Diabetes and Its Complication Dr. Miada Mahmoud Rady EMS / 474 Endocrinal Emergencies lecture II.
Obstetric emergency lecture 3 Dr. Miada Mahmoud Rady.
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Transcript of Obstetric emergency lecture 3 Dr. Miada Mahmoud Rady.
Obstetric emergency lecture 3
Dr. Miada Mahmoud Rady
SPECIAL OBSTETRIC PROBLEMS
Lecture 3
Topics
1. supine hypotension syndrome .
2. Cardiac problems during pregnancy
3. Hypertension during pregnancy
4. Seizers
5. Diabetes
6. Respiratory problem during pregnancy
7. Hyperemesis gravidarum
Supine hypotension syndrome
Definition: Decrease in blood pressure when pregnant women
lies supine .
Timing : seen in third trimester when uterus is large and patient
mobility is impaired.
Etiology : pressure of the gravid uterus on inferior vena cava
Pathogenesis :
I. Gravid uterus press in inferior vena cava .
II. Decrease venous return .
III. Which decrease cardiac out put .
IV. Which decrease blood pressure .
Enlarged uterus
• pathogenesisPress on
IVC • of supine
Decrease VR
• Hypotension syndrome Decrease
COP
Decrease blood pressure
Supine hypotension syndrome
Complication : can result in significant maternal
hypotension which can lead to fetal distress .
Clinical presentation :
it usually occurs 3-7 min. after lying down.
• Early → nausea , dizziness and tachycardia.
• Later → breathing difficulty and syncope.
Supine hypotension syndrome
Management :
Placing patient in the left lateral recumbent position
Treating underlying causes
Monitoring blood pressure and other vital signs
Obtaining an ECG
Caused by position
Treated by position
Cardiac diseases
When taking history of pregnant female with possible cardiac
disease the following should be documented :
1. Cardiac medications.
2. Dysrhythmias or heart murmurs.
3. History of rheumatic fever.
4. Congenital heart defect : Could be deteriorated by
pregnancy.
5. Dizziness, light-headedness, or syncope : may be
signs of dysrhythmias that could be dangerous
during labor.
Hypertension during pregnancy
Hypertension with pregnancy can cause great morbidity and
mortality .
Border line and preexisting hypertension could be exacerbated
by pregnancy.
Types :
Chronic HTN : hypertension before pregnancy ,
or occurring before 20th week .
Pregnancy induced HTN : occurring after 20th
week of pregnancy.
Eclampsia and pre-eclampsia .
Chronic HTN Pregnancy induced HTN
Present before pregnancy Occurs before 20th gestational
week Persist postpartum
Occurs after 20th gestational week Resolves spontaneously after
labor.
Can cause stroke and cardiovascular problem
May be sign of pre-eclamspsia .
Blood pressure ≥ 140/90 . Blood pressure ≥ 140/90 .
Preeclampsia
Incidence : occurs in about 8% of all pregnancies
Risk factors:
I. First pregnancy before age of 20 (highest risk
factor).
II. Women with advanced maternal age.
III. History of multiple pregnancies.
IV. Chronic hypertension or previous preeclampsia.
V. Renal disease.
VI. Diabetes.
Clinical presentation :
Manifests after 20th week with a triad of symptoms :
1. Edema (usually of the face, ankles, and hands)
2. Gradual onset of hypertension
3. Protein in the urine
Other symptoms include:
Severe headache.
Nausea and vomiting.
Rapid weight gain.
Visual disturbances.
Preeclampsia Complication :
Cerebral hemorrhage
Placental abruption
HELLP syndrome (hemolysis, elevated liver
enzymes, low platelets)
Retard growth of the fetus.
Impair liver and renal function .
pulmonary edema .
Progress to life-threatening seizure
(eclamspia ) .
Preeclampsia Management :
1. address ABCS and supportive care.
2. emergency antihypertensive may be necessary.
3. Eclampsia :
Seizers control : magnesium sulfate is
recommended.
ICU admission in dark quiet room.
Immediate C.S may be necessary to save
mother life.
Seizures Can be caused by:
a. Hypertension
b. Toxemia
c. Preeclampsia
d. Preexisting seizure disorder
Treatment : difficult because drugs normally used for
seizures cause fetal distress.
Magnesium sulfate is recommended ,
especially with eclampsia.
High-flow oxygen is needed to prevent
hypoxia.
Diabetes Diabetes during pregnancy is either :
Preexisting before pregnancy ,or gestational diabetes mellitus.
Gestational diabetes : glucose intolerance due to effect of
pregnancy hormone.
Patient may be asymptomatic or have the same signs as
diabetes mellitus:
I. Polyuria
II. Polydipsia
III. Polyphagia
Complication :
Fetal macrosomia ( large baby ) which may lead to
obstructed labor .
prematurity and preterm labor .
May continue after delivery.
Treatment :
A. Diet control : first line .
B. Insulin .
C. Prehospital : supportive care , I.V D50 if
hypoglycemia present .
Respiratory problems
shortness of breath ( dyspnea ) :
Commonest complaint during pregnancy .
Due to the effect of hormones.
Careful history and examination is necessary to
exclude other causes.
Treatment is assurance.
Remember physiological
changes
Respiratory problems
Asthma
Asthma is common condition that usually
complicates pregnancy .
Patient may be known asthmatic or asthma
may present for the first time during pregnancy.
Acute episode of asthma can cause serious
maternal and fetal complication.
Complication of asthma
Maternal
• Premature labor
• Preeclampsia, eclampsia
• Respiratory failure
• Vaginal hemorrhage
Fetal
• Premature birth
• Low birth weight.
• Growth retardation.
• Fetal death.
Respiratory problems
Pneumonia :
One of the leading indirect causes of maternal death in
the United States.
More sever during pregnancy due to depressed immune
system of pregnant female .
Caused by :
Infectious agent : bacterial , viral or
parasitic.
Non-infectious : chemical inhalation.
Respiratory problems
complications of pneumonia :
I. Low birth weight
II. Premature labor
III. Preterm delivery
Hyperemesis gravidarum
Definition : persistent nausea and vomiting during
pregnancy which is more serious than morning sickness .
Etiology : Exact cause is unknown, but possibly from:
I. Increased hormones (estrogen, human
chorionic gonadotropin).
II. Stress.
III. Gastrointestinal system changes.
Hyperemesis gravidarum
Complication : dehydration , malnutrition and electrolyte
imbalance.
Symptoms :
Severe and persistent vomiting more than
three or four times daily.
Projectile vomiting, consisting of bile and
sometimes blood.
Severe nausea.
Pallor.
Hyperemesis gravidarum
Prehospital treatment :
Administer 100% supplemental oxygen.
Start IV line of normal saline.
If protocols allow, administer
diphenhydramine.
Check blood glucose levels.
Check orthostatic vital signs, obtain an
ECG.
Transport to a hospital.
Summary Supine hypotension syndrome could be avoided by lying
on left lateral position.
Hypertension with pregnancy causes great morbidity and
mortality
Gestational D.M could be controlled by diet .
Asthma is very common and dangerous in pregnancy.
Pregnancy can exacerbate asymptomatic congenital
heart disease .
Delivery is the only line of treatment for eclampsia .