Dr. Al-Harbi - OB Emergencies
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Transcript of Dr. Al-Harbi - OB Emergencies
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OBSTETRICEMERGENCIES
Dr. Ahmed Al HarbiObstetrics/Gynecology
Consultant
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Overview: Obstetric emergencies - cause damage and
death to mothers and babies. They requirequick, decisive and effective action from thestaff immediately available.
In the UK, the maternal mortality rate is around
11.4 per 100,000.
Worldwide, the situation is much worse, witharound 600,000 maternal deaths reported
each year.
The causes of maternal death:1. Embolism (Thrombotic & Amniotic Fluid)
2. Hypertensive Disorders3. Haemorrhage
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Definition of
Obstetric Emergencies:
An emergency is an occurrence of
serious and dangerous nature,
developing suddenly and
unexpectedly, demanding immediate
attention.
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Obstetric emergencies related
directly to pregnancy include, forinstance:
1. Pre-eclampsia
2. Eclampsia
3. Antepartum Haemorrhage
4. Postpartum Haemorrhage5. Amniotic Fluid Embolism
6. Congenital Heart Disease
7. Epilepsy
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Principles Of Managing
Obstetric Emergencies
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Management: Ifbreathing 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.
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Obstetric Haemorrhage
Any blood loss from the vagina
greater than a show during pregnancy
Or excessive blood loss after
delivery.
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Managing severe haemorrhage
1. Call For Help:
Senior Obstetrician
Anaesthetist
2. Notify blood bank and consult
haematologist.
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Pulmonary Embolism (PE)
Occurs in association with
approximately 3:1000 pregnancies.
Two thirds of cases of puerperium.
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Diagnosis of Pulmonary Embolism:
1. Symptoms
Acute Breathlessness
Pleuritic Chest Pain
Haemoptysis
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2. Signs
Tachycardia
Cyanosis
Hypotension
May be Confusion (hypoxia)
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3. Investigations
Reduced oxygen tension in arterial
blood
Electrocardiogram lead 3
Large Q waves, inverted T waves
Chest X-ray
Ventilation perfusion scan
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Clinical Presentation
OfAmniotic Fluid Embolism
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1. Symptoms
Sudden severe chest pain
Dyspnea
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2. Signs
Hypotension Tachycardia
Pulmonary Oedema
Peripheral Shutdown
Haemorrhage due to coagolation
failure
May be seizure seccondary to
hypoxia or cardiac arrest.
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3. Investigations
Electrocardiogram rightventricular strain
Abnormal coagolation screen
Reduced oxygen tension in
arterial blood
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4. Treatment
Urgent resuscitation andcirculatory support
Intubation and 100% oxygen
Treat the coagolupathy
agressively
Correct acidosis
Dopamine and steroids may be
useful
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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
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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.
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Symtoms Of Severe Pre-Eclampsia
Frontal Headache
Visual Disturbance
Epigastric Pain
General Malaise & Nausea
Restlessness
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Signs Of Severe Pre-Eclampsia
Agitation
Hyper-Reflexia
Facial & Peripheral Oedema
Right Upper Quadrant
Tenderness Poor Urine Output
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Treatment Of Eclampsia:
1. Turn the woman onto her side with her head
down
2. Ensure the airway is protected
3.
Give oxygen4. Give a 5g bolus of magnesium sulphate
intravenously over a few minutes.
5. Progress to stabilizing the womanscondition
6. The mothers condition needs to be
stabilized urgently, before considering
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7. Senior obstetric and anaesthetic staff must
be involved
8. Antihypertensive
Hydralazine
Labetalol
9. Anticonvulsants
Magnesium Sulfate
10. Fluid Balance
To avoid pulmonary and cerebral oedema,Central Venous Pressure (CVP)
INPUT & OUTPUT
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Indications For Urgent Delivery
1.Blood pressure persistently at 160/100mmHgor more with significant
proteinuria
2. Elevated liver enzymes
3. Low platelet count
4. Eclamptic Fit
5. Anuria
6. Significant foetal distress
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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
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Hypertensive Disorders
1. Fulminating pre-eclampsia & eclampsia are
dangerous
2. Recognize women at risk
3. Manage minor hypertensive problems to
prevent progression4. 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
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The Collapse Obstetric Patient
Complete or partial loss of
consciousness is very
uncommon in pregnancy
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Causes Of Loss Of Consciousness
1. Simple Faint
2. Epileptic Fit
3. Hypoglycaemia
4. Profound Hypoxia
5. Intracerebral Bleeding
6. Cerebral Infarction
7. Cardiac Arrhythmia Or Myocardial
Infarction
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8. Pulmonary Embolism
9. Anaphylaxis
10. Septic Shock
11.Anaesthetic Problems
12. Major Haemorrhage
13. Eclampsia
14.Amniotic Fluid Embolus15. Uterine Inversion
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Basic Life Support Skills
1. Shake & Shout
2. Airway
3. Breathing
4. Circulation5. Look for hypovolaemia (Tachycardia, Pallor)
6. Aggressive Fluid Replacement
7. Stop Haemorrhage8. Stabilize and seek a cause
9. Senior multi-disciplinary assistance
throughout