obstetric emergencies panel discussion

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OBSTETRIC EMERGENCIES

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  • 1. Top Emergencies

2. Top Emergencies Antepartum haemorrhage Postpartum haemorrhage Severe pre-eclampsia Acute ectopic pregnancy 3. CASE 1 26yrs primi 8months pregnancy with bleeding pv. WHAT IS THE DIAGNOSIS? WHAT R THE CAUSES ? HOW WILL U DIFFERENTIATE? HOW WILL U MANAGE? 4. WHAT IS THE DIAGNOSIS ? 5. ANTEPARTUM HEMORRHAGE Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. 6. WHAT ARE THE CAUSES ? 7. Antepartum haemorrhage 1.Uteroplacental causes a) Placental abruption b) Placenta praevia c) Uterine rupture 2.Cervical lesions 3.Vasa praevia 4.Unexplained 5.Excessive show Bleeding at > 24weeks ( 12 hours Pyrexia in labour Retained placenta Mediolateral episiotomy Antenatal or intrapartum Morbidly adherent placenta Most cases of PPH have no identifiable risk factors 34. PPH MANAGEMENT ? 35. INITIAL RESUSITATION 1. Call for help 2. ABC a) O2 b) Large bore IV access x 2 c) FBC, coag, cross match d) Urinary catheter 3. Identify cause(s) of PPH 4. Control bleeding 5. Replace the blood loss 36. SPECIFIC MANAGEMENT ? 37. stages in management in vaginal delivery 1. Ensure 3rd stage complete if not MROP 2. Rub uterine fundus to stimulate contraction +/- bimanual compression if required to stop uterine bleeding 3. Assess for cervical/vaginal wall/perineal tears if present, repair 38. stages in management 4. Medical management of atony with oxytocic medicines a) Syntocinon b) Ergometrine c) Carboprost d) Misoprostol 5. Surgical management a) Intra uterine balloon device b) B lynch suture if at Caesarean section c) Uterine artery embolisation/ligation d) Hysterectomy 39. MEDICAL MANAGEMENT ? 40. Newer Therapies ? B-Lynch Brace Suture Angiography and selective embolization Recombinant activated Factor VII 41. B-Lynch brace sutures 42. UTERINE COMPRESSION SUTURES SQUARE VERTICAL Cho JH, Jun HS, Lee CN: Haemostatic Suturing Technique For uterine Bleeding during Cesarean Section delivery. Obstet Gynecol 200 0 96:129-131 A Straight needle is passed anterior to posterior and passed over fundus and ligated anteriorly. Multiple square sutures are Passed intramurally and tied at Various points. 43. Selective Artery Embolisation Advantages Preserves Fertility Useful in Haemorrhage associated with Placenta praevia Disadvantages Requires 24hr availability of radiological expertise. Patients must be stable Complications include: Necrosis of uterine wall, contrast adverse effects, local haematoma formation 44. Recombinant Activated Factor VII Novoseven is FDA approved for bleeding episodes in hemophilia patients It has been effective in nonhemophiliac patients with extensive organ damage, hemorrhage and coagulopathy that did not respond to transfusion 45. ROLE OF HYSTERECTOMY ? HYSTERECTOMY LAST BUT DEFINITIVE 46. Stepwise devascularization 47. Pelvic Hematoma DO NOT IGNORE 48. Thank you