Obstetric Emergency

Definition:

Emergency is term that denotes an unexpected or sudden

occurrence demanding prompt action.

The list of potential and unexpected obstetric

occurrences demands prompt action is extensive.

1.Placental abruption

2.Placental praevia

3.Post-partum haemorrhage

* placenta accreta

* uterine inversion

* puerperal hematoma

4. Uterine rupture

5. Ectopic pregnancy

6. Hypovolaemia due to haemorrhage

7. Eclampcia

8. Amniotic and thromboembolism

9. Obstetric septic shock

10. Acute respiratory failure

11. Pre-Term labour

12. Shoulder dystocia

Post- Partum Haemorrhage

Definition

Increase blood loss during or following the 3rd stage of

more than 600cc.

Types-:

1. Primary post Partum haemorrhage

2. Secondary post Partum haemorrhage  

 

Primary Post-Partum Haemorrahage

Aetiology:

A. Placental site bleeding

I. Atonic post-partum haemorrhage

A) The factors of predispoic to:

1. Prolonged labour - exhaustion

2. Antepartum haemorrhage

3. Anaemia +++

4. Fibroid in uters

5. Full Bladder or rectum

B. Trauma: Perineum, vulva, vagina and

cervix

II. Retention of placenta - partially or complete support

III. Hypofibrinogenaemia

Clinical Picture

A. General examination

B. Abdominal Examination

C. Vagincal examination

Prophylaxis

Avoid predisposing factors

A) During labour:

a. Avoid traumatic delay delivry

b. Proper Management of 3rd stage

c. Avoid traction on cord

d. Examine birth canal

e. Bladder should be empty

B) The patient should be observed 2 hours after

delivery.

C) Delivery in good hospital

Active Treatment

1. Blood Transfusion

2. Fibrinogen 4-10 gm I.V.

3. Double or triple strength plasma

4. Epsilon Amino caproic acid

Secondary Post-partum Haemorrhage

Causes:

1. Retained part of placenta

2. Infection.

3. Submucous fibroid

4.Local gynae case - erosion

5. Puerperal inversion

6. Choriocarcinoms

7. Oestrogen withdrawal

8. Choriocarcinoma

Retained Placenta

Placenta failed to be expelled.

A) Aetiology

1. Retention, separllted placenta

2. Atony of uterus

3. Contraction ring – hour glass contraction

B. Retention of non-separated placenta

1. Atony of uterus

2. Abnormal adhesion of placenta

Clinical Picture

1.Bleeding

2. Atonic uterus

3. Vaginal examination

* hour glass

* placenta accreta

* ruptu of the uterus

Treatment

A. In case of uterine atony

Ergometrine

Massage of uterus

Manual removal of placenta

B. In case of contraction ring

Deep anaesthesia

Arrange nitrate inhalation

C. In case of adherent placenta

Manual removal.

D. In case of rupture of uterus

Acute Puerperal InversionThe uterus is partially or completely turned inside out.

Aetiology

1. Usually induced

pressing fundus

traction or cord

2. Spontaneous

a. precipitation labour

b.traction of fetus on short cord

c. submucous fibroid

Degree

1st deg

2nd deg

3rd deg

Clinical Picture

Shock

Bleeding un the placenta attached

Pain

Treatment

A) Prophylaxis

B) Active Treatment

1. Anti-shock measures

2. Blood transfusion

3. Reduce invasim

Shock in Obstetrics

Types of shock

Surgical shock

 Neurogenic

Idiopathic obstetric shock

Hypovolaemia shock

Emdotoxic or septic shock

Clinical Picture

1. Hypotension

2. Tachycardia

3. Pallor

4. Cyanosis

Treatment of shock

Hypofibrinegemia

Aetioiogy

1. Concealed accidental haemorrhage

2. IUFD

3. Amniotic fluid embolism

Fibrinogen 4 - 16 gm IV

Antifibrinolysin EACA 4-6 gm

Rupture of Uterus

Indication* Malpresentation

* Big size baby

* Pendulous

* Weak uterine muscle

* osteomalacia

Aetiology:Rupture during pregnancy:

Spontaneous

1. Rupture scar (upper segment ea rean section,

myomectomy perforation)

2. Severe concealed accidental haemorrhage

3. Anterior sacculation - incarcerated R.V. gravid uterus

4. Rupture rudimentary haemorrhage of bicornuate uterus

Clinical Picture

A. Rupture of uterus during pregnancy or early or in early in labour

1. Severe abdominal pain + sign and symptoms of internal haemorrhage

2. Abdominal - fetus is easly felt

- FHS not heard

3. Vaginally - may be vaginal bleeding

B. Rupture of the uterus late in labour

1. Spontaneous rupture due to obstructed labour

(1) Before actu.1 rupture - impending rupture

2. When actu.al rupture occurs:

a. Severe abdominal Pain - cessation of uterine contraction

b. shock

c. Abdominal fetus is easly felt

Site of Rupture

1. Rupture due to obstructed labour - involve lower uterine

 2. Traumatic in late labour involve lower segment and

usually incomplete

3. Rupture of upper segment scar - complete

4. Rupture of lower segment scar - complete

- incomplete

Clinical Conditions allegedly associated with Utrine Rupture

Casesarean Section

Oxytocin

Multipara

Epidural anasthesia

Abruptio placenta

Mid forceps  

Breech version / extraction

External trauma to the abdomen

Pertomlon of uterus - D & C

Rupture during labourI. Spontaneous  

1. Obstructed labour2. Rupture of uterine scar 3. Idiopathic

 II. Traumatic

 1. IPV after drainage2. Destructive operdon 3. Forceps application

 II. Improper use of syntoclnon drugs

Types of Rupture

1. Complete

2. Incomplete

Clinical signs and symptome associated with uterine

rupture

1. Fetal distress

2. Abdominal pain

3. Vaginal bleeding

4. Recession of presenting part

5. Uterine hypertonias

6. Altered uterine contour

TreatmentBlood transfusion Labarotomy

ComplicationsA. Maternal

1. Shock 2. Haernorrhage 3. Sepsis4. Paralytic ileus 5. Injury to the bladder