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Obstetric Emergencies In The I
 

Obstetric Emergencies In The I

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    Obstetric Emergencies In The I Obstetric Emergencies In The I Presentation Transcript

    • OBSTETRIC EMERGENCIES IN THE I.C.U PROF. DR. SAKINA JAFFERY MBBS, MCPS, FCPS CONSULTANT ANAESTHESIOLOGIST & INTENSIVIST.
      • ICU receives obstetric patients with medical & surgical emergencies as well as specific obstetric complications.
      • Proportion of obstetric patients in most ICUs is low
      • Relative inexperience in management & team-work between intensivist & obstetrician.
    • BASIC PRINCIPLES FOR OBSTETRIC EMERGENCIES.
      • Physiological changes in pregnancy modify:
              • Presentation of the problem
              • Normal physiological variables
              • Response to treatment
      • Both mother & fetus are affected by the pathology & subsequent treatment.
      • Mother’s welfare always takes precedence over fetal concerns ---
      • Fetal survival is usually dependant on optimal maternal management.
    • PHYSIOLOGICAL CHANGES IN PREGNANCY
      • After 20 weeks aorto-caval compression.
      • Complicated tracheal intubation due to edematous tissues, delayed gastric emptying & increased oxygen consumption.
      • Prophylaxis for thrombo-embolism with low molecular weight heparin & elastic compression stockings
    • CARDIO-PULMONARY ARREST
      • Cardiac arrest rare in pregnancy (1 in 30000 deliveries)
      • Usually associated with particular obstetric complications like amniotic fluid embolism, drug toxicity from Magnesium sulphate & local anesthetics.
      • Technique for external cardiac massage:
              • External cardiac massage in non-obstetric patient provides 30% cardiac output.
              • After 20 weeks reduced further due to veno-caval compression.
              • Relief of aorto-caval compression part of BLS:
              • left lateral tilt --- decreased efficacy of compressions
              • wedge 27 0 angle allows 80% of maximal force to be dissipated
              • rescuer’s thigh as wedge.
      • Sodium bicarbonate controversial as it leads to fetal acidosis but pH has to be kept above 7.30 to prevent uterine vasoconstriction.
      • International Liaison Committee on Resuscitation (ILCOR)
      • “ if there is no response to ALS, peri-mortem caesarean delivery should be made within 5 minutes of arrest”
    • TRAUMA
      • Occurs in 6-7% of all pregnancies.
      • Hospital admissions only 0.3- 0.4 % of all pregnancies.
      • 1% of all trauma cases are pregnant.
      • Maternal deaths associated most commonly with head injuries & severe hemorrhage.
      • Fetal deaths associated with placental abruption & maternal death.
      • Initial resuscitation should follow normal plan of ABC.
      • Hypotension may not be present until 35% or more blood volume is lost.
      • Aorto-caval compression release
      • Rule out pelvic fractures, uterine injury & retro-peritoneal hemorrhage
      • Fetal monitoring with cardio-tocographic monitor & USG.
      • Rh immunoglobulin – within 72 hours.
      • Radiation hazards:
              • 1 st trimester >5 cGy
              • Chest x-ray < 5 cGy
              • Pelvic film <1 cGy
              • Abdomino-pelvic CT scan 5-10 cGy
    • BURNS
      • Increased levels of prostaglandins predispose to pre-term labour.
      • Replacement of fluids vis-à-vis increased volumes in pregnancy.
      • Inhalational injury- hypoxia & carbon monoxide poisoning
      • Infections- prophylactic antibiotics controversial
      • Topical Povodine iodine- affects fetal thyroid functions
    •