Obstetric Emergencies

Transcription

1 Obstetric Emergencies Dr. Si Lay Khaing Senior Lecturer/ O&G Specialist Faculty of Medicine University of Malaya 15 th March 2014

2 Abstract Life Saving, The obstetric patient is unique in medicine as two or more lives are involved with the challenge of needing to balance the sometimes conflicting interests of the mother and her fetus within a pregnant physiology. Keywords: Obstetrics; Contraception; Life saving; Obstetric emergency

3 The Emergency An emergency situation arises when delay in appropriate management over minutes to a few hours may result in death, permanent organ damage or disability. The challenge in management is compounded by the time limitation inherent in emergencies. KNOW YOUR LIMIT!!! Ensure you are putting yourself at risk!

4 Causes of Emergencies during pregnancy and childbirth Cardiac (Heart) arrest Eclampsia (Fits) Bleeding per vagina (Antenatal haemorrhage) Leaking liquor+/- Cord Prolapse Bleeding per Vagina after delivery (Post partum Haemorrhage)

5 HEART STOP

6 1. Heart arrest (1:30,000) Causes Heart disease Heart failure due to hypertension in Pregnancy Embolism Bleeding Trauma, accident

7 Quickly ask! Whether she has Fall, Trauma, Accident Heart disease Hypertension difficulty in breathing bleeding

8 Assessment (sign & symptoms) Pale/Blue Breathing Heart beat Pulse BP Eyes

9 ABC A Airway B Breathing C Circulation Do in order because airway and/or breathing problem will kill before circulation problem Assess airway and breathing, and treat And then, assess circulation, and treat.

10 Airway and breathing Hello, Ma Saung!!! Ma Saung!!! Tilt to left lateral position If no response: Assess she is breathing or not! Look Look for breathing by looking for movement of the chest Listen for breathing or noisy breathing Feel for breathing

11 If no breathing Open airway by head tilt Open air way by chin lift Open air way by Jaw thrust Not all 3 methods of opening airway need to be used if one is successful. A combination of 2 methods may be necessary in some cases. Head tilt and chin lift can be done at the same time.

12 PRACTICE!!! Ma Saung!!!! Ma Saung!!!!

13 If still no breathing! Gentle suction Place Oropharyngeal tube (Metal spoon) Give rescue breath If still no breathing! ****NOTE!!! This is probably NO Circulation Chest compression

14 Chest Compression Place heel of first hand on lower part of sternum Place heel of second hand on the top of first Interlock fingers Keep arm straight

15 Chest compression Compress the sternum at the rate of 30 compressions per 2 breaths

16 If breathing Turn into recovery position Call for help Check pulse, BP Reassess Send to nearest Hospital KNOW YOUR LIMIT!!!

17 Fits during Pregnancy

18 Fits during Pregnancy Causes Eclampsia Epilepsy Head injury Brain Tumour

19 Quickly ask! Whether she has Hypertension Epilepsy Fall, Trauma Accident Vomiting Brain tumour Any medicine taken

20 Assessment (sign & symptoms) Pale/Blue Breathing Heart beat Pulse BP ( very high in Eclampsia) Eyes?Head injury Swollen whole body (Oedema in Eclampsia)

21 Complications of Eclampsia Brain Eyes Lung Heart Liver Kidney Fetus ( small/ death) Mother..may complicate up to death

22 What to do?

23 What to do? Call for Help Place the patient on floor (Not to fall) Recovery position Head tilt, body turn Open air way (Mouth piece or wooden spoon) Maintain/ clear air way

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25 SHOCK

26 Shock Inadequate supply of oxygenated blood to vital organs (Brain, Lungs, Heart, Kidneys..). Causes Bleeding Sepsis Heart failure

27 Quickly ask! Whether she has Hypertension Fall, Trauma, Accident Known placenta previa during this pregnancy Bleeding after delivery at home Any high fever Any attempted abortion

28 Assess Conscious or NOT! Brain--anxious, confused Level of Consciousness AVPU! A V P U Alert Not alert but response to voice No response to voice but response to pain No response to pain- Unresponsive

29 Assessment (sign & symptoms) Skin-- sweat, cold Breathing-- Rapid Eyes--Pale Temperature very high in sepsis Pulse-- weak and fast >100/minutes BP--very low Kidney--No urine output

30 Assess!! Fetus--less movement Amount of Blood loss Guess how much she lost Bring all blood stained clothes to Hospital WEAR GLOVES!!!!

31 Be aware of Blood lost Sign Slight increase in Pulse rate Blood loss 700 mls Increase in pulse rate and respiration rate Fall in blood pressure 1,500 mls 2,000mls Cold, drowsy, very rapid pulse or can not get pulse, Very low BP 2,500mls

32 Call for Help What to do? Air way ; breathing; Circulation ABC Look Look for breathing by looking for movement of the chest Listen for breathing or noisy breathing Feel for breathing Both legs up (more blood supply to brain and heart) Keep warm (Blanket) Arrange transport to nearest hospital

33 Bleeding Can loose both baby and mother s life Most common cause of maternal death worldwide Blood loss can be underestimated When there are signs, they are significant Act Quickly!!!

34 Umbilical Cord Prolapse

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38 Umbilical cord is coming down to the vagina below the fetal part after breaking the water bag. Baby can die if you do not know what to do.

39 What to do? See or Gently feel the Cord If Pulsating---Baby is still alive Keep the patient in Knee Chest position OR Put pillows under the buttock Replace cord into vagina if it is outside the vagina If no pulsating, the fetus is dead.

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41 Warning!!!! Please send her to hospital if she experiences water bag broken (Leaking Liquor) How to differentiate from Urine? Urine can be controlled. Leaking can not be controlled. If no cord prolapse, send her to hospital in left lateral position.

42 Indications for hospital delivery Primi-gravida; Multi-gravida Too old; Too young Too short; Too tall Bleeding; Leaking; Oedema Twin Pregnancies Too many medical problems

43 Summary Practice Know your limit Protect yourself Call for help Immediate referral to nearest hospital

44 Thank you

45 References 1. Vallikkannu, Narayanan, Wan Nordin Nadzratulaiman, Siti Zawiah Omar, Si Lay Khaing, and Peng Chiong Tan. "Talcum powder or aqueous gel to aid external cephalic version: a randomised controlled trial." BMC pregnancy and childbirth 14, no. 1 (2014): Mya, Mya, Than Win, Mi Mi Khaing, and Si Lay Khaing. "Contraceptive prevalence survey and urban Mandalay." (1992). 3. Mya, Mya and Si Lay Khaing. "Contraceptive prevalence survey in rural Hlegu." (1992). 4. Mastor, Asmah, Si Lay Khaing, and Siti Zawiah Omar. "Users perspectives on Implanon in Malaysia, a multicultural Asian country." Open Access Journal of Contraception (2011):