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High Risk Pregnancy And Labour <ul><li>Dr. Jasmine Mehta </li></ul><ul><li>FTG,Cl-1 </li></ul><ul><li>G.K.G.H.,Bhuj </li><...
High risk pregnancy and Labour <ul><li>Pregnancy and labour is physiological </li></ul><ul><li>Yet, high risk pregnancy ma...
Statistics <ul><li>World wide- </li></ul><ul><li>6 lakh maternal death per year </li></ul><ul><li>Every min one mother die...
Causes of maternal Mortality Direct cause-75% Hemorrhage 25% Sepsis 15% Unsafe abortion 13% Eclampsia 12% Obstructed labou...
Maternal mortality in our Hospital <ul><li>Total deliveries in last year-1451 </li></ul><ul><li>Total maternal mortality-1...
Abortion 10-20% Ectopic pregnancy 0.66% Vesicular mole 0,25% Multiple pregnancy 1.25% PET 10% Placenta pravia 0.5 -1% Abru...
High risk LABOUR <ul><li>Preterm labour-5-10% </li></ul><ul><li>Post term labour 10% </li></ul><ul><li>Previous LSCS 10-12...
High risk pregnancy and Labour
ABORTION <ul><li>Threatened  </li></ul><ul><li>Complete bed rest  </li></ul><ul><li>Inj. calmpose im stat </li></ul><ul><l...
Ectopic Pregnancy <ul><li>Diagnose the iceberg by </li></ul><ul><li>1 1/2  to 2mth of amenorrhea  </li></ul><ul><li>Mild b...
APH
 
Pregnancy Induced Hypertention <ul><li>Diagnosis </li></ul><ul><li>High risk consent </li></ul><ul><li>Antihypertensive me...
Warning Signs Of Eclampsia <ul><li>Headache </li></ul><ul><li>Blurring of vision </li></ul><ul><li>Vomiting  </li></ul><ul...
Eclampsia  <ul><li>Gc poor sign </li></ul><ul><li>O 2 inhalation and suction </li></ul><ul><li>Inj. Mgso 4 :4gm iv diluted...
Eclampsia  <ul><li>Antihypertensive </li></ul><ul><li>Foley’s catheterization &strict u/o chart </li></ul><ul><li>No inj m...
Anemia <ul><li>Mild to moderate in early preg. </li></ul><ul><li>Treat with oral iron therapy </li></ul><ul><li>Severe ana...
Cardiac Disease <ul><li>Pregnancy regular Digitalis and suppt. Med. </li></ul><ul><li>correct anaemia &any inf. </li></ul>...
Cardiac Disease <ul><li>Avoid overloading of iv fluids <75ml/hr </li></ul><ul><li>O 2  inhalation sos 5-6lit/min </li></ul...
Cardiac Disease <ul><li>Squating or head up position is favourable in cardiac patients </li></ul>
  Diabetes <ul><li>Inj. plain insulin infusion slowly </li></ul><ul><li>u/s every 2 hourly </li></ul><ul><li>Antibiotic co...
Rh Negetive Mother <ul><li>Regular anc care and USG </li></ul><ul><li>Clamp cord early </li></ul><ul><li>Avoid manual remo...
Jaundice in Pregnancy <ul><li>Rule out DIC </li></ul><ul><li>Strict FHS monitoring  </li></ul><ul><li>Universal precaution...
PPH <ul><li>Atonic: severe bleeding, uterus atonic </li></ul><ul><li>Traumatic: fresh bleeding, uterus contracted </li></u...
Atonic PPH <ul><li>Call for help  </li></ul><ul><li>2 iv line –wide bore/BT/iv inf. </li></ul><ul><li>Bimenual massage </l...
Atonic PPH
Retained placenta <ul><li>Inj.. pitocin 30 unit in one pint </li></ul><ul><li>Inj.. Prostodin IM stat </li></ul><ul><li>Ta...
Obstructed labor <ul><li>Do not miss –prolonged labor - moulding and caput ,bandle’s ring – hot vagina </li></ul><ul><li>D...
Previous LSCS <ul><li>Watch for scar tenderness </li></ul><ul><li>Signs of imminent scar rupture: scar tenderness, tachyca...
Shoulder dystocia <ul><li>Do not be panicky </li></ul><ul><li>Do not give traction head </li></ul><ul><li>Do not apply fun...
Shoulder dystocia <ul><li>Rotate posterior arm to anterior position </li></ul><ul><li>Extraction of posterior arm </li></u...
Inversion of uterus <ul><li>Do not employ any method to expel placenta while uterus is relaxed </li></ul><ul><li>Do not pu...
Inversion of uterus <ul><li>Management </li></ul><ul><li>Inj.. atropine </li></ul><ul><li>Iv fluids </li></ul><ul><li>Seda...
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High Risk Pregnancy And Labour final

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  1. 1. High Risk Pregnancy And Labour <ul><li>Dr. Jasmine Mehta </li></ul><ul><li>FTG,Cl-1 </li></ul><ul><li>G.K.G.H.,Bhuj </li></ul>
  2. 2. High risk pregnancy and Labour <ul><li>Pregnancy and labour is physiological </li></ul><ul><li>Yet, high risk pregnancy may end into pathological status….leading to… </li></ul><ul><li>Maternal and Neonatal mortality </li></ul><ul><li>Goal of FOGSI-BETI BACHAO,BETI PADHAO </li></ul><ul><li>Goal of RCH- Safe motherhood </li></ul>
  3. 3. Statistics <ul><li>World wide- </li></ul><ul><li>6 lakh maternal death per year </li></ul><ul><li>Every min one mother dies </li></ul><ul><li>99% in developing countries </li></ul><ul><li>80% r preventable </li></ul><ul><li>India- </li></ul><ul><li>MMR is 480 per `1 lakh live child birth </li></ul><ul><li>Maternal morbidity is 16 times that of mortality </li></ul>
  4. 4. Causes of maternal Mortality Direct cause-75% Hemorrhage 25% Sepsis 15% Unsafe abortion 13% Eclampsia 12% Obstructed labour 5% Indirect-25% Anemia 20% Cardiac disease, hepatitis
  5. 5. Maternal mortality in our Hospital <ul><li>Total deliveries in last year-1451 </li></ul><ul><li>Total maternal mortality-11 </li></ul><ul><li>MMR-750 per one lakh LCB </li></ul>Cause No PPH 6 Eclampsia 3 APH 1 Anemia 1
  6. 6. Abortion 10-20% Ectopic pregnancy 0.66% Vesicular mole 0,25% Multiple pregnancy 1.25% PET 10% Placenta pravia 0.5 -1% Abruptio placenta 0.5-1% Anemia 40-80% Cardiac disease- MC is MS(80%) 1% Diabetes Jaundice 0.04 HIV <0.5% Rh negative mother 5-10% Grand multipara 25%
  7. 7. High risk LABOUR <ul><li>Preterm labour-5-10% </li></ul><ul><li>Post term labour 10% </li></ul><ul><li>Previous LSCS 10-12% </li></ul><ul><li>CPD 20% </li></ul><ul><li>Malposition MC-Breech </li></ul><ul><li>Prolonged labour 2-4% </li></ul><ul><li>Obstructed labour 1-2%s </li></ul><ul><li>Shoulder dystocia </li></ul><ul><li>PPH-1% </li></ul><ul><li>Retained placenta </li></ul><ul><li>inversion of uterus </li></ul><ul><li>Rupture uterus </li></ul><ul><li>Perineal tear </li></ul>
  8. 8. High risk pregnancy and Labour
  9. 9. ABORTION <ul><li>Threatened </li></ul><ul><li>Complete bed rest </li></ul><ul><li>Inj. calmpose im stat </li></ul><ul><li>Inj. RL/DNS </li></ul><ul><li>Analgesics </li></ul><ul><li>Progesterone support </li></ul><ul><li>Inevitable/Incomplete abortion </li></ul><ul><li>Replace blood loss with iv fluids and BT </li></ul><ul><li>Antibiotics </li></ul><ul><li><12wks:e&c, </li></ul><ul><li>Misoprost 4tab </li></ul><ul><li>Inj. Prostodin </li></ul><ul><li>>12wks:Inj pitocin </li></ul>
  10. 10. Ectopic Pregnancy <ul><li>Diagnose the iceberg by </li></ul><ul><li>1 1/2 to 2mth of amenorrhea </li></ul><ul><li>Mild bleeding p/v </li></ul><ul><li>severe abd pain and </li></ul><ul><li>tenderness </li></ul><ul><li>UPT+ve </li></ul><ul><li>Severe pallor/shock </li></ul><ul><li>Management:o 2 inhalatiion,iv fluids,antibiotics,and BT </li></ul>
  11. 11. APH
  12. 13. Pregnancy Induced Hypertention <ul><li>Diagnosis </li></ul><ul><li>High risk consent </li></ul><ul><li>Antihypertensive medication </li></ul><ul><li>Iv line </li></ul><ul><li>Sedation </li></ul><ul><li>No inj methargin after delivery </li></ul><ul><li>Inj. calmpose +Inj. lasix after delivery </li></ul><ul><li>Bed side clotting test,<7min. </li></ul>
  13. 14. Warning Signs Of Eclampsia <ul><li>Headache </li></ul><ul><li>Blurring of vision </li></ul><ul><li>Vomiting </li></ul><ul><li>Oliguria </li></ul><ul><li>Rt sided abd pain </li></ul>
  14. 15. Eclampsia <ul><li>Gc poor sign </li></ul><ul><li>O 2 inhalation and suction </li></ul><ul><li>Inj. Mgso 4 :4gm iv diluted over 5min </li></ul><ul><li>5gm imRt buttock </li></ul><ul><li>5gm imlt buttock </li></ul><ul><li>2gm iv diluted if conv.again </li></ul><ul><li>Monitor:u/o>100ml in 4hrs,knee jerk+,Resp. </li></ul><ul><li>rate >16/min. </li></ul>
  15. 16. Eclampsia <ul><li>Antihypertensive </li></ul><ul><li>Foley’s catheterization &strict u/o chart </li></ul><ul><li>No inj methargin after del. </li></ul><ul><li>Inj. lasix after del. </li></ul><ul><li>W/F shock after del. </li></ul>
  16. 17. Anemia <ul><li>Mild to moderate in early preg. </li></ul><ul><li>Treat with oral iron therapy </li></ul><ul><li>Severe anaemia at term/labour </li></ul><ul><li>inj BT </li></ul><ul><li>don’t overload with iv fluids </li></ul><ul><li>strict asepsis and antibiotic cover </li></ul><ul><li>inj metergin im </li></ul><ul><li>del. In squatting position </li></ul><ul><li>inj prostodin/T.misoprost after del. </li></ul><ul><li>strict w/f PPH </li></ul>
  17. 18. Cardiac Disease <ul><li>Pregnancy regular Digitalis and suppt. Med. </li></ul><ul><li>correct anaemia &any inf. </li></ul><ul><li>vigilance for ccf </li></ul><ul><li>Adequate rest/hospitalization </li></ul><ul><li>Labour </li></ul><ul><li>Inj. abs coverage for 5 days,bed rest, </li></ul><ul><li>lt lat.post. </li></ul>
  18. 19. Cardiac Disease <ul><li>Avoid overloading of iv fluids <75ml/hr </li></ul><ul><li>O 2 inhalation sos 5-6lit/min </li></ul><ul><li>Strictly monitor pulse & spo 2 ,p>110 </li></ul><ul><li>Vaccum del./forcep del </li></ul><ul><li>No inj methergin after del.give T.misoprost </li></ul><ul><li>Inj. lasix after del </li></ul><ul><li>Strictly w/f PPH,CCF </li></ul>
  19. 20. Cardiac Disease <ul><li>Squating or head up position is favourable in cardiac patients </li></ul>
  20. 21. Diabetes <ul><li>Inj. plain insulin infusion slowly </li></ul><ul><li>u/s every 2 hourly </li></ul><ul><li>Antibiotic coverage &strict asepsis </li></ul><ul><li>Strict FHS monitoring </li></ul><ul><li>w/f hypoglycemia </li></ul><ul><li>Vigilance for shoulder dystocia,pph </li></ul><ul><li>Postpartum antibiotics & feeding </li></ul><ul><li>Look for 3cord vessel </li></ul><ul><li>Pediatric opinion. </li></ul>
  21. 22. Rh Negetive Mother <ul><li>Regular anc care and USG </li></ul><ul><li>Clamp cord early </li></ul><ul><li>Avoid manual removal of placenta </li></ul><ul><li>No inj methargin </li></ul><ul><li>Baby BgRh and paed opinion </li></ul><ul><li>Inj. Anti-D in 72 hrs if baby BgRh is+ve </li></ul>
  22. 23. Jaundice in Pregnancy <ul><li>Rule out DIC </li></ul><ul><li>Strict FHS monitoring </li></ul><ul><li>Universal precaution during del. </li></ul><ul><li>No inj methargin </li></ul><ul><li>Inj. vit K prior to del. </li></ul><ul><li>Hepatitis B vaccine and Ig to baby </li></ul><ul><li>Other STD </li></ul>
  23. 24. PPH <ul><li>Atonic: severe bleeding, uterus atonic </li></ul><ul><li>Traumatic: fresh bleeding, uterus contracted </li></ul><ul><li>DIC: bleeding from all sites, 5ml bed side blood clotting test positive </li></ul>
  24. 25. Atonic PPH <ul><li>Call for help </li></ul><ul><li>2 iv line –wide bore/BT/iv inf. </li></ul><ul><li>Bimenual massage </li></ul><ul><li>Inj. methargin iv,repeat every 15 min ,max3 </li></ul><ul><li>Inj. pitocin 30units at rate of 30drops/min,max 3 pints </li></ul><ul><li>Inj. prostodin im,repeat after 15min.,max5, </li></ul><ul><li>never iv. </li></ul><ul><li>T.misoprost 5tab P/R. </li></ul>
  25. 26. Atonic PPH
  26. 27. Retained placenta <ul><li>Inj.. pitocin 30 unit in one pint </li></ul><ul><li>Inj.. Prostodin IM stat </li></ul><ul><li>Tab. Misoprost 3 tab P/R </li></ul><ul><li>Inj.. Pitocin 1 amp in cord vein </li></ul><ul><li>Manual removal of placenta </li></ul>
  27. 28. Obstructed labor <ul><li>Do not miss –prolonged labor - moulding and caput ,bandle’s ring – hot vagina </li></ul><ul><li>Do foley’s catheter </li></ul><ul><li>IV anti biotics </li></ul><ul><li>Keep one BT ready </li></ul>
  28. 29. Previous LSCS <ul><li>Watch for scar tenderness </li></ul><ul><li>Signs of imminent scar rupture: scar tenderness, tachycardia, fetal distress, blood in urine </li></ul><ul><li>Do –stop bearing down –inj tidilan – inj BT </li></ul>
  29. 30. Shoulder dystocia <ul><li>Do not be panicky </li></ul><ul><li>Do not give traction head </li></ul><ul><li>Do not apply fundal pressure </li></ul><ul><li>Do give supra pubic pressure with abduction of thighs </li></ul>
  30. 31. Shoulder dystocia <ul><li>Rotate posterior arm to anterior position </li></ul><ul><li>Extraction of posterior arm </li></ul><ul><li>All procedures should not take more than five minutes </li></ul>
  31. 32. Inversion of uterus <ul><li>Do not employ any method to expel placenta while uterus is relaxed </li></ul><ul><li>Do not pull cord while uterus is relaxed. </li></ul><ul><li>Ask pt to not to cough, sneeze or bear down while uterus is relaxed </li></ul>
  32. 33. Inversion of uterus <ul><li>Management </li></ul><ul><li>Inj.. atropine </li></ul><ul><li>Iv fluids </li></ul><ul><li>Sedatives </li></ul><ul><li>Reposition of uterus </li></ul><ul><li>Uterine packing </li></ul>
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