OBGYN Emergencies

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-.0 Obstetrics and Gynecology

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OBGYN EMERGENCIES

OBSTETRICS

APH PPH Eclampsia Shoulder dystocia Cord prolapse Maternal collapse Uterine inversion

GYNAECOLOGY

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

ALE

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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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Antepartum Haemorrhage

Placenta Cervix MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED.

Abruptio placenta

Placenta previa

Type

Definition Diagnosis Complication Management

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

Post partum Haemorrhage

Definition

Classification

Causes 4 Ts

Management

Documentation

Explanation

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Eclampsia

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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Shoulder Dystocia The turtle sign

HEELLLPP!!! SHOULDER DYSTOCIA!

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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Cord Prolapse

Documentation

Explanation

Caesarean section

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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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Uterine Inversion

3rd stage of labour

Classification

O’ Sullivan hydrostatic technique

Manual reduction

Explanation

Documentation

Surgical

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Ectopic pregnancy

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

Presentation

Clinical Assessment

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Twisted ovarian cyst

RESUSCITATION

SURGERY

ASSESSMENT

PRESENTATION

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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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