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Obstetrical emergencies PowerPoint Presentation

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Description : Check out this medical presentation on Obstetrics & Gynecology, which is titled "Obstetrical emergencies", to know about the different types of obstetrical emergencies.

Tags : Obstetrics, Gynecology, Obstetrical emergencies

Published on : Jul 18, 2021 | Views : 2973 | Downloads : 19

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Slide 1-

Obstetrical emergencies Nancy E Fay MD FACOG Division of Reproductive Medicine
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Obstetrical Hemorrhage Blood volume expands by 40% RBC’s increases by 30% = hemodilution Fibrinogen is double the non-pregnant level Uterine blood flow at term >500-700 cc/minute 15% of cardiac output Blood loss for vaginal delivery <500 cc Blood loss for c-section <1,000 cc
Slide 3-

First trimester bleeding Light bleeding: Implantation Ectopic Polyp or cervical irritation Heavy Threatened AB Heavy bleeding: Ectopic Inevitable or incomplete AB
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Categories of hemorrhage Class I Loss of 15% of blood volume No change in clinical status BP, RR and HR unchanged Class II Loss of 15-35% blood volume Tachycardic 100-120 Tachypneic 20-24 Cool, pale and clammy
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Categories of hemorrhage Class III 30-40% of blood volume Altered mental status Hypotensive, HR >120 Class IV >40% of blood volume Altered mental status or minimal responsiveness Hypotensive, tachycardic, no urine output
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Blood loss Soaked raytec=50 cc Soaked lap=100 cc Coke can=350 cc 2 cups=500 cc Weigh to measure
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Incidence of hemorrhage 1-5% of deliveries and increasing a result of atony Developed world 1/100,000 deliveries Third world 1/1,000 deliveries After delivery bleeding slows as a result of Uterine contraction Local PA-1 from decidua and clotting factors Any alteration of above results in hemorrhage
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Uterine atony Causes 80% of postpartum hemorrhage Immediate most common Delayed most likely from retained products of conception Uterus not palpable postpartum
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Treatment of atony Massage: external vs bimanual Confirm no retained placental or membrane products Empty the bladder IV access if none, and bolus IV fluids Medications Oxytocin Misoprostol Methyl ergonovine Hemabate/carboprost
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Surgical treatment OB Alert/Massive transfusion protocol Laparotomy: ligation of uterine arteries B Lynch procedure Other surgical control of atony Uterine balloon or packing Hysterectomy Interventional radiology
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B Lynch Procedure
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Risk factors for Atony Induction of labor Prolonged labor or precipitous delivery Over-distended uterus: macrosomia, multiples, polyhydramnios etc… Prior hemorrhage*** Preeclampsia, abruption, previa, trauma Grand multiparity Coagulopathy Infection
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Delayed hemorrhage Usually retained tissue Other risk factors Evacuate Increased likelihood of infection Asherman’s syndrome risk
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Anatomic causes for bleeding Cervical lacerations Vaginal lacerations Vaginal hematoma Uterine inversion Cause Replacement medication
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Placenta accreta Abnormal decidualization allow villi invade myometrium Accreta=myometrial superficial invasion Increta=deep myometrial invasion Percreta=serosal invasion and beyond Incidence: In 1950 1/30,000 pregnancies 1980 1/2,500 1990 1/500
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Placenta percreta
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Risk factors Location of implantation: lower uterine segment, cervix, cornua Scars in decidua: c-section, myomectomy, multiple D&C’s, Asherman’s Syndrome, septum resection Uterine anomalies Grand multiparity
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Accreta incidence One prior section=0.3% Two prior sections=0.6% Three prior sections=2.4% If concurrent previa: No scar 1-5% One section 11-25% Two sections 35-47% Three sections >40%
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Diagnosis of accreta Antepartum ultrasound, confirm with MRI Treatment Prior to delivery How to deliver When to deliver Discovery after vaginal delivery
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Uterine rupture With prior one low transverse c-section, incidence <1% With two prior LTV c-sections? With classical c-section? First sign of uterine rupture in trial of labor or VBAC? Trauma Drug use/abuse
Slide 21-

Placenta Previa “________” third trimester vaginal bleeding
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Placenta previa Complete central, partial, marginal vs low lying Incidence at term 1%, in second trimester?
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Risk factors for previa Prior section Prior uterine surgery: D&C’s or myomectomies, septum resections etc… Increasing parity Multiple gestation Prior previa
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Management of previa Risk to fetus: IUGR, stillbirth, prematurity Preterm labor risk Mode of delivery….? Timing of delivery: No bleeding With bleeding At hemorrhage… Steroid use Magnesium sulfate neuroprotection Historic “double set-up”
Slide 25-

Placental abruption “____________” third trimester vaginal bleeding
Slide 26-

Placental abruption Marginal, concealed, complete