OBSTETRIC EMERGENCIES

1. OBSTETRIC EMERGENCIES Dr. Ahmed Al Harbi Obstetrics/Gynecology Consultant

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

4. Obstetric emergencies related directly to pregnancy include, for instance: Pre-eclampsia Eclampsia Antepartum Haemorrhage Postpartum Haemorrhage Amniotic Fluid Embolism Congenital Heart Disease Epilepsy

5. Principles Of Managing Obstetric Emergencies

6. 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.

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

8. Managing severe haemorrhage Call For Help: Senior Obstetrician Anaesthetist Notify blood bank and consult haematologist.

9. Pulmonary Embolism (PE) Occurs in association with approximately 3:1000 pregnancies. Two thirds of cases of puerperium.

10. Diagnosis of Pulmonary Embolism: Symptoms Acute Breathlessness Pleuritic Chest Pain Haemoptysis

11. Signs Tachycardia Cyanosis Hypotension May be Confusion (hypoxia)

12. Investigations Reduced oxygen tension in arterial blood Electrocardiogram lead 3 Large Q waves, inverted T waves Chest X-ray Ventilation perfusion scan

13. Clinical Presentation Of Amniotic Fluid Embolism

14. Symptoms Sudden severe chest pain Dyspnea

15. Signs Hypotension Tachycardia Pulmonary Oedema Peripheral Shutdown Haemorrhage due to coagolation failure May be seizure seccondary to hypoxia or cardiac arrest.

16. Investigations Electrocardiogram � right ventricular strain Abnormal coagolation screen Reduced oxygen tension in arterial blood

17. Treatment Urgent resuscitation and circulatory support Intubation and 100% oxygen Treat the coagolupathy agressively Correct acidosis Dopamine and steroids may be useful Transfer to intensive care unit

18. 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.

19. 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.

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

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

22. Treatment Of Eclampsia: Turn the woman onto her side with her head down Ensure the airway is protected Give oxygen Give a 5g 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

23. 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

24. 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

25. 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.

26. Hypertensive Disorders 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

27. The Collapse Obstetric Patient Complete or partial loss of consciousness is very uncommon in pregnancy

28. Causes Of Loss Of Consciousness Simple Faint Epileptic Fit Hypoglycaemia Profound Hypoxia Intracerebral Bleeding Cerebral Infarction Cardiac Arrhythmia Or Myocardial Infarction

29. Pulmonary Embolism Anaphylaxis Septic Shock Anaesthetic Problems Major Haemorrhage Eclampsia Amniotic Fluid Embolus Uterine Inversion

30. Basic Life Support Skills Shake & Shout Airway Breathing Circulation Look for hypovolaemia (Tachycardia, Pallor) Aggressive Fluid Replacement Stop Haemorrhage Stabilize and seek a cause Senior multi-disciplinary assistance throughout