Your SlideShare is downloading. ×
0
OBSTETRIC EMERGENCIES IN THE I.C.U PROF.  DR. SAKINA JAFFERY MBBS, MCPS, FCPS CONSULTANT ANAESTHESIOLOGIST & INTENSIVIST.
<ul><li>ICU receives obstetric patients with medical & surgical emergencies as well as specific obstetric complications. <...
BASIC PRINCIPLES FOR OBSTETRIC EMERGENCIES. <ul><li>Physiological changes in pregnancy modify: </li></ul><ul><ul><ul><ul><...
PHYSIOLOGICAL CHANGES IN PREGNANCY
<ul><li>After 20 weeks aorto-caval compression. </li></ul><ul><li>Complicated tracheal intubation due to edematous tissues...
CARDIO-PULMONARY ARREST <ul><li>Cardiac arrest rare in pregnancy (1 in 30000 deliveries) </li></ul><ul><li>Usually associa...
<ul><li>Technique for external cardiac massage: </li></ul><ul><ul><ul><ul><ul><li>External cardiac massage in non-obstetri...
TRAUMA <ul><li>Occurs in 6-7% of all pregnancies. </li></ul><ul><li>Hospital admissions only 0.3- 0.4 % of all pregnancies...
<ul><li>Aorto-caval compression release </li></ul><ul><li>Rule out pelvic fractures, uterine injury & retro-peritoneal hem...
BURNS <ul><li>Increased levels of prostaglandins predispose to pre-term labour. </li></ul><ul><li>Replacement of fluids vi...
 
Upcoming SlideShare
Loading in...5
×

Obstetric Emergencies In The I

3,957

Published on

Published in: Health & Medicine
1 Comment
1 Like
Statistics
Notes
No Downloads
Views
Total Views
3,957
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
111
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide

Transcript of "Obstetric Emergencies In The I"

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

    Clipping is a handy way to collect important slides you want to go back to later.

×