a review to obst & gynae
DESCRIPTION
A short review to obstetric and gynecological conditions....TRANSCRIPT
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
PRESENTED BY:-Ms. DEEPTI DAMODARAN
REVIEW OF
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
ANATOMY OF FEMALE REPRODUCTIVE SYSTEM
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Anatomy
Female reproductive system is divided
into:
External genitalia (vulva)Internal genitalia andAccessory reproductive organs
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
PHYSIOLOGY (MENSTRUATION CYCLE)
• Length of menstrual cycle is 28 day• 14th day – Ovulation day
PHASES :- • Menstrual phase :- shedding of endometrium with
discharge through vagina. Release of FSH and low level of LH, ovarian estrogen secretion begins
• Proliferative phase:- endometrium regenrates and thickens in preparation for implantation. Single dominant follicle develops to mature follicle, decrease in FSH level (negative feedback), increase in LH (positive feedback), Ovulation occurs
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
• Leutal phase:- begins after ovulation and is a relatively finite time period of about 12 to 14 days under LH secretion , Corpus leuteum is formed from ruptured follicle, release of progestrone and estrogen
Progestrone helps preparation of endometrium
If fertilization does not Corpus leuteum becomes non functional after 10 to 12 days after ovulation and menstruation returns
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EVENTS FOLLOWING FERTILIZATION
Process of fusion of spermatozoon with mature ovum which occurs in Ampulary part of fallopian tube
• MORULA: two cell stage 30 hrs after fertilization
• BLASTOCYST: It possesses an inner cell mass (ICM), or embryoblast, which subsequently forms the embryo, and an outer layer of cells, or trophoblast, surrounding the inner cell mass and a fluid-filled cavity known as the blastocoele
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
• Blastocyst formation begins at day 5 after fertilization
• IMPLANTATION: occurs in endometrium between 10-11th day.
• TROPHOBLAST: placenta and fetal membrane develop from trophoblast
• DECIDUA: endometrium of the pregnant uterus
• CHORION: outermost layer of the two fetal membrane
• AMNION: inner layer of the fetal membrane
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
PLACENTA AND FETAL MEMBRANE
• Placenta is discoid in shape, with two surfaces
Maternal (rough and spongy) Foetal surface (covered by smooth and glistening
amnion with umbilical cord attached) Fetal blood flow through the placenta is 400 ml/mt Fetal membrane has two parts Amnion (inner
smooth layer) and Chorion (outer thick layer)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
UMBILICAL CORD (Funis)
• Wharton’s jelly:- a gelatinous substance within the umbilical cord
• There are 2 umbilical arteries (deoxygenated blood) and one umbilical vein (oxygenated blood)
• Length: 50cm
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
PREGNANCY
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Stages of Pregnancy
1st trimester (first 12 weeks)– Fetus is being formed
2nd trimester (13-28 weeks)– Uterus grows rapidly, reaching the
umbilicus
3rd trimester (29-40 weeks)– Uterus now reaches the epigastrium
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
LEVEL OF FUNDUS AT DIFFERENT
WEEKS
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EVENTS IN 1ST TRIMESTERSIGNS• Jacquemier’s / Chadwick’s sign:- dusky hue of
vestibule and ant. vaginal wall. (local vascular congestion)
• Vaginal / Osiander’s sign:- increased pulsation felt at laterla fornices (8th week)
• Cervical / Goodle’s sign:- marked softening of the cervix (6th week)
• Piskacek’s sign:- asymmetrical enlargement of uterus in case of lateral implantation
• Hegar’s sign:- upper part of uterus is enlarged with growing ovum and lower part is empty (6-10 weeks)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EVENTS IN 2ND TRIMESTER
• Quickening :- feeling of fetal movement by mother (18 week, 2wks early in multiparae)
• Chloasma:- pigmentation over forehead and cheek (24th week)
• Linea nigra:- linear pigmented zone from symphysis pubis to ensiform cartilage
• Striae gravidarum:- (pink and white)• Braxton- Hicks contraction:- irregular, infrequent,
spasmodia and painless contraction without effect on dilatation of cervix
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EVENTS IN 3RD TRIMESTER
FUNDAL HEIGHT
Lightening :- at 38th week engagement of presenting part takes place in the pelvis which decreases the fundal height.
32 weeks:- level of ensiform cartilage
36-38 weeks:- engagement takes place at fundus comes down to 32 week level at 40 wks
Head floating: 32 wks
Head engaged: 40 weeks
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
FETAL SKULL
SUTURES:-
• SAGITTAL – lies between two parietal bones
• CORONAL- run between parietal and frontal bone
• FRONTAL – lies between two frontal bones
• LAMBDOID- separate the occipital bone and two parietal bones
• ENGAGING DIAMETER OF FETUS:- Biparietal or Bitemporal diameter
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
FETUS IN UTERO
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Types of Presentation
Cephalic– Normal, head-first birth
Breech-Buttocks or both feet deliver first
Face - mentum or chin presenting first
Brow - frontal bone or brow line
Shoulder – acromian process
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
STAGES OF LABOUR
FIRST STAGE: onset of labour pain to full dilatation of cervix (12 hrs primi, 6 hrs multi)
SECOND STAGE: full dilatation of cervix to expulsion of fetus (2 hrs primi, 30 mts multi)
THIRD STAGE: expulsion of fetus to expulsion of placenta and membrane (15 mts)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
MECHANISM OF LABOURDIAMETER OF ENGAGEMENT:
Available transverse diameter
ENGAGEMENT DIAMETER OF HEAD: Suboccipito bregmatic (9.5 cm) / Suboccipito frontal (10 cm)
D Engagement
E
S Internal flexion
C
E Internal rotation of head and simultaneous rotation of shoulder
N
T Crowning
Delivery of head by extension
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
D Restitution
E
S External rotation
C
E Delivery of shoulder and trunk by lateral flexion
N
T
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Post Delivery
Same level as mother
Wait for pulsating to stop
Clamp and cut umbilical cord
Note exact time of birth
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Cutting the Umbilical Cord
Infant warm
Sterile clamps or umbilical tape
1st clamp 10 inches
2nd clamp 7 inches
Cut between clamps
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
SEPARATION OF PLACENTA
Methods of separation
SCHULTZE :- central separation
MATHEW-DUNCAN :- marginal separation
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Care of the Newly Born
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Care of the Newly Born
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Assessment—Newly Born
Breathing, heart rate, crying, movement, skin color
Pulse greater than 100 bpm
Vigorous crying
Moving extremities
Blue coloration hands and feet ONLY
Reassess after 5 minutes
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Resuscitation—Newly Born
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Respirations
Newborn should begin breathing within 30 secondsProvide only small puffs of air if using mouth to maskRate of 40 to 60 per minute Adequate respirations and a pulse rate greater than 100 per minute– Supplemental oxygen
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Heart Rate
Heart rate less than 100 beats per minute– Ventilate at a rate of 40 to 60 per minute
Heart rate is less than 60 beats per minute – Initiate chest compressions
Rate of 120 compressions per minute3:1 ratio of compressions to respirations90 compressions and 30 ventilations per minute
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
NORMAL PUERPERIUM
LOCHIACOLOUR:
Lochia rubra- red ( 1- 4 days)
Lochia serosa- yellowish / pink/pale (5-9 days)
Lochia alba – pale white (10-15 days)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
HEAMORRHAGE IN PREGNANCY
ABORTION:- termination of preg before period of viability (28 wks)
TYPES:-THREATENED: process of abortion has
started but recovery is possibleINEVITABLE:- changes have progressed
to a stage that recovery is impossibleCOMPLETE:- product of conception
expelled en masse
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
INCOMPLETE:- entire product of conception not expelled instead a part is left in uterine cavity
MISSED:- when fetus is dead and retained inside uterus for a viable period
SEPTIC :- associated with clinical evidence of infection of the uterus
CIRCLAGE OPERATION:- Shirodkar and McDonald surgery
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
CHILDBIRTH COMPLICATIONS
Breech presentation
Prolapsed cord
Limb presentation
Multiple births
Premature birth
Meconium
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Most common abnormal delivery
Buttocks first or both legs first
Increased risk of prolapsed cord
Possible meconium staining
Breech Presentation
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
BREECH PRESENTATION
• Frank breech (buttocks alone)
• Complete breech (buttocks ans feet)
• Footling breech (both feet)
• COMPLICATION:- cord prolapse
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Breech Presentation
Provide high-concentration oxygen.
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Prolapsed Cord
Position mother head down and buttocks raised.
Provide high-concentration oxygen.
Check for pulses and wrap cord.
Insert several fingers into vagina to push up on baby’s head.
Transport.
(cont.)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Prolapsed Cord
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Limb Presentation
Limb protrudes from vagina
Commonly a foot or arm
Cannot be delivered in prehospital
Rapid transport
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Assessment—Limb Presentation
Look for crowning
Arm or leg
Arm and leg together
Shoulder and arm
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Limb Presentation
High-concentration oxygen
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Multiple Births
More than one baby born during single delivery
Twins not considered complication
Call for assistance.
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Multiple Births
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Premature Birth
Infant weighs < 5-1/2 lbs (2.5 kgs)
Born before 37th week
Assessment– Full term vs. premature– Head is larger
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Premature Birth
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Meconium
Results from fetus defecating
Sign of fetal or maternal distress
Assessment– Amniotic fluid greenish or brownish-
yellow– Risk for respiratory problems
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Meconium
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EMERGENCIES IN PREGNANCY
Ante partum hemorrhage
Rupture uterus
Ectopic Pregnancy
Seizures
Miscarriage and Abortion
Stillbirths
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Placenta Previa
Placenta is situated in the lower uterine segment
Painless bright red vaginal bleeding
TYPES:• Lateral • Marginal • Complete • Incomplete
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Abruptio Placentae
Premature separation of the placenta
Severe abdominal pain
Dark red bleeding
TYPES:-• Revealed• Concealed • Mixed
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Ruptured Uterus
As the uterus enlarges throughout pregnancy,
the uterine wall becomes extremely thin and is prone to spontaneous or traumatic rupture
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Signs and Symptoms
Main sign—profuse bleeding
Associated abdominal pain
Shock
Rapid heartbeat
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Excessive Bleeding
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Ectopic PregnancyNormal pregnancy—egg divides in the oviduct (fallopian tube)Ectopic pregnancy—egg implanted anywhere outside the uterine cavity Acute abdominal painVaginal bleedingRapid and weak pulse (later sign)Low blood pressure (a very late sign)Features of shock CULLEN’S SIGN : dark bluish discolouration around umbilicus (intraperitoneal bleeding)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Ectopic Pregnancy
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care: Ectopic Pregnancy
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Seizures in Pregnancy
Pre eclampsia – Hypertension + proteinuria + oedema
after 20th week
Eclampsia– Preeclampsia superimposed by
convulsions or fits
Assessment– Elevated BP (above 140/90 mm of Hg)– Excessive weight gain (>1lb a week/ 0.45
kg)– Swelling of face and extremities– Headache
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Seizures
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Miscarriage and AbortionTermination of pregnancy before 28th week
Induced abortion- legal and illegal
TYPES: THREATENED (preg can be continued) INEVITABLE (impossible to continue preg) COMPLETE (product of conception expelled en
masse) INCOMPLETE ( product of conception expelled
in parts) MISSED (dead fetus retained In uterus for long
time) SEPTIC (evidence of infection of uterus)
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Signs and Symptoms
Cramping abdominal pains– Associated with 1st stage of labor
Bleeding– Moderate– Severe
Discharge – Tissue– Blood
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Miscarriage
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Stillbirths
Baby dies in the womb
Continue resuscitation
Records
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Assessment—Stillbirth
Obvious blisters
Foul odor
Skin or tissue deterioration and discoloration
Softened head
Cardiac or pulmonary arrest
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Patient Care—Stillbirth
Obviously dead– No resuscitation
Pulmonary or cardiac arrest– Basic life support
Imminent death– Prepare to provide life support.
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Gynecological Emergencies
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
MEDICAL PROBLEMS ASSOCIATED WITH
PREGNANCY
Anaemia
Diabetes
Hypertension
Heart disease
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
ANAEMIA
• Hb level is 11gm/100ml or less (acc to WHO)
CLASSIFICATION• Mild (b/w 8 to 10 gm%)• Moderate (6.5 to less than 8 gm%)• Severe (< 6.5 gm%)
TREATMENT• Daily administration of oral iron ferrous sulphate
200 mg (containing 60 mg of element iron)• Along with 1mg Folic acid • Dietary supplementation
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Intravenous and Intramuscular iron therapy
• Iron dextran (imferon) which contains 50mg elemental iron in one millimeter
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
DIABETES IN PREGNANCY
• Glucose travels across the placental membrane via facilitated diffusion
• Glucagon is present in the fetal circulation at 8 weeks of gestation
• FIRST TRIMESTER : Maternal fasting blood glucose level decreases slightly to approximately 75mg/ 100ml of blood because of the increased glucose supplied to the fetus
• SECOND TRIMESTER : Placental hormones (human placental lactogen,progesterone, estrogen) have a diabetogenic effect (producing diabetic-like state). HPL breaks down adipose tissue and release glycerol and fatty acid for the use of primary maternal fuel
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
• Third trimester: Delivery of placenta brings about an abrupt drop in the levels of circulating placental hormones, insulinase, & cortisol
CRITERIA FOR DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS
Criteria for diagnosis of GDM with 100gm of oral glucose
GTT: Venous plasma (mg/dl) TIME mg/dl Fasting 1 hour 2 hours 3 hours
95 mg/dl 180 mg/dl 155 mg/dl 140 mg/dl
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
EFFECT OF DIABETES
MOTHER
• Abortion
• Preterm labour
• Pre-eclampsia
• Polyhydramnios
• Maternal distress
• Diabetic retinopathy
• KETOACIDOSIS
FETUS
• Fetal macrosomia
• Congenital malformation
• Birth trauma and perineal asphyxia
• Hyperbilirubinemia
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
HYPERTENSION
Pre-eclampsia
• A pregnancy-induced hypertension
• ≥ 20 weeks gestation
• Previously normotensive
• ≥140/90 mmHg on at least two occasions
• + proteinuria ≥ 0.3g in 24h
• ± oedema
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
Complications (fetal)
• IUGR
• Oligohydramnios
• Placental infarcts
• Placental abruption
• Uteroplacental insufficiency
• Prematurity
• PPH
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
ECLAMPSIA
• Pre eclampsia superimposed by convulsions is called eclampsia
• Magnesium sulphate given IV by infusion pump to prevent or limit seizure
• Antihypertensive: methyldopa, hydralazine
• Monitor FHR
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
HEART DISEASE IN PREGNANCY
• 50% have origin from rheumatic fever, congenital and mitral valve disorder
• Oxygen consumption increased 10% to 20%related to growing fetus
• Plasma level and blood volume increase
MANAGEMENT:- Give semi fowlers position Assisted birth / Cesarean delivery Monitor heart rate Monitor fetus for IUGR, preterm birth and hypoxia
Limmer et al., Emergency Care, 11th Edition© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
DOT Directory
POST PARTUM HAEMORRHAGE
• Bleeding in excess of 500 ml following delivery is called PPH
TYPES:-
• Primary PPH - occurs in the third stage of labour. It is defined as a loss of blood from the genital tract within the first 24 hours after birth.
• Secondary PPH - occurs 24h-12 weeks after birth (end of puerperium).