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This document provides information about amniotic fluid embolism (AFE), a life-threatening obstetric emergency. AFE occurs when amniotic fluid, fetal cells, hair or debris enters the mother's bloodstream during labor or delivery. It can cause sudden collapse, profound hypotension, hypoxemia, and disseminated intravascular coagulation (DIC). Treatment is symptomatic and focuses on oxygenation, hemodynamic support, and correcting coagulopathy through resuscitation, intravenous fluids, inotropes, and hematological support such as blood transfusions. Despite treatment, AFE continues to have a high mortality rate.
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Amniotic fluid embolism
Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency that occurs when amniotic fluid, fetal cells, hair or debris enters the mother's bloodstream during labor and delivery. It can cause sudden collapse, hypoxemia and disseminated intravascular coagulation (DIC). Treatment is supportive and aims to maintain oxygenation and hemodynamic stability through oxygen supplementation, IV fluids, vasopressors and blood products. Even with aggressive management, AFE carries a high risk of developing acute respiratory distress syndrome, heart failure and death.
amniotic fluid embolism and cardiac arrest in pregnancy
obstetric emergency. amniotic fluid embolism-pathophysiology,clinical presentation, diagnosis, treatment, laboratory investigations and prognosis. cardiac arrest in preganacy and ACLS 2015 guidelines for CPR and new updates
Amniotic fluid-embolism - Define, Sign, Symptoms, Etiology, Pathology, Diagno...
AFE is a rare but life-threatening complication of pregnancy caused when amniotic fluid, fetal cells or debris enter the maternal circulation. It has a high mortality rate and serious implications for both mother and infant. AFE should be suspected in pregnant patients experiencing sudden respiratory distress, cardiac collapse, seizures or abnormal bleeding. Prompt diagnosis and aggressive treatment including ventilation, fluid resuscitation, vasopressors and coagulopathy management are required but outcomes remain poor.
Amniotic fluid embolism
Amniotic fluid embolism (AFE) occurs when amniotic fluid enters maternal circulation, most commonly during labor and delivery. It can cause respiratory failure, cardiogenic shock, and disseminated intravascular coagulation. Symptoms are nonspecific initially but may progress rapidly to include hypoxia, cardiac collapse, and seizures. While the exact cause is unknown, it is thought to involve an immune response or abnormal substances in amniotic fluid. Prompt diagnosis and treatment of hypoxia, shock, and coagulopathy is needed but outcomes remain poor, with maternal mortality rates around 60-90%.
Amniotic fluid embolism
Amniotic fluid embolism (AFE) is a rare but serious complication of pregnancy and childbirth that can cause respiratory distress, cardiac arrest, and coagulopathy in the mother. It occurs when amniotic fluid enters the mother's bloodstream during delivery or other obstetric procedures. AFE has no known cause and is difficult to diagnose, but symptoms include sudden hypotension, hypoxemia, and coagulopathy in the mother. Treatment focuses on supportive care and aggressive intervention to stabilize the mother's vital systems, but AFE continues to be associated with high mortality rates over 60% for both mothers and infants. Obstetricians must be aware of AFE to promptly diagnose and treat it.
Maternal death autopsy
Maternal death can be classified as direct, indirect, or coincidental based on the cause. Direct causes are conditions directly related to pregnancy and delivery, such as pre-eclampsia, postpartum hemorrhage, and sepsis. Indirect causes do not directly involve pregnancy but are exacerbated by it, like venous thromboembolism and cardiac diseases. Autopsies aim to determine the precise cause of death through examination of organs like the lungs, brain, kidneys, and placenta as well as sterile blood cultures and histopathological analysis. Understanding the cause is important for improving maternal healthcare and assessing claims of clinical negligence.
Anaesthetic management of obstetric emergencies
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
Amniotic Fluid Embolism Sept 2019.ppt
Amniotic Fluid Embolism (AFE) is a rare but life-threatening complication of pregnancy where amniotic fluid enters the maternal circulation, potentially triggering anaphylaxis. It has a high mortality rate and can cause sudden cardiorespiratory collapse in the mother. Definitive diagnosis is challenging and treatment requires prompt resuscitation, management of coagulopathy, and delivery of the baby. Even with treatment, maternal and infant mortality from AFE remains significant.
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Amniotic fluid embolism
Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency that occurs when amniotic fluid, fetal cells, hair or debris enters the mother's bloodstream during labor and delivery. It can cause sudden collapse, hypoxemia and disseminated intravascular coagulation (DIC). Treatment is supportive and aims to maintain oxygenation and hemodynamic stability through oxygen supplementation, IV fluids, vasopressors and blood products. Even with aggressive management, AFE carries a high risk of developing acute respiratory distress syndrome, heart failure and death.
amniotic fluid embolism and cardiac arrest in pregnancy
obstetric emergency. amniotic fluid embolism-pathophysiology,clinical presentation, diagnosis, treatment, laboratory investigations and prognosis. cardiac arrest in preganacy and ACLS 2015 guidelines for CPR and new updates
Amniotic fluid-embolism - Define, Sign, Symptoms, Etiology, Pathology, Diagno...
AFE is a rare but life-threatening complication of pregnancy caused when amniotic fluid, fetal cells or debris enter the maternal circulation. It has a high mortality rate and serious implications for both mother and infant. AFE should be suspected in pregnant patients experiencing sudden respiratory distress, cardiac collapse, seizures or abnormal bleeding. Prompt diagnosis and aggressive treatment including ventilation, fluid resuscitation, vasopressors and coagulopathy management are required but outcomes remain poor.
Amniotic fluid embolism
Amniotic fluid embolism (AFE) occurs when amniotic fluid enters maternal circulation, most commonly during labor and delivery. It can cause respiratory failure, cardiogenic shock, and disseminated intravascular coagulation. Symptoms are nonspecific initially but may progress rapidly to include hypoxia, cardiac collapse, and seizures. While the exact cause is unknown, it is thought to involve an immune response or abnormal substances in amniotic fluid. Prompt diagnosis and treatment of hypoxia, shock, and coagulopathy is needed but outcomes remain poor, with maternal mortality rates around 60-90%.
Amniotic fluid embolism
Amniotic fluid embolism (AFE) is a rare but serious complication of pregnancy and childbirth that can cause respiratory distress, cardiac arrest, and coagulopathy in the mother. It occurs when amniotic fluid enters the mother's bloodstream during delivery or other obstetric procedures. AFE has no known cause and is difficult to diagnose, but symptoms include sudden hypotension, hypoxemia, and coagulopathy in the mother. Treatment focuses on supportive care and aggressive intervention to stabilize the mother's vital systems, but AFE continues to be associated with high mortality rates over 60% for both mothers and infants. Obstetricians must be aware of AFE to promptly diagnose and treat it.
Maternal death autopsy
Maternal death can be classified as direct, indirect, or coincidental based on the cause. Direct causes are conditions directly related to pregnancy and delivery, such as pre-eclampsia, postpartum hemorrhage, and sepsis. Indirect causes do not directly involve pregnancy but are exacerbated by it, like venous thromboembolism and cardiac diseases. Autopsies aim to determine the precise cause of death through examination of organs like the lungs, brain, kidneys, and placenta as well as sterile blood cultures and histopathological analysis. Understanding the cause is important for improving maternal healthcare and assessing claims of clinical negligence.
Anaesthetic management of obstetric emergencies
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
Amniotic Fluid Embolism Sept 2019.ppt
Amniotic Fluid Embolism (AFE) is a rare but life-threatening complication of pregnancy where amniotic fluid enters the maternal circulation, potentially triggering anaphylaxis. It has a high mortality rate and can cause sudden cardiorespiratory collapse in the mother. Definitive diagnosis is challenging and treatment requires prompt resuscitation, management of coagulopathy, and delivery of the baby. Even with treatment, maternal and infant mortality from AFE remains significant.
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Pulmonary hemorrhage is bleeding into the lungs that commonly affects premature infants. It presents with bloody secretions from the endotracheal tube and causes rapid clinical deterioration. Risk factors include prematurity, respiratory problems, sepsis, and mechanical ventilation. The pathophysiology involves stress on capillaries from transmural pressure, alveolar surface tension, and lung inflation. Management focuses on supportive care like ventilation, volume expansion, and transfusions to improve oxygenation and stop the bleeding. Prognosis depends on the severity and underlying causes, with mortality up to 50% in very premature infants.
Pulmonary causes of peripartum hypoxia
This document discusses various pulmonary causes of peripartum hypoxia including both chronic and acute conditions. Chronic causes mentioned include pneumonia, bronchial asthma, tuberculosis, and interstitial lung diseases. Acute causes discussed in more detail include venous thromboembolism, aspiration pneumonia, amniotic fluid embolism, ARDS, pulmonary edema, anesthetic complications, and pneumothorax. For each condition, the document outlines signs and symptoms, diagnostic criteria, and recommended treatment approaches.
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Pathophysiology of shunt lesions
Major complications
Cardiac failure
Pulmonary hypertension
Preoperative assessment
Anaesthetic management
Postoperative management
Conclusion
Obstetric good Emergencies and treatmentpptx
1. Obstetric hemorrhage is a leading cause of maternal mortality. Massive obstetric hemorrhage is defined as blood loss greater than 1500 ml or signs of shock. It is difficult to diagnose due to masking of signs by pregnancy physiology.
2. Placenta previa occurs when the placenta covers the cervix and can cause painless bleeding in the second or third trimester. Diagnosis is by ultrasound and management involves expectant care in hospital or cesarean delivery depending on placental location.
3. Placental abruption occurs when the placenta separates from the uterus before delivery and can cause concealed bleeding. It is diagnosed clinically but ultrasound can help.
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This is an acute terrifying emergency following delivery in which patient suddenly develops dyspnoea, apnoea, cyanosis with or without seizure and shock among other features. It usually occurs secondary to several catastrophic events and may be a tragic experience to the patient and the physician
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This document discusses the pathophysiology of pregnancy induced hypertension. It begins by noting that hypertension is a leading cause of maternal and perinatal mortality, with an incidence of 5-10% that is increasing. It then describes the normal hemodynamic changes in pregnancy, including increased plasma volume and cardiac output. The document discusses etiologies such as poor placentation and immunological factors. It outlines the pathogenesis, including vasospasm, endothelial activation, and angiogenic/antiangiogenic factors. It details effects on organ systems like the brain, liver, kidneys and cardiovascular system. Finally, it provides classifications for HELLP syndrome and reviews its associated maternal morbidities.
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Maternal collapse is a rare but life-threatening event with various potential causes. Prompt resuscitation is crucial to improve outcomes for both mother and fetus. Common causes of maternal collapse include hemorrhage, thromboembolism, amniotic fluid embolism, cardiac issues, sepsis, and drug overdoses. Physiological changes in pregnancy can accelerate the development of hypoxia and acidosis, making ventilation more difficult. Effective resuscitation requires protecting the airway, providing supplemental oxygen, performing chest compressions while tilting the woman to relieve aortocaval compression, and addressing any underlying causes of collapse.
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Amniotic Fluid Embolism [AFE] Approach to Management
Amniotic fluid embolism (AFE) is a life threatening obstetric emergency characterized by sudden cardiorespiratory collapse and disseminated intravascular coagulation.
Steiner and Luschbaugh first described AFE in 1941, after they found fetal debris in the pulmonary circulation of women who died during labor. Data from the National Amniotic Fluid Embolus Registry (USA) suggest that the process is more similar to anaphylaxis than to embolism, and the term anaphylactoid syndrome of pregnancy has been suggested because fetal tissue or amniotic fluid components are not universally found in women who present with signs and symptoms attributable to AFE.
The diagnosis of AFE has traditionally been made at autopsy when fetal squamous cells are found in the maternal pulmonary circulation; however, fetal squamous cells are commonly found in the circulation of laboring patients who do not develop the syndrome. The diagnosis is essentially one of exclusion based on clinical presentation. Other causes of hemodynamic instability should not be neglected.
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Pulmonary causes of peripartum hypoxia
This document discusses various pulmonary causes of peripartum hypoxia including both chronic and acute conditions. Chronic causes mentioned include pneumonia, bronchial asthma, tuberculosis, and interstitial lung diseases. Acute causes discussed in more detail include venous thromboembolism, aspiration pneumonia, amniotic fluid embolism, ARDS, pulmonary edema, anesthetic complications, and pneumothorax. For each condition, the document outlines signs and symptoms, diagnostic criteria, and recommended treatment approaches.
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1. Obstetric hemorrhage is a leading cause of maternal mortality. Massive obstetric hemorrhage is defined as blood loss greater than 1500 ml or signs of shock. It is difficult to diagnose due to masking of signs by pregnancy physiology.
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Amniotic fluid embolism (AFE) is a life threatening obstetric emergency characterized by sudden cardiorespiratory collapse and disseminated intravascular coagulation.
Steiner and Luschbaugh first described AFE in 1941, after they found fetal debris in the pulmonary circulation of women who died during labor. Data from the National Amniotic Fluid Embolus Registry (USA) suggest that the process is more similar to anaphylaxis than to embolism, and the term anaphylactoid syndrome of pregnancy has been suggested because fetal tissue or amniotic fluid components are not universally found in women who present with signs and symptoms attributable to AFE.
The diagnosis of AFE has traditionally been made at autopsy when fetal squamous cells are found in the maternal pulmonary circulation; however, fetal squamous cells are commonly found in the circulation of laboring patients who do not develop the syndrome. The diagnosis is essentially one of exclusion based on clinical presentation. Other causes of hemodynamic instability should not be neglected.
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This document summarizes preeclampsia, including its classification, etiology, epidemiology, risk factors, symptoms, complications, prevention, and conclusion. Preeclampsia is a pregnancy complication characterized by hypertension and proteinuria. It remains a leading cause of maternal and infant mortality. The pathophysiology involves poor placentation leading to placental ischemia and release of factors causing maternal endothelial dysfunction. Risk factors include previous preeclampsia, age under 18 or over 40, family history, chronic hypertension, diabetes, and obesity. Symptoms may include edema, headaches and nausea. Complications can include eclampsia, HELLP syndrome, stroke and death. Prevention focuses on delivery, and treatment involves blood pressure management
Cranial Hemorrhage of The Newborn
Cranial hemorrhage in newborns can be extracranial (e.g. cephalhematoma) or intracranial (e.g. subdural hemorrhage). Intracerebral hemorrhage, especially germinal matrix and intraventricular hemorrhage, is the most common type seen in preterm infants. Risk factors include prematurity, fluctuations in blood pressure, and hypoxic events. Intraventricular hemorrhage is graded based on its extent using cranial ultrasound or CT scan. Most hemorrhages occur within 3 days of birth and management involves supportive care though progressive ventricular dilation may require ventricular shunting. Outcomes depend on the grade of hemorrhage
Meconium stained amniotic fluid aspiration syndrome
Meconium stained amniotic fluid can occur in 10-25% of births after 34 weeks and may lead to meconium aspiration syndrome (MAS) in 4-10% of cases. MAS causes respiratory distress due to meconium being inhaled into the lungs and can lead to complications like pulmonary hypertension. Risk factors include placental insufficiency, maternal diabetes/hypertension, and post-term delivery. Diagnosis is based on clinical features and chest x-ray findings, and management involves respiratory support, antibiotics, and treatments for pulmonary hypertension. While most cases resolve, severe MAS can cause long-term pulmonary or neurological issues.
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Inventory control involves planning and coordinating all activities related to materials and inventory from acquisition to use in manufacturing or services. It aims to ensure adequate supply of necessary items while minimizing costs through various classification and analysis methods. Nurses play a key role in inventory control by indenting, receiving, storing, and replenishing supplies and equipment and maintaining accurate records to facilitate smooth hospital operations.
a presentation on e- nursing, e -learning
The document discusses e-nursing/e-learning in nursing. It defines e-nursing as using computers or electronic devices to provide training, education and learning materials. It discusses the goals of e-nursing as enhancing nursing skills and outcomes. It outlines different styles and forms of e-learning, including asynchronous learning like email/forums and synchronous learning like video calls. The benefits are discussed as flexibility, cost-effectiveness, and standardized delivery. Challenges include lack of IT skills and isolation. Overall, the document promotes e-learning as an effective way to support nursing education and development.
MATERNAL INJURIES.pptx
Maternal injuries following childbirth are common and can lead to morbidity or death if not properly managed. Injuries often occur in the vulva, perineum, and cervix during delivery. Prevention focuses on proper conduct during the second stage of labor and taking care of the perineum. Risk factors for serious third degree tears include high birth weight babies, first births, narrow pelvis, and instrument-assisted deliveries. Injuries are usually repaired immediately but some tears may need to wait 3 months for repair. Complications include hemorrhage, infection, and problems with the pelvic floor later in life if not addressed properly.
prparation of childbirth and parenthood.pptx
This document discusses the preparation of childbirth and parenthood. It defines childbirth as an educational approach to labor and delivery where parents are specially prepared. Parenthood refers to promoting a child's development from infancy to adulthood. The aims of preparation include supporting couples, providing parenting information, and encouraging coordination between professionals and pregnant women. Important points covered include planning birth attendants, exercises to reduce pain during labor, and the importance of institutional delivery for antenatal care, newborn care, immunization and hygienic conditions. Prenatal counseling is also discussed as a way to identify and modify risks to promote healthy behaviors and outcomes.
Fetal circulation.pptx
The fetal circulation differs from adult circulation due to the presence of three major vascular shunts that allow blood to bypass the lungs while oxygen is received from the placenta. The placenta functions as the fetal lungs, exchanging gases and nutrients between maternal and fetal blood without their blood mixing. At birth, changes in pulmonary and systemic vascular resistances cause the ductus arteriosus and foramen ovale to close, adapting circulation to extrauterine life with gas exchange occurring in the lungs.
DRUGS.pptx
Rh incompatibility occurs in 5-10% of pregnancies in India when an Rh-negative mother is carrying an Rh-positive baby. RhIG (Rh0(D) immune globulin) is given to Rh-negative mothers during and after delivery to prevent Rh isoimmunization. RhIG works by coating Rh-positive red blood cells from the baby with IgG antibodies, which allows mononuclear cells to clear the coated cells from circulation through Fc gamma receptors and phagocytosis. Administering RhIG can prevent Rh isoimmunization in non-sensitized Rh-negative mothers during pregnancy events like miscarriages or amniocentesis as well as during and after delivery.
GENETICS PPT.pptx
This document provides information on various genetics concepts including genes, chromosomes, inheritance patterns, and examples of genetic disorders. It discusses the basics of genetics including definitions of key terms like gene, chromosome, karyotype, genotype, phenotype, alleles, mutation, and inheritance patterns such as autosomal recessive, autosomal dominant, X-linked recessive, and examples for each. Specific genetic disorders discussed include cystic fibrosis, mucopolysaccharidoses, phenylketonuria, sickle cell disease, Tay-Sachs disease, and Duchenne muscular dystrophy.
STANDARDIZED & NON-STANDARDIZED TESTS.pptx
This document defines and compares standardized and non-standardized assessment tools. It provides examples of different types of assessment tools used in education, healthcare, the workplace, research, psychology, government, and other fields to evaluate individuals, inform decisions, and guide interventions. Standardized tools are designed for uniform administration and scoring to ensure fairness and allow meaningful comparisons against norms, while non-standardized tools have more flexibility in their use.
Uterine Malformations.pptx
Uterine malformations occur due to abnormal development of the Mullerian ducts during embryogenesis. They can range from complete agenesis to defects involving the shape of the uterus. The American Fertility Society classifies uterine anomalies into 7 main categories based on the type of defect. Uterine malformations may cause issues with fertility, pregnancy maintenance, and delivery due to complications like abortion, preterm birth, malpresentation, and postpartum hemorrhage. Corrective surgeries can help address some types of defects to enable normal conception and pregnancy.
healthinsurance-140115042716-phpapp02.pptx
This document provides information about health insurance, including its purpose of covering medical costs and protecting against unexpected high costs. It discusses how to get and claim health insurance, as well as the advantages like risk coverage, tax benefits, and peace of mind. The disadvantages include restricted hospitals and pre-existing conditions not being covered. It also outlines how to surrender a health insurance policy and avoid health insurance scams by verifying agents and not giving sensitive information or paying premiums through agents.
INFERTILITY.pptx
This document discusses various factors that can cause infertility in males and females. It describes abnormalities that can impair sperm production or function in males such as low sperm count, abnormal sperm morphology or motility. It also discusses erection or ejaculation issues. In females, it mentions disorders of ovulation, fallopian tube abnormalities, cervical issues, or recurrent pregnancy loss as factors. Some diagnostic tests and treatments for infertility are also outlined such as semen analysis, ovulation predictor kits, fertility drugs, artificial insemination, IVF etc.
Infection Control Practice and Standard Safety Measures.pptx
The document discusses infection control and standard safety measures in healthcare facilities. It covers topics like infection control programs, the chain of infection, hand hygiene, personal protective equipment, needlestick injury prevention, environmental cleaning, cleaning and sterilization of medical equipment, biomedical waste management, safe injection practices, and the roles and responsibilities of hospital infection control committees. The overall aim is to prevent healthcare-associated infections and protect both patients and healthcare workers from infections.
BABY FRIENDLY HOSPITAL.PPT
The document summarizes the WHO/UNICEF Baby-Friendly Hospital Initiative, which aims to make hospitals and birthing centers centers of breastfeeding support. It outlines the 10 steps of the initiative, including establishing written breastfeeding policies, training staff, rooming-in, and not providing breastmilk substitutes. Implementing these steps could save 1.5 million lives annually by promoting exclusive breastfeeding for the first six months. The document also describes the process for facilities to become Baby-Friendly designated through a self-appraisal and external assessment against global criteria.
ANEMIA AND NUTRITIONAL DEFICIENCIES IN PREGNANCY.pptx
This document discusses anemia and nutritional deficiencies that commonly affect pregnant women in developing countries. It defines anemia in pregnancy according to the WHO as a hemoglobin level less than 11 g/dL. The main causes of anemia in pregnancy discussed are iron deficiency, folate and vitamin B12 deficiencies, chronic blood loss, infections, and hereditary conditions like thalassemia and sickle cell anemia. Treatment focuses on iron supplementation as well as addressing the underlying cause. Complications of anemia for both mother and fetus are also outlined.
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āEnvironmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the publicā.The overall importance of sanitationĀ are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
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Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
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GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
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These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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Gastritis and Gastric Health
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amniotic fluid embolism.pptx
- 1. AMNIOTIC FLUID EMBOLISM MRS. DEEPTI KUKRETI PG NURSING TUTOR OBSTETRICS& GYNAECOLOGY
- 2. AMNIOTIC FLUID EMBOLISM DEFINITION ā¢ Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency. ā¢ It happens due to sudden gush of amniotic fluid ,fetal cells , hair and amniotic debry entering the maternal circulation. ā¢ Signs and Symptoms: 1. Sudden collapse due to profound hypotension. 2. Hypoxemia 3. DIC (Disemminated intravascular coagulation)
- 3. Differential Diagnosis Obstetric Causes ā¢ Acute hemorrhage ā¢ Amniotic fluid embolism ā¢ Placental abruption ā¢ Uterine rupture ā¢ Uterine atony ā¢ Eclampsia ā¢ Peripartum cardiomyopathy Anesthetic Causes ā¢ High spinal anesthesia ā¢ Aspiration ā¢ Local anesthetic toxicity Non obstetric Causes ā¢ Pulmonary embolism ā¢ Air embolism ā¢ Anaphylaxis ā¢ Sepsis/septic shock ā¢ Intracerebral bleed ā¢ Drug toxicity ā¢ Acute myocardial infarction
- 4. Factors that may be associated withAFE ā¢ Advanced maternal age ā¢ Multiparity ā¢ Meconium stained liquor ā¢ Obstructed labor ā¢ Intrauterine fetal death ā¢ Polyhydramnios ā¢ Tetanic uterine contractions ā¢ Maternal history of allergy or atopy ā¢ Uterine rupture ā¢ Placenta accreta ā¢ Trauma ā¢ Diabetes mellitus ā¢ Operative delivery including cesarean section.
- 5. Symptoms Signs Dyspnea Hypotension Cough Fetal Distress Headache Pulmonary edema/ARDS Chest Pain Cyanosis Coagulopathy Seizures Bronchospasm Cardiopulmonary arrest UterineAtony CLINICAL FEATURES
- 6. Treatment ā¢ Management is symptomatic and supportive. ā¢ Targets- Maintaining oxygenation ,hemodynamic support and correction of coagulopathy ā¢ Immediate Resuscitation-ABC ļ§ Airway and breathing ā¢ Administer 100% oxygen via a non-rebreathing reservoir face mask ā¢ Prompt assessment, with control of the airway and ventilation of the lungs with tracheal intubation may be essential. ļ§ Circulation ā¢ 2 large bore iv lines, send blood for coagulation profile, CBC, crossmatch, arrange 6units blood. ā¢ Left lateral tilt/Manual uterine displacement. ā¢ Hemodynamic support would include preload optimization and vasopressors.
- 7. ā¢ Fluid resuscitation with crystalloid/colloid to optimize filling. ā¢ Infusion of an inotrope may be required to maintain a mean arterial blood pressure and achieve an adequate urine output. ā¢ An arterial line for continuous blood pressure monitoring is essential, and the use of a non-invasive cardiac output monitor may be helpful. ā¢ Continuously monitor the fetus and early consideration should be given to delivery of baby. ļ§ Uterine tone āPharmacologic agents such as oxytocin, ergometrine and prostaglandins carboprost and misoprost. ļ§ Coagulation: ā¢ Use of plasma, cryoprecipitate, and platelets to be guided by clinical condition of the patient and laboratory investigations. ā¢ Recombinant factor VII may be used, but one should be careful as this can cause thrombotic complications ļ§ Antifibrinolytics, like e-aminocaproic acid and tranexamic acid, might be helpful but evidence is lacking.
- 8. Investigations ā¢ Coagulation profile: AFE is associated with DIC in >80% cases ā¢ Electrocardiogram shows tachycardia, ST segment and T-wave changes, and findings consistent with right ventricle strain ā¢ Arterial blood gases: changes consistent with hypoxia ā¢ Chest X-ray: consistent with pulmonary edema ā¢ Echocardiogram ā¢ Serum tryptase
- 9. Management ā¢ Intensive care monitoring ā¢ One should be aware that there is high-risk at developing: ARDS, heart failure, DIC ā¢ Supportive treatment: Ventilation, inotropic support, Hematological support ā¢ Steroids may be useful Potential Interventions for Severe Life Threatening Cases of AFE ā¢ Inhaled nitric oxide for pulmonary hypertension leading to right-sided heart failure ā¢ ECMO for severe hypoxia and left heart failure.
- 10. THANK YOU