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Obstetrical emergencies

Obstetrical emergencies

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Obstetrical emergencies

  1. 1. OBSTETRICAL EMERGENCIES
  2. 2. OBSTETRICAL EMERGENCIES • • • • Pre-eclampsia and eclampsia HELLP syndrome Post-partum haemorrhage Amniotic fluid embolus
  3. 3. Pre-eclampsia and eclampsia • The hallmark of pre-eclampsia is hypertension with proteinuria. It is considered mild if proteinuria is 0.25–2g/l and severe if >2g/l. • Eclampsia is the same condition associated with seizures.
  4. 4. Management Circulatorymanagement • To Treat High BP use controlled plasma volume expansion as the first line treatment. • Fluid management. • Anti-hypertensives such as labetalol, nifedipine or hydralazine.
  5. 5. Convulsions • Convulsions are best avoided by good blood pressure control. • Benzodiazepines to control seizure • Magnesium sulphate is the treatment of choice for eclamptic convulsions. Magnesium levels should be monitored and kept between 2.53.75mmol/l. Above 3.75mmol/l toxicity with possible cardiorespiratory arrest may be seen. • Prophylactic anticonvulsant therapy with magnesium for pre-eclampsia. • Elective intubation, mechanical hyperventilation and further anticonvulsant therapy.
  6. 6. Early fetaldelivery • If fetal maturity has been reached immediate delivery after control of seizures and hypertension is necessary.
  7. 7. Drug dosages • • • • Labetolol Nifedipine Hydralazine Magnesium
  8. 8. HELLP syndrome • HELLP syndrome is a pregnancy related disorder associated with haemolysis, elevated liver function tests and low platelets.
  9. 9. Clinical features • Epigastric or right upper quadrant pain with malaise. • Nausea and vomiting. • Generalised oedema is usual but hypertension is less common. Presentation may occur postpartum.
  10. 10. Criteria for diagnosis of HELLP syndrome • Haemolysis – Abnormal blood film – Hyperbilirubinaemia – LDH >600U/l • Elevated liver enzymes – AST >70U/l • Thrombocytopenia – Platelets <100×109/l
  11. 11. Management • Resuscitation and exclusion of hepatic haemorrhage or ruptured liver. • In case of ruptured liver an early Caesarean section and definitive surgical repair are urgent. • Treat Microangiopathic haemolysis and thrombocytopenia using plasma exchange and fresh frozen plasma infusion. • Platelet transfusions only in case of an active bleeding.
  12. 12. Post-partum haemorrhage • Resuscitation • Aortic compression using the pressure between the fist and vertebral column • Stimulated uterine contraction-Prostaglandin F2α injected locally in to the uterus or IM • Arterialocclusion-Angiographic embolisation or internal iliac artery ligation
  13. 13. Amniotic fluid embolus • The initial response of the pulmonary vasculature to the presence of amniotic fluid is intense vasospasm resulting in severe pulmonary hypertension and hypoxaemia. • Amniotic fluid contains lipid-rich particulate material which stimulates a systemic inflammatory reaction. Hence it leads to capillary leak and disseminated intravascular coagulation.
  14. 14. Management • Respiratory support – Oxygen (FiO2 0.6–1.0). • CPAP or mechanical ventilation. • Cardiovascular support-controlled fluid loading and inotropic support. • Haematological management-blood product therapy. • Treatment with cryoprecipitate.
  15. 15. Thank you

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