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MANAGEMENT OF OBSTETRIC EMERGENCIES

MANAGEMENT OF OBSTETRIC EMERGENCIES. DR ADEWALE S ADEYEMI Senior Lecturer/Consultant Department of Obstetrics & Gynaecology, LAUTECH, Ogbomoso. Obstetric Emergencies. Overview:.

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MANAGEMENT OF OBSTETRIC EMERGENCIES

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  1. MANAGEMENT OF OBSTETRIC EMERGENCIES DR ADEWALE S ADEYEMI Senior Lecturer/Consultant Department of Obstetrics & Gynaecology, LAUTECH, Ogbomoso

  2. Obstetric Emergencies

  3. Overview: • Obstetric emergencies - cause damage and death to mothers and babies. They require quick, decisive and effective action from the staff immediately available. • Worldwide, there are 600,000 maternal deaths reported each year. • In the UK, the maternal mortality rate is around 11.4 per 100,000. • In Nigeria, the maternal mortality rate is put at 630 per 100, 000

  4. Definition of Obstetric Emergencies: • An emergency is an occurrence of serious and dangerous nature, developing suddenly and unexpectedly, demanding immediate attention.

  5. Obstetric emergencies related directly to pregnancy include: • Pre-eclampsia • Eclampsia • Antepartum Haemorrhage • Postpartum Haemorrhage • Prolonged Obstructed Labour • Peurperal Sepsis • Amniotic Fluid Embolism • Congenital Heart Disease • Epilepsy

  6. Principles Of Managing Obstetric Emergencies Key Concept: Although you have two patients, maternal circulation is to be maintained at the expense of the fetus. Without mom, the baby will surely die. Mom should be kept in left lateral decubitus This is where knowing the physiologic changes of pregnancy becomes extremely important ! Mom can lose up to 35% of her blood volume before showing any signs of shock!

  7. Principles Of Managing Obstetric Emergencies

  8. Management: • If breathing spontaneously: • She must be moved to the left lateral position; aspiration of stomach. • If there is no spontaneous respiration : • Check the circulation at the carotid or femural pulse prior to chest compression if necessary. • Artificial respiration is required if managing a case alone. • Obtain as much help as is possible immediately. • Summon the cardiac arrest team immediately.

  9. Obstetric Haemorrhage • Any blood loss from the vagina greater than a show during pregnancy • Or excessive blood loss after delivery.

  10. Obstetric Haemorrhage • Bleeding can be from: • Placenta Praevia • Abruptio placenta

  11. Definitions • Placental abruption: part of the placenta becomes detached from the uterus • Placenta Praevia: The placenta is inserted wholly or in part into the lower segment of the uterus and therefore lies in front of the presenting part. ** AVOID PV exam; placenta praevia may bleed catastrophically **

  12. Signs and symptoms

  13. Postpartum haemorrhage • Estimated blood loss ≥ 500ml • Primary: within 24hrs of delivery • Secondary: 24hrs-6weeks post delivery

  14. Causes (4 Ts) • Tone: uterine atony • Tissue: retained placenta or retained products, • Trauma: cervical or perineal, or ruptured uterus, • Thrombin: coagulation disorder

  15. Risk factors Top 5 • APH • Multiple pregnancy • Retained placenta • Mediolateral episiotomy • Emergency LSCS

  16. Risk factors

  17. PPH – signs • Pale • Confused • Increased HR, reduced BP (late sign) • Reduced urine output • Obvious or hidden bleeding

  18. PPH Management Top 5 • Call for help • ABC • O2 • Large bore IV access x 2 • FBC, coag, cross match • Urinary catheter • Identify cause(s) of PPH • Control bleeding • Replace the blood loss

  19. Top 5: stages in management • Ensure 3rd stage complete – if not MROP • Rub uterine fundus to stimulate contraction +/- bimanual compression if required to stop uterine bleeding • Assess for cervical/vaginal wall/perineal tears – if present, repair

  20. Top 5: stages in management 4. Medical management of atony with oxytocic medicines • Syntocinon • Ergometrine • Misoprostol 5. Surgical management • Intra uterine balloon device • B lynch suture if at Caesarean section • Uterine artery embolisation/ligation • Hysterectomy

  21. Hypertensive Disorders: • Pre-eclampsia • Is a disease of pregnancy characterized by a blood pressure of 140/90 mmHg or more on two separate occasions after the 20th weekof pregnancy in a previously normotensive woman. • Accompanied by significant proteinuria (>300mg in 24 hours) • Eclampsia • A same condition that has proceeded to the presence of convulsions. • Imminent Eclampsia or Fulminating Pre-eclampsia • The transitional condition characterized by increasing symptoms & signs.

  22. Incidence & Epidemiology: • Eclampsia • Relatively rare in the UK, occurring in approximately 1:2000 pregnancies. • It may occur • Antepartum – 40% • Intrapartum – 20% • Postpartum – 40% • Severe Pre-eclampsia • A blood pressure of 160/110 mmHg or more.

  23. Symtoms Of Severe Pre-Eclampsia • Frontal Headache • Visual Disturbance • Epigastric Pain • General Malaise & Nausea • Restlessness

  24. Signs Of Severe Pre-Eclampsia • Agitation • Hyper-Reflexia • Facial & Peripheral Oedema • Right Upper Quadrant Tenderness • Poor Urine Output

  25. Treatment Of Severe Preeclampsia/Eclampsia: • Turn the woman onto her side with her head down • Ensure the airway is protected • Give oxygen • Give a 4g bolus of magnesium sulphate intravenously over a few minutes. • Progress to stabilizing the woman’s condition • The mother’s condition needs to be stabilized urgently, before considering delivery in antenatal cases

  26. Senior obstetric and anaesthetic staff must be involved • Antihypertensive • Hydralazine • Labetalol • Anticonvulsants • Magnesium Sulfate • Fluid Balance  To avoid pulmonary and cerebral oedema, Central Venous Pressure (CVP) INPUT & OUTPUT

  27. Indications For Urgent Delivery • Blood pressure persistently at 160/100 mmHg or more with significant proteinuria • Elevated liver enzymes • Low platelet count • Eclamptic Fit • Anuria • Significant foetal distress

  28. HELLP Syndrome H - Haemolysis E - Elevated L -Liver Enzymes L -Low P -Platelets 5 to 10% of cases of severe pre-eclampsia  May be associated with dissaminated intravascular coagulation, placental abruption & foetal death.

  29. Hypertensive Disorders(Summary) • Fulminating pre-eclampsia & eclampsia are dangerous • Recognize women at risk • Manage minor hypertensive problems to prevent progression • In the serious case: • Prevent or control convulsion • Bring down the blood pressure • Minimize or avoid organ damage • Control coagulopathy • Avoid fluid overload • Deliver a healthy baby safely

  30. Prolonged Obstructed Labour • Rare in developed countries • Still common in our environment • Contributing significantly to maternal morbidly/mortality

  31. Signs • Toxic • Dehydrated • Conjunctiva Hyperaemia • Febrile • Tachycardia • Bandle’s Ring

  32. Signs • Alive or dead fetus • Oedematous Vulva • Severe Caput • Severe moulding

  33. Management • Rehydration • Antibiotics • Catheterization • EMLSCS • Destructive Operation

  34. Management • Catheterization for 10-14/7 • Continue antibiotics

  35. Complications • VVF • Sepsis • Anaemia • PPH • Obstetric neuropraxia • Fetal death • Maternal death

  36. Thank you

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