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APH PPH Eclampsia Shoulder  dystocia Cord prolapse Maternal collapse Uterine  inversion

Per vaginal bleeding Miscarriages Acute abdomen Ectopic pregnancy Ovarian accident (twisted/ruptured) Infection Septic miscarriage

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History taking LNMP, early dating scan HOPI Antenatal history Past Obstetric,  Gynae , Family, Medical/surgical & Social history Physical examination General, Cardio-respiratory, Abdomen, Vaginal examination, CNS Investigations Blood, Urine, Imaging Treatment ABC resuscitation According to cases

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Plaænta
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MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED.

Definition Diagnosis Complication Management

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Source: Expert Rev of Obstet Gynecol @ 2013 Expert Reviews Ltd

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Sudden
Weight
Protein
Urine
Rising High
Blood Pressure
Above Normal
Blurred Vision. Headache
& trt&ty
Ptting Edema
Swollen Face, Hnis
&arnp; Feet
Abdorninal Pain
Muscle Twnchlng
Seizures & Coma

GOAL
Control
seizures
Control
hypertension
Stabilize &
deliver
(ACOG, 2002)
MANAGEMENT
Protect mother
Protect airway
Activate multidisciplinary team
Administer Magnesium Sulfate
Administer labetalol or hydralazine
Give other antihypertensive medications
per MD
Assess mother and fetus
Delivery method depends on maternal,
fetal, & obstetric conditions

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HELPERR
for Shoulder Dystocia
H Call for Help
E Evaluate for Episiotomy
L McRoberts Maneuver
Legs:
P External Pressure-suprapubic
E Enter: rotational
maneuvers
posterior arm
R Roll the patientto her
OALSO
hands and knees

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POSSIBLE CAUSES Haemorrhage   Pulmonary embolism  Cardiac disease: MI, cardiomyopathy, valve lesions, arrhythmias  Pre-eclampsia / Eclampsia  Amniotic fluid embolism  Local  anaesthetic  toxicity  High regional block (total spinal)  Failed  intubation/ventilation-Hypoxia  Anaphylaxis  Sepsis  Intracranial pathology:  o Subarachnoid /  Cerebral  haemorrhage o Cerebral vein thrombosis

MATERNAL COLLAPSE
Cardiopulmonary
resuscitation
4 minutes
Return of spontaneous circulation
No
Yes
Gestational age 24 weeks
(Per history or fundal height)
NO
Perimortem Cesarean Section
Continue CPR
Successful resuscitation
Call for help:
• Resuscitation team
Obstetric surgeons
• Neonatologists
Order blood products
• Left lateral shift
• Do not transport
•Stabilize
•Transfer to tCtJ
Ignore:
• Informed consent
• Technique sterility
• Urinary catheter
No
Aesthetic wound closure
Yes
Hemostasis • meticulous
Layered sutures
Uterotonics administration
Antibiotic prophylaxis

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MANAGEMENT OF RUPTURED ECTOPIC
PRINCIPLE: Resuscitation and Laparotomy
ANTI SHOCK TREATEMENT:
- IV line made patent, crystalloid is started
- Blood sample for Hb, blood grouping & cross matching, PT,PTTK,INR
- Catheterization done
- Colloids for volume replacement
LAPAROTOMY:
Principle is 'Quick in and Quick out'
- Rapid exploration of abdominal cavity is done
- Salpingectomy is the definitive surgery (sent for HPE)
- Blood transfusion to be given

Tubal (isthmus)
Interstitial
Tubal (ampullary
Ovarian
Infundibular (ostial)
Peritoneal
—Abdominal

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Identify risk factors, precaution        and counselling  When the event occur:      Initiate RED ALERT      Call for HELP      ABC Resuscitation      Mother comes first      Documentation       Explanation to patient/ spouse /             family members

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“ There is a beautiful massive change  that  happens within you  when  you start to concentrate in  bettering  yourself.” Umm Umar Khaled

OBGYN Emergencies