The all things in the ppt are very good for the knowledge . you can use this for the presentation. and it is very easy to understand

1. Seminar on
obstetrical emergencies
Presented by - PRAVIN GHODKE

2. Defination
• Obstetrical emergencies are life threatening
medical conditions that occur in pregnancy or
during or after labor and delivery.

3. 1.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 vessels.it is a life
threatening condition.
• It occurs in 1 in 2500 births

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. SYMPTOMS
The baby’s blood is a
darker red color due to the
naturally lower oxygen
levels of a fetus
Sudden onset of painless
vaginal bleeding,
especially in their second
and third trimesters
If very dark burgundy
blood is seen when the
water breaks, this may be
an indication of vasa
previa

6. Diagnosis
• The classic triad of the vasa praevia is
membrane rupture
painless vaginal
bleeding
fetal bradycardia
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.

7. TREATMENT
• Baby can be delivered by C- section between
the 35th and 37thweek of pregnancy
• Hospitalization throughout third trimester is
also recommended .
• Steroids are sometimes used to mature the
lungs of the fetus if fetus is immature.

8. 2.AMNIOTIC FLUID EMBOLISM
Defination
An amniotic fluid embolism is rare but
serious condition that occur when amniotic
fluid,fetal material, such as hair, enters the
maternal bloodstream

10. 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

11. CAUSES
A maternal age of 35 years or older
Caesarean or instrumental vaginal delivery
Polyhydramnios
Cervical laceration or uterine rupture
Placenta previa or abruption
Amniocentesis
Eclampsia
Abdominal trauma
Ruptured uterine or cervical veins
Ruptured membranes

12. 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
• Seizures
• Coma

13. 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.

14. 3.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

15. CAUSES
• Hypovolemia (Hemorrhage (occult /overt),
hyperemesis, diarrhea, diabetic acidosis,
peritonitis, burns.)
• sepsis
• Cardiogenic (cardiomyopathies, obstructive
structural, obstructive non -structural,
dysrhythmias).
• Anaphylaxis
• Distributive (Neurogenic- spinal injury, regional
anesthesia}

16. STAGES OF SHOCK

18. 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.

19. cont’d
• 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

20. 4.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.

21. 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

24. 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

25. 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.

26. • 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

27. 5.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

29. 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.

30. 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

31. 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.

32. 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

33. 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

34. Management of a ruptured
uterus in health Center
Lie patient flat
Put up iv drip
Give pethidine
Transfer her to the nearest hospital
Bring donors
Go with patient

35. 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

36. Management
1. Hysterectomy
2. Repair of the uterus.

37. 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

39. BIBLIOGRAPHY
• MIDWIFERY AND GYNECOL0GICAL NURSING –
AUTHOR - ANNAMMA JACOB EDITION 4TH
PAGE NO. – 463-471
• WIKIPEDIA