Obstructed labor

1. OBSTETRIC EMERGENCIES.
Dr.Regan,
MD

2. Definition of obstetric emergencies:
Are health problems that are life threating for pregnant women and
their babies.
Examples of those conditions are Antepartum hemorrhage, obstructed
labour, pre eclampsia, post partum hemorrhage,etc.

3. ANTEPARTUM HAEMORRHAGE.(APH)
Definition:
Bleeding from the vagina of the pregnant mother after the fetus is viable (~28 wks and
above) and before the fetus is born (before the 3rd stage of labour).

4. BACKGOUND INFORMATION:
• Non-pregnant state: uterus receives 1% of cardiac output
• Plasma volume increases by 50%
•CO increases by 30-50%
• Third trimester: uterus receives 20% of an increased output
• Real potential for massive hemorrhage
• Third trimester bleeding occurs in approximately 4% of patients.
• Approximately 50% will have an inconsequential cause and 50% will
have a life-threatening event .

5. Causes of Antepartum Hemorrhage.
• Placenta causes:
Placenta Previa
Abruptio placenta
• Non placenta causes
Vasa previa
Uterine rupture

6. PLACENTA PREVIA.
Definition: is a complication of pregnancy, when the placenta is in the
lower segment of the uterus and covers part or all of the cervix.
Placental migration:
• At 17 weeks gestation, placental tissue will cover the os in 5-15% of
all patients
• Differential growth of the lower uterine segment
• 90% will resolve by term

7. Risk factors.
• Multiparty
• Increased maternal age >35years
• Previous placenta previa, recurrence rate 4-8%
• Multiple gestation
• Previous cesarean section
• Uterine anomalies
• Maternal smoking
• Uterine fibroid

8. Clinical features.
Painless vaginal bleeding, which is unprovoked occurred during at
rest or when sleeping
• The bleeding is small in amount at first but it increases, it stain the
underwear or soak the lying sheet or trickles down the foot.
Normal fetal heart sound
High presenting part or no engagement
Fetal malpresentation
• Vaginal examination is contraindicated since you may provoke
severe bleeding.

9. Grades of Placenta Previa.
• Grade 1: the placental edge is in the lower uterine segment but does
not reach the internal os (low implantation).
• Grade 2: the placental edge reaches the internal os but does not
cover it, marginal placenta lie.
• Grade 3: the placenta covers the internal os when it is close and is
asymmetrically situated (partial).
• Grade 4: the placenta covers the internal os and is centrally situated
(complete)

11. Management of Placenta Previa.
Investigations:
• Hb level
• Grouping & cross match
• Obstetric Uss to localize placenta.
• Coagulation profile

12. Treatment.
 If partial PP and asymptomatic – Bed rest at home and follow up every 2weeks
If complete placenta Previa
o Admit for close monitoring and observation
o Perform ultrasound to localize the placenta
o Perform FBP, Coagulation tests, Blood grouping and cross matching.
o Keep at least 2 units of blood ready in the bank for transfusion in case of acute bleeding
o Consider Blood transfusion if indicated
o Avoid vaginal digital examination
o If ˃34weeks and no PV bleeding or contraction, expectant management
o Deliver by Cesarean section preferably at 37–38 weeks of gestation
o Deliver by caesarean section by C/S any time incase of onset of labour or severe Pv bleeding
o Partial or marginal placenta Previa: Carefully perform amniotomy for vaginal delivery if the
head is engaged.

13. Pharmacological management
• Dexamethasone (PO) 6mg 12hourly for 48 hours if pregnancy is
˂34weeks for fetal lung maturation
• Nifedipine (PO) 20mg 8hourly until labour symptoms subside

14. Complications.
Maternal complications
• Hemorrhagic shock
• Consumptive coagulopathy
• Placenta accreta or increta more common in low lying placenta and
placenta previa
• Hysterectomy in case of plac. increta with severe postnatal bleeding
• Acute kidney injury due excessive blood loss
Fetal complications
• Prematurity
• Fetal death or still birth

15. End of placenta Previa
•Thank you all…………..
•ANY
QUESTION….?????????