This document discusses identifying and managing high-risk pregnancies. It defines a high-risk pregnancy as one with maternal complications or obstetric risk factors that could threaten the life of the mother or baby. Conducting risk assessments during antenatal care allows early detection of issues and timely referral for specialized care. Key aspects of managing high-risk pregnancies include monitoring for common risks like hypertension and bleeding, providing appropriate medical treatment, and arranging delivery at tertiary care centers that can handle emergencies. A multidisciplinary team approach involving education of mothers is emphasized to provide the best care and reduce mortality risks.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
HOW TO DO A CESAREAN SECTION, EVIDENCE BASED by DR DELEKemi Dele-Ijagbulu
Introduction and Epidemiology, Indications and Classifications of Cesarean Section, Preoperative, Intra-operative and Postoperative Management, Complications, Concerns about Cesarean Sections, New Evidences on How To Perform a Caesarean Section, and Recommendations
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
HOW TO DO A CESAREAN SECTION, EVIDENCE BASED by DR DELEKemi Dele-Ijagbulu
Introduction and Epidemiology, Indications and Classifications of Cesarean Section, Preoperative, Intra-operative and Postoperative Management, Complications, Concerns about Cesarean Sections, New Evidences on How To Perform a Caesarean Section, and Recommendations
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
Best Ever Guide Shared by Rosa Belinda Sanchez About Importance of Antenatal ...Rosa Belinda Sanchez
Rosa Belinda Sanchez Shared a detailed presentation on importance of antenatal care. This will defiantly help you. If you have any other queries related antenatal care do share in comment section. Find Rosa Belinda Sanchez at https://www.crunchbase.com/organization/rosa-belinda-sanchez-mother-children-care-specialists
High risk approach in maternal and child healthShrooti Shah
High risk pregnancy is defined as one which is complicated by factor or factors that adversely affects the pregnancy outcome –maternal or perinatal or both.The risk factors may be pre-existing prior to or at the time of first antenatal visit or may develop subsequently in the ongoing pregnancy labour or puerperium.
Over 50 percent of all maternal complications and 60 percent of all primary caesarean sections arise from the high risk group of cases.
Introduction
Screening of high risk cases
High risk cases (according to WHO)
Management of high risk cases
Risk approach (according to WHO)
Interventions to reduce maternal mortality
2. Introduction
• Pregnancy including labour & delivery is itself
a high risk event.
• The aim of risk assessment is to identify the
factors that may constitute greater than
average risk to a pregnancy.
• This permits the prediction of potential
adverse pregnancy outcomes & enables the
process of selecting women who may benefit
from extra researches.
4. Introduction
• It is impossible for the process of risk
assessment to predict every perinatal event.
• WHO recommends that a risk assessment
approach be used in the mgt. of maternal,
fetal health care.
• It also suggest arrangement for delivery at
tertiary care center for high risk obst. pts.
.
5. Aim
• To identify women with maternal
complications & obst. risk factors.
7. • It will reduce the number of cases
brought in a state of emergency when
t/t is most difficult & least effective.
• If t/t is started in time, it is possible to
save life of both mother & baby.
• Timely referral after appropriate
medication is important improving the
prognosis.
8.
9. Maternal Mortality
Major causes of maternal mortality are
• PIH
• Eclampsia
• APH
• PPH
• Puerperal sepsis
• Obstructed labour
• Unsafe abortions
10. Maternal mortality is a gender issue
& speaks about the status of women
in the society.
Maternal mortality is an equity issue
as maximum maternal death are
reported from people living below
poverty line from under privilege
community
11. Except for hemorrhage other causes of
maternal mortality can be identified &
treated effectively, thus maternal
mortality can be greatly reduced.
12. Obstetric Emergencies
The obst. emergencies are life threatening
• Fatality rate is more
• Difficult to treat
• Surgery rate is increased
• BT rate is increased
• Hospitalization prolonged
• Morbidity more
13. Cost Effectiveness
• Early diagnosis leads to less
emergencies hence less drug
requirement & less morbidity
• Thus the risk assessment system along
with timely referral is highly cost
effective.
14. What to Do ?
1. Early diagnosis
2. Community awareness about
antenatal care
3. Early initiation of appropriate therapy
4. T/t plan stream lining
5. Early identification
6. Timely referral
15. What to Tell ?
Every clinic must emphasize the following
1. ANC it is essential need
2. Eat more
3. Rest more
4. Get immunized (Inj TT)
5. Take Tab. FS
6. Hospital delivery
16. Ante-natal care
• Periodic check-ups
• Risk factors identified on time
• Treatment started early
• Hospital delivery
• Maternal complications diagnosed early
• Maternal & fetal mortality less
17. Early Registration
• Early – before 12 wks (preferably)
• Before 20 wks
• At 32 wks
• At 36 wks
• Encourage to visit more often in 3rd
trimester
18. ANC
• Careful history
• Physical examination
• Pregnancy progressing normally
• Complications if occurs diagnosed early
• Timely referral
• Institutional delivery
19. History
• LMP/EDD
• Age of the patient < 18 yrs. > 35
yrs.
• Order of pregnancy primigravida or
grand multi.
• Interval of < 2 yrs since last
pregnancy
• H/o cardiac disease, diabetes,
chronic hypertension
20. Past Obst. History
• Parity
• H/o still birth
• IUFD
• BOH
• Preterm labour
• Macrosomic baby
• IUGR baby
• Sev. PIH
21. Life Threatening Situations
• H/o PPH
• H/o APH
• H/o MRP
• H/o Eclampsia/HELLP
• H/o Other complications
associated with
pregnancy which were life
threatening
22. Complaints
• Breathlessness
• Excessive tiredness
• Palpitation
• Puffiness of face
• Headache
• Blurring of vision
• Bleeding p/v
• Leaking p/v
• Pain in abdomen
23. Physical Examination
• Maternal weight
• Maternal height < 140 cm
• Look for pallor, puffiness
of face, oedema of feet.
• Blood pressure 120/80
mmHg > 140/90 mmHg
after 20 wks. S/o PIH
25. Abdominal Examination
• Abdominal examination is done to
monitor the progress of pregnancy, fetal
growth, fetal lie and fetal presentation.
• Height of uterus 12 wks just palpable
24 wks at umbilicus
36 wks at xiphisternum
29. FHS
• Normal 120-160 b.p.m.
• Fetal tachycardia > 160 b.p.m.
• Fetal bradycardia < 120 b.p.m.
• Loss of fetal movement
• Passage of meconium
• All suggestive of fetal distress
36. Low Risk Labour
• Spontaneous onset at 37 to 40 wks
• Single fetus with vertex presentation
• Estimated fetal weight average
• Normal vital signs
• No pregnancy complications
• No abnormal intrapartum bleeding
37. Normal Low Risk Labour
• Acceptable rate of cervical dilatation
• FHS normal
• Head engaged at full dilatation
• Normal delivery within 2 hrs of good
expulsive force
• Third stage < 30 min
• Total blood loss < 500 ml
43. Partogram
• Concept of alert line
• Concept of action line
• Assessment of maternal
condition
• Assessment of fetal
condition
• Timely referral
44. Each and every one working
in the health department is
committed to reduce the
maternal mortality and to
realize the reproductive rights
of a women.
46. Referral Obst. Emergencies
• Position of the patient
• Left lateral position
• Mouth gag
• Start IV fluid – ringer lactate
• First dose of broad spectrum antibiotics
• Other specific medication as indicated e.g.
inj. MgSo4 in eclampsia
• Breast feeding to be continued during transfer
in cases of PPH
47. Referral Note
• Should mention salient
points about the
history
• Main clinical findings
• Medications (dose,
route, time of
administration)
• If telephonic facility is
available should alert
the referral hospital
48. Advise to Family Members
• About high risk situation
• About blood donation
• About financial aspects
• Blood donors
• Senior members for consent
50. Through a team approach all of the skills
of the health care members involved can
be combined to provide the best possible
approach to meet the pregnancy’s need.
The role of patient education can not be
over emphasized. Incorporating the
mother as an active member in her health
care is an investment in time and effort
that is cost effective both during
pregnancy and labour.
51. A systematic & a well begun
programme with a positive thinking
will definitely show road to success
to accept this challenge