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Obstetric emergencies part 1


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Obstetric emergencies part 1

  1. 1. Obstetric Emergencies obstetricsII by mukerem BY MUKEREM.A 2007
  2. 2. Obstetric emergency cont… Purpose: The purpose of this topic is to introduce students to an organized and effective approach in providing care to obstetric emergencies. learning objectives: • By the end of this chapter, the students will be able to: • Describe key steps in rapid initial assessment of a woman with emergency problems. • Outline key emergency management steps for specific obstetric emergency problems. • Demonstrate steps in detection and management of “shock”. BY MUKEREM.A 2007
  3. 3. . Prolapse of the cord and cord presentation Objectives By the end of this session students should: Know the definition of cord prolapse Understand the risk factors associated with cord prolapse Be confident to managing a mother with cord prolapse BY MUKEREM.A 2007
  4. 4. Obstetric emergency cont… 1. Prolapse of the cord and cord presentation Cord presentation: This occurs when the umbilical cord lies in front of the presenting part with the membranes still intact  Cord prolapse. (Overt prolapsed cord): In this case the cord lies in front of the presenting part and the membranes are ruptured. obstetricsII by mukerem BY MUKEREM.A 2007
  5. 5. Cont… BY MUKEREM.A 2007
  6. 6. Obstetric emergency cont… Occult cord prolapse: The cord lies along side but not in front of the presenting part.  Funic occult: The umbilical cord has prolapsed in front of the presenting part but not through the cervical Os in the presence of intact membranes BY MUKEREM.A 2007
  7. 7. Obstetric emergency cont… Possible causes or predisposing factors Any badly fitting presenting part Malpresentaiton – is the most common cause Breech presentation Shoulder presentation Face and brow presentations Prematurity of the fetus. This condition offers space between the fetus and the pelvis BY MUKEREM.A 2007
  8. 8. Obstetric emergency cont… Amniotomy the cord swept due to gush of fluid  Multiple pregnancies – particularly second twin  Contracted pelvis  Poly hydramnios – the cord is liable to be swept down in a gush of liquor if the membrane ruptures spontaneously.  Lower implantation of the placenta  Abnormally long cord Congenital abnormality of uterus BY MUKEREM.A 2007
  9. 9. GROUP DISSCUSSION 1) Do U think we can prevent Prolapse of the cord and cord presentation ??? 2) Which one is more risky 4 fetus??? BY MUKEREM.A 2007
  10. 10. Clinical features • Umbilical cord visibleat,orexternal to,the vaginal opening • Evidence of membranes having ruptured • A nonreassuring fetal status: - change in fetal movement pattern - Meconium in the amnioticfluid (vaginal discharge may be stainedgreen) - Fetal tachycardia - Fetal bradycardia(morecommon) BY MUKEREM.A 2007
  11. 11. Obstetric emergency cont… Diagnosis 1. Feeling of the cord during vaginal examination 2. An abnormal fetal heart rate particularly Bradycardia 3. Occasionally the loop of the cord seen at the vulva. 4. ultrasaund BY MUKEREM.A 2007
  12. 12. Obstetric emergency cont… Management The treatment depends up on the; degree of cervical dilatation the live of the fetus the type of presentation Emergency Care 1. Insert a gloved hand in to the vagina and push the presenting part up to decrease pressure on the card and dislodge the presenting part from the pelvis BY MUKEREM.A 2007
  13. 13. Obstetric emergency cont… 2. Relieve pressure Raise end of bed Put mother knee chest position Exaggerated sims position 3. Do vaginal examination note Presentation; dilatation and pulsation of the cord. 4. If membranes intact avoid rupturing them. BY MUKEREM.A 2007
  14. 14. Obstetric emergency cont… Complications The risk to the fetus is hypoxia and death as a result of cord compression. The risks are greatest in cephalic presentation than complete or footling breech and transveres lie. Primgrvida than multigrvida obstetricsII by mukerem BY MUKEREM.A 2007
  15. 15. Obstetric emergency cont… Management in the first stage of labor 1. An immediate caesarean section is performed if the fetus is alive obstetricsII by mukerem BY MUKEREM.A 2007
  16. 16. Obstetric emergency cont… Management in the second stage of labor If the lie is longitudinal and the cx is fully dilated forceps delivery or breech extraction may be done. If there is any possibility that a vaginal delivery may be difficult a C/S should be performed. If the fetus is dead with a longitudinal lie no urgent treatment required but spontaneous vaginal delivery should be a waited. BY MUKEREM.A 2007
  17. 17. Obstetric emergency cont… NB:- In the community if the fetus is alive the woman should be transferred to hospital by ambulance immediately while the midwife relieves pressure on the cord as described above. The knee – chest position is uncomfortable for the woman to maintain for any length of time. An exaggerated sims position is preferable. obstetricsII by mukerem BY MUKEREM.A 2007
  18. 18. Obstetric emergency cont… 3. Managing amniotic fluid embolism Amniotic fluid embolism This condition when amniotic fluid containing meconium, vernix and fetal cells enter the maternal circulation under pressure between the placental and the uterine wall and forming an embolus which obstructs one of the pulmonary arterioles or alveolar capillaries. BY MUKEREM.A 2007
  19. 19. Obstetric emergency cont…  Predisposing Factors 1. Rapid or precipitate labour This considered being the most common cause. hypertonic contraction which occurs in this type of labour. 2. Over stimulation of the uterus. Excessive use of oxytocin drugs or prostaglandins may cause hypertonic uterine action. 3. Uterine trauma  Eg. During uterine rupture and internal podalic version. obstetricsII by mukerem BY MUKEREM.A 2007
  20. 20. Obstetric emergency cont… Sign and Symptoms Sudden onset of maternal respiratory distress such as severe dyspenia and cyanosis. Cardio vascular collapse Tachycardia Hypotension Cardiac arrest Convulsions Hemorrhage Usually result of disseminated intravascular coagulation. Amniotic fluid is rich in thromboplastin which attracts fibrinogen. obstetricsII by mukerem BY MUKEREM.A 2007
  21. 21. Obstetric emergency cont… Emergency management 1. Anyone of the above symptoms is indicative of an acute emergency. The doctor/midwife should immediately summon. 2. Oxygen administered by face mask 4 lt/min 3. Suction 4. Resuscitation equipment should be at hand 5. If she undelivered the fetal heart rate should be monitored continuously. 6. Treat hemorrhage BY MUKEREM.A 2007
  22. 22. Obstetric emergency cont… Complications Death due to cardiopulmonary collapse DIC Acute renal failure obstetricsII by mukerem BY MUKEREM.A 2007
  23. 23. Obstetric emergency cont… 4. Managing rupture of the uterus Rupture of the uterus The most serious complication in midwifery and obstetrics It is often fatal for the fetus and may also be responsible for the death of the mother. Defn :- This is where there is a tear in the uterine wall BY MUKEREM.A 2007
  24. 24. Obstetric emergency cont… Two types of tear (rupture) Complete rupture:- When the overlying peritoneal coat is torn and bleeding and fetus is under abdominal skin. Incompletes:- When the peritoneum remains intact and bleeding tracks under the peritoneal cavity. obstericsII by mukerem BY MUKEREM.A 2007
  25. 25. Obstetric emergency cont… Causes /Risk factors Obstructed labour Separation of previous C/S scar Trauma due to operative manipulation The unwise use of oxytocin The extension of an old cervical tear. Neglected labour High parity BY MUKEREM.A 2007
  26. 26. Obstetric emergency cont… Silent rupture of uterus Defn: - rupture in previous c/s scare known as silent rupture. Signs of a silent rupture Rise in pulse above 90/min Pain over the old scar and tenderness Slight vaginal bleeding and vomiting Shock which comes on very slowly Labour will not progress soon  no FHB. BY MUKEREM.A 2007
  27. 27. Obstetric emergency cont… Abrupt rupture Defin:- rupture in obstructed labour know as abrupt rupture Signs of abrupt rupture History of obstructed labour Bandl’s ring is seen before rupture Vomiting of dark brown vomitus No FHB BY MUKEREM.A 2007
  28. 28. Obstetric emergency cont… Confirmation or diagnosis of rupture uterus History of obstructed labour V/S – B/P low with weak and rapid pulse Tender abdomen No FHB Vaginal bleeding No fetal movement No uterine contraction High head Sign of shock and dehydration BY MUKEREM.A 2007
  29. 29. Obstetric emergency cont… Management of a ruptured uterus in health Center Lie patient flat Put up iv drip Give pethidine Transvere her to the nearest hospital Bring donors Go with patient BY MUKEREM.A 2007
  30. 30. Obstetric emergency cont… • Management of a ruptured uterus in the hospital • 1. Lie patient flat • 2. Blood group and cross match • 3. Put Intravenous drip • 4. Get patient to sign consent form • 5. Give pre medication • 6. Carry out doctor’s order BY MUKEREM.A 2007
  31. 31. Obstetric emergency cont… Management 1. Hysterectomy 2. Repair of the uterus. BY MUKEREM.A 2007
  32. 32. Obstetric emergency cont… GROUP DISSCUITON 1) How to Prevent rupture to uterus??? BY MUKEREM.A 2007
  33. 33. Obstetric emergency cont… Prevention of rupture uterus Constant and careful antenatal care Refere to hospital mother who has obstructed labour Detect high risk mothers and select them for hospital delivery Previous section must always delivery in Hospital Care during manipulation Careful observation of the mother in labour to exclude obstructed labour Avoid giving pitocin for previous classical c/s scar BY MUKEREM.A 2007
  34. 34. BY MUKEREM.A 2007