Obstertic Emergencies

Obstetric Emergencies Tut Maternal deaths Direct causes: directly resulting from obstetric complications Indirect causes: resulting from a previously existing disease PPH Any bleeding after birth oft the baby Incidence of 5 to 15%. Major killer in women Primary – mainly in the first hour but can be up to 24 hours Secondary -> up to 12 weeks When blood is more than 500ml Midwives will try to get a kidney dish to catch as much blood as possible Physiological changes -> to help reduce bleeding Right shift of maternal oxyhemoglobin Increased ability to clot Changes in WCC -> may make the interpretation of an infection harder Risk factors We check out for them in the anetenala period Previous PPH Greater risk and a larger PPH Anaemia Atepatrum hemrroage 3/4 have no risks Obesity APH Obesity Previous CS APH GDM Episiotomy Pre-eclampsia Tocolytics APH Reduction Identication of RF Talk to woman about signs of symptoms e.g. hypovolume Treat anameia Tell her about complications Try to get their Hb, iron and bloods good well before hand during the antenatal period Active management of the third stage Checking the placenta and membranes for completeness Check for vagina, cervix etc. or any bleeding Need to be repaired within the first hours of blood If there is a laceration -> apply pressure methods to minimise blood loos Always check placenta and membranes after managed bleeding, to ensure that non are in situ If there is still in -> we expect to still bleed until all out -> may need to go to theatre In Campbelltown – carbtoxycin Faster acting When ladies present in their booking – we must know about their thrombin Different weights/sizes may have different reactions E.g. a woman who is 45 kg and loss 300 m; may cause shock While a woman who is 6 foot and weighs a lot -> 500 mls may not cause low BP or pulse changes O negative blood should be used When taking the woman to the theatre we have to tell her that there is a possibility of a hysterectomy as sometimes these are the only ways to stop the bleeding. If there is a severe laceration of the cervix that requires a surgery -> scar -> next time is giving birth -> will get lots of bleeding, Hence will need a c section Need to inform her Complications Anameia -> breasteeding issye Rolonged hospital sat Coma Hypotension hypovomlema Arrythmias Coagulopathies Renal failtre Need for a hystrecomy DIC Death VTE Give drug 5 minutes to work -> if does not improve vitals -> try another one Cord prolapses Cord prolapses vs cord presentation The main difference is the membrane status and the cord’s position to relieve the presenting part and the cervix Cord presentation Cord Prolapse Umbilical cord is between the presenting part and the cervix The membranes Descends through the cervix/vagina after membrane rupture are intact Ruptured membranes The Once ruptured -> cord is expose -> cord is vulnerable to compression amniotic fluid cushions the cord and prevents cord compression Cord is palpable Cord may be visible on ultrasound or felt or visible in vagina or introus during High risk of cord compression, hypoxia, fetal death a vaginal exam Immediate c section May progress into a prolapse Fetal compromise is not immediate unless there is a rupture of membranes Manage closely RF In twins It is usually in the second baby Small baby Large baby Malpresentation Artificial rupture o the membranes Aucult cord -> may happen in vaginal exam Diagnosis Vaginal examination The examiner either rsees the umbilical cord protruding through the vagina or feels a soft pulsating structure in the vagina Always list to the FHR Management Manage polyhdramnios This if a woman has polyhdramnios and she is inpatient as her to tell you if her membranes rupture If patient who wants to deliver at home her mmebranes rupture but cannot feel movement Aks her to come in Management of ARM with a high head and unstable lie If a c section is being done then place fingers in the vagina to elevated the presenting part -> DO NOT TAKE THE FINGERS OUT UNLESS THE BABY IS OUT Allows a certain amount of oxygen to the fetus If the malpresentation is shoulder – then we almost definitely cannot do a vaginal If cervix is not fully dilated we have to do a c section To stop the contraction and there is a delay for surgery Use tocorlytics Stop oxytocin -> as this is going to work against us 500 mls of warm saline Mainly we need a c section in cord prolapse in that case a verbal consent for a c section is enough we want have time for an informed consent that is details, so we just cover the important stuff as per what time permits -> e.g. if we do not di it your baby may die May not have time to go oxygenate her before General anestehtic Even if we loose fetal heart rate we still move through as may be movements, of maternal pulse etc. And they can often be resuscitated quite well If there’s no cord pulsation or extreme Prematurity would fry everything we can to out the cord in, even though there is usually not successful If there is a suspected feta death we need to confirm with an ultrasound