Obstetric emergencies part 1

Obstetric
Emergencies
obstetricsII by mukerem BY MUKEREM.A 2007

Obstetric emergency cont…
Purpose: The purpose of this topic is to introduce students to an organized
and effective approach in providing care to obstetric emergencies.
learning objectives:
• By the end of this chapter, the students will be able to:
• Describe key steps in rapid initial assessment of a woman with
emergency problems.
• Outline key emergency management steps for specific obstetric
emergency problems.
• Demonstrate steps in detection and management of “shock”.
BY MUKEREM.A 2007

. Prolapse of the cord and cord
presentation
Objectives
By the end of this session students
should:
Know the definition of cord prolapse
Understand the risk factors associated
with cord prolapse
Be confident to managing a mother with
cord prolapse
BY MUKEREM.A 2007

1. Prolapse of the cord and cord presentation
Cord presentation:
This occurs when the umbilical cord lies in front
of the presenting part with the membranes still
intact
 Cord prolapse. (Overt prolapsed cord):
In this case the cord lies in front of the presenting
part and the membranes are ruptured.
obstetricsII by mukerem
BY MUKEREM.A 2007

Occult cord prolapse:
The cord lies along side but not in front of
the presenting part.
 Funic occult:
The umbilical cord has prolapsed in front of
the presenting part but not through the
cervical Os in the presence of intact
membranes
BY MUKEREM.A 2007

Possible causes or predisposing factors
Any badly fitting presenting part
Malpresentaiton – is the most common cause
Breech presentation
Shoulder presentation
Face and brow presentations
Prematurity of the fetus. This condition offers space
between the fetus and the pelvis
BY MUKEREM.A 2007

Amniotomy the cord swept due to gush of fluid
 Multiple pregnancies – particularly second twin
 Contracted pelvis
 Poly hydramnios – the cord is liable to be swept
down in a gush of liquor if the membrane ruptures
spontaneously.
 Lower implantation of the placenta
 Abnormally long cord
Congenital abnormality of uterus
BY MUKEREM.A 2007

GROUP DISSCUSSION
1) Do U think we can prevent Prolapse
of the cord and cord presentation
???
2) Which one is more risky 4 fetus???
BY MUKEREM.A 2007

Clinical features
• Umbilical cord visibleat,orexternal to,the
vaginal opening
• Evidence of membranes having ruptured
• A nonreassuring fetal status:
- change in fetal movement pattern
- Meconium in the amnioticfluid
(vaginal discharge may be stainedgreen)
- Fetal tachycardia
- Fetal bradycardia(morecommon)
BY MUKEREM.A 2007

Diagnosis
1. Feeling of the cord during vaginal
examination
2. An abnormal fetal heart rate particularly
Bradycardia
3. Occasionally the loop of the cord seen at the
vulva.
4. ultrasaund
BY MUKEREM.A 2007

Management
The treatment depends up on the;
degree of cervical dilatation
the live of the fetus
the type of presentation
Emergency Care
1. Insert a gloved hand in to the vagina and push
the presenting part up to decrease pressure on
the card and dislodge the presenting part from
the pelvis
BY MUKEREM.A 2007

2. Relieve pressure
Raise end of bed
Put mother knee chest position
Exaggerated sims position
3. Do vaginal examination note
Presentation; dilatation and pulsation of the
cord.
4. If membranes intact avoid rupturing them.
BY MUKEREM.A 2007

Complications
The risk to the fetus is hypoxia and death as
a result of cord compression.
The risks are greatest in cephalic
presentation than complete or footling
breech and transveres lie.
Primgrvida than multigrvida
obstetricsII by mukerem BY MUKEREM.A 2007

Management in the first stage of labor
1. An immediate caesarean
section is performed if the
fetus is alive
obstetricsII by mukerem
BY MUKEREM.A 2007

Management in the second stage of labor
If the lie is longitudinal and the cx is fully
dilated forceps delivery or breech extraction
may be done.
If there is any possibility that a vaginal
delivery may be difficult a C/S should be
performed.
If the fetus is dead with a longitudinal lie no
urgent treatment required but spontaneous
vaginal delivery should be a waited.
BY MUKEREM.A 2007

NB:- In the community if the fetus is alive
the woman should be transferred to hospital
by ambulance immediately while the
midwife relieves pressure on the cord as
described above. The knee – chest position is
uncomfortable for the woman to maintain
for any length of time. An exaggerated sims
position is preferable.
BY MUKEREM.A 2007

3. Managing amniotic fluid embolism
Amniotic fluid embolism
This condition when amniotic fluid containing
meconium, vernix and fetal cells enter the
maternal circulation under pressure between
the placental and the uterine wall and forming
an embolus which obstructs one of the
pulmonary arterioles or alveolar capillaries.
BY MUKEREM.A 2007

 Predisposing Factors
1. Rapid or precipitate labour
This considered being the most common cause.
hypertonic contraction which occurs in this type of
labour.
2. Over stimulation of the uterus.
Excessive use of oxytocin drugs or prostaglandins
may cause hypertonic uterine action.
3. Uterine trauma
 Eg. During uterine rupture and internal podalic
version. obstetricsII by mukerem
BY MUKEREM.A 2007

Sign and Symptoms
Sudden onset of maternal respiratory distress such as severe dyspenia
and cyanosis.
Cardio vascular collapse
Tachycardia
Hypotension
Cardiac arrest
Convulsions
Hemorrhage
Usually result of disseminated intravascular coagulation. Amniotic fluid
is rich in thromboplastin which attracts fibrinogen.
BY MUKEREM.A 2007

Emergency management
1. Anyone of the above symptoms is indicative of
an acute emergency. The doctor/midwife
should immediately summon.
2. Oxygen administered by face mask 4 lt/min
3. Suction
4. Resuscitation equipment should be at hand
5. If she undelivered the fetal heart rate should
be monitored continuously.
6. Treat hemorrhage
BY MUKEREM.A 2007

Complications
Death due to cardiopulmonary collapse
DIC
Acute renal failure
BY MUKEREM.A 2007

4. Managing rupture of the uterus
Rupture of the uterus
The most serious complication in midwifery
and obstetrics
It is often fatal for the fetus and may also be
responsible for the death of the mother.
Defn :- This is where there is a tear in the
uterine wall
BY MUKEREM.A 2007

Two types of tear (rupture)
Complete rupture:- When the overlying
peritoneal coat is torn and bleeding and fetus is
under abdominal skin.
Incompletes:- When the peritoneum remains
intact and bleeding tracks under the peritoneal
cavity.
obstericsII by mukerem
BY MUKEREM.A 2007

Causes /Risk factors
Obstructed labour
Separation of previous C/S scar
Trauma due to operative manipulation
The unwise use of oxytocin
The extension of an old cervical tear.
Neglected labour
High parity
BY MUKEREM.A 2007

Silent rupture of uterus
Defn: - rupture in previous c/s scare known as
silent rupture.
Signs of a silent rupture
Rise in pulse above 90/min
Pain over the old scar and tenderness
Slight vaginal bleeding and vomiting
Shock which comes on very slowly
Labour will not progress soon
 no FHB. BY MUKEREM.A 2007

Abrupt rupture
Defin:- rupture in obstructed labour know as
abrupt rupture
Signs of abrupt rupture
History of obstructed labour
Bandl’s ring is seen before rupture
Vomiting of dark brown vomitus
No FHB
BY MUKEREM.A 2007

Confirmation or diagnosis of rupture uterus
History of obstructed labour
V/S – B/P low with weak and rapid pulse
Tender abdomen
No FHB
Vaginal bleeding
No fetal movement
No uterine contraction
High head
Sign of shock and dehydration
BY MUKEREM.A 2007

Management of a ruptured uterus in health
Center
Lie patient flat
Put up iv drip
Give pethidine
Transvere her to the nearest hospital
Bring donors
Go with patient
BY MUKEREM.A 2007

• Management of a ruptured uterus in the
hospital
• 1. Lie patient flat
• 2. Blood group and cross match
• 3. Put Intravenous drip
• 4. Get patient to sign consent form
• 5. Give pre medication
• 6. Carry out doctor’s order
BY MUKEREM.A 2007

Management
1. Hysterectomy
2. Repair of the uterus.
BY MUKEREM.A 2007

GROUP DISSCUITON
1) How to Prevent rupture to uterus???
BY MUKEREM.A 2007

Prevention of rupture uterus
Constant and careful antenatal care
Refere to hospital mother who has obstructed labour
Detect high risk mothers and select them for hospital
delivery
Previous section must always delivery in Hospital
Care during manipulation
Careful observation of the mother in labour to
exclude obstructed labour
Avoid giving pitocin for previous classical c/s scar
BY MUKEREM.A 2007

Obstetric emergencies part 1

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Obstetric emergencies part 1