment of shock

  19. HypofibrinegemiaAetioiogy1. Concealed accidental haemorrhage2. IUFD3. Amniotic fluid embolism Fibrinogen 4 - 16 gm IV Antifibrinolysin EACA 4-6 gm

  20. Rupture of Uterus

  21. Indication * Malpresentation * Big size baby * Pendulous * Weak uterine muscle * osteomalaciaAetiology: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

  22. Clinical PictureA. 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

  23. Site of Rupture1. 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

  24. Clinical Conditions allegedly associated with Utrine RuptureCasesarean SectionOxytocinMultipara Epidural anasthesiaAbruptio placenta Mid forceps   Breech version / extraction External trauma to the abdomen Pertomlonof uterus - D & C

  25. Rupture during labourI. Spontaneous 1. Obstructed labour 2. Rupture of uterine scar 3. Idiopathic II. Traumatic 1. IPV after drainage 2. Destructive operdon 3. Forceps application II. Improper use of syntoclnon drugs

  26. Types of Rupture 1. Complete 2. Incomplete

  27. 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

  28. TreatmentBlood transfusion LabarotomyComplicationsA. Maternal 1. Shock 2. Haernorrhage 3. Sepsis 4. Paralytic ileus 5. Injury to the bladder

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