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Obstetrical emergencies

emergencies in obstetrics

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Obstetrical emergencies

  2. 2. Definition Obstetrical emergencies are life threatening medical conditions that occur in pregnancy or during or after labor and delivery.
  3. 3. VASA PREVIA It is an abnormality of the cord that occurs when one or more blood vessels from the umblical cord or placenta cross the cervix but it is not covered by Wharton’s jelly. This condition can cause hypoxia to the baby due to pressure on the blood is a life threatening condition. It occurs in 1 in 2500 births.
  4. 4. ETIOLOGY These vessels may be from either Velamentous insertion of umblical cord placental lobe joined to the main disk of the placenta. Low-lying placentas Previous delivery by C-section
  5. 5. SYMPTOMS Sudden onset of painless vaginal bleeding, especially in their second and third trimesters. The baby’s blood is a darker red color due to the naturally lower oxygen levels of a fetus. If very dark burgundy blood is seen when the water breaks, this may be an indication of vasa previa
  6. 6. Diagnosis  The classic triad of the vasa praevia is  antenatal sonography with color-flow Doppler reveals a vessel crossing the membranes over the internal cervical os. The diagnosis is usually confirmed after delivery on examination of the placenta and fetal membranes. membrane rupture painless vaginal bleeding fetal bradycardia
  7. 7. TREATMENT o Baby can be delivered by C- section between the 35th and 37thweek of pregnancy o Hospitalization throughout third trimester is also recommended . o Steroids are sometimes used to mature the lungs of the fetus if fetus is immature.
  8. 8. AMNIOTIC FLUID EMBOLISM This rare but catastrophic condition occurs when amniotic fluid enters the maternal circulation by uterus and placental site. The presence of amniotic fluid in maternal circulation trigger an anaphylactic response.
  9. 9. The body respond in 2 phases. The initial phase is one of pulmonary vasospasm causing hypoxia, hypotension, pulmonary edema and cardiovascular collapse. The second phase sees the development of left ventricular failure, with hemorrhage and coagulation disorders and further uncontrollable hemorrhage.
  10. 10. CAUSES Ruptured membranes Ruptured uterine or cervical veins Abdominal trauma Amniocentesis. A maternal age of 35 years or older Caesarean or instrumental vaginal delivery Polyhydramnios Cervical laceration or uterine rupture Placenta previa or abruption Eclampsia Fetal distress
  11. 11. SIGNS AND SYMPTOMS Sudden shortness of breath Excess fluid in the lungs Sudden low blood pressure Sudden circulatory failure Life-threatening problems with blood clotting (disseminated intravascular coagulopathy) Altered mental status Nausea or vomiting Chills Rapid heart rate Fetal distress SeizuresComa
  12. 12. TREATMENT  Administer oxygen to maintain normal saturation. Intubate if necessary.  Initiate cardiopulmonary resuscitation (CPR) if the patient arrests. If she does not respond to resuscitation, perform a cesarean delivery.  Treat hypotension with crystalloid and blood products.  Consider pulmonary artery catheterization in patients who are hemodynamically unstable.  Continuously monitor the fetus.
  13. 13. OBSTETRIC SHOCK Shock is a critical condition and a life threatening medical emergency. Shock results from acute, generalized, inadequate perfusion of tissues, below that needed to deliver the oxygen and nutrients for normal function.
  14. 14. CAUSES Hypovolemia (Hemorrhage (occult /overt), hyperemesis, diarrhea, diabetic acidosis, peritonitis, burns.) sepsis Cardiogenic (cardiomyopathies, obstructive structural, obstructive non -structural, dysrhythmias, regurgitant lesions). Anaphylaxis Distributive (Neurogenic- spinal injury, regional anesthesia
  15. 15. STAGES OF SHOCK Stage1 Compensated -- fall in BP and cardiac output is compensated by adjustment of homeostatic mechanism.  Stage2 Decompensate-- Maximal compensatory mechanism are acting but tissue perfusion is reduced. Vital organ (cerebral, renal, myocardial) function reduced.  Stage3 Irreversible--Vital organ perfusion badly impaired. Acute tubular necrosis, severe acidosis, decreased myocardial perfusion and contractility the profound decrease in perfusion leads to cellular death & Organ failure.
  16. 16. DIAGNOSIS
  17. 17. MANAGEMENT Active management of shock should start as soon as it is suspected Resuscitation follows ABC  An Airway--Patent airway is assured and high pressure oxygen (15 l/min) using mask/intra tracheal intubation and anesthesia machine.  B Breathing--Ventilation checked and supported if needed.  C Circulation 1. Insert two wide bore cannulas 2. Restore blood volume and reverse hypotension with crystalloids/colloids. 3. Initial request for 4-6 units of blood should be sent. O Rh negative blood may be transfused.
  18. 18. Monitor the response to therapy - Pulse, BP, SPO2, urine output & its ph.  Position of patient - Head down and left lateral tilt to avoid aortocaval compression which may further worsen the hypotension.
  19. 19. UTERINE INVERSION Uterine inversion is a potentially fatal childbirth complication with a maternal survival rate of about 85%. It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out.
  20. 20. ETIOLOGY  The exact cause of uterus inversion is unclear.  The most likely cause is strong traction on the umbilical cord, particularly when the placenta is in a fundal location, during the third stage of labor.
  22. 22. GRADES OF INVERSION INCOMPLETE INVERSION - the top of the uterus (fundus) has collapsed, but the uterus hasn’t come through the cervix. COMPLETE INVERSION - the uterus is inside-out and coming out through the cervix. PROLAPSED INVERSION - the fundus of the uterus is coming out of the vagina. TOTAL INVERSION - both the uterus and vagina protrude inside-out (this occurs more commonly in cases of cancer than childbirth)
  23. 23. DIAGNOSIS  Prompt diagnosis is crucial and possibly lifesaving. Some of the signs of uterine inversion could include:  The uterus protrudes from the vagina.  The fundus doesn’t seem to be in its proper position when the doctor palpates (feels) the mother’s abdomen.  The mother experiences greater than normal blood loss.  The mother’s blood pressure drops (hypotension).  The mother shows signs of shock (blood loss).  Scans (such as ultrasound or MRI) may be used in some cases to confirm the diagnosis.
  24. 24. TREATMENT Treatment options vary, depending on the individual circumstances and the preferences of the hospital staff, but could include:  Attempts to reinsert the uterus by hand.  Administration of drugs to soften the uterus during reinsertion.  Flushing the vagina with saline solution so that the water pressure ‘inflates’ the uterus and props it back into position (hydrostatic correction).  Manual reinsertion of the uterus while the woman is under general anaesthetic.  Abdominal surgery to reposition the uterus if all other attempts to reinsert it have failed.  Antibiotics to reduce the risk of infection.  Intravenous liquids.  Blood transfusion.  Intravenous administration of oxytocin to trigger contractions and stop the uterus from inverting again.  Emergency hysterectomy (surgical removal of the uterus) in extreme cases where the risk of maternal death is high.  Close monitoring in intensive care for a few days, if necessary.