Obstetrical Emergencies

Posted by e-Medical PPT
Postpartum Hemorrhage
Defined as >500 ml blood loss vaginal or >1000 ml blood loss after c-section
PPH - Cause
Think of the 4 T’s:
Tone – decreased uterine tone – most common cause
Trauma – Laceration / Uterine inversion
Tissue – retained placental tissue
Thrombin – depleted coagulation factors

PPH – Retained placenta
Failure to deliver placenta in 30 minutes
Gentle cord traction
Consider injection of 20 units of pitocin in the umbilical vein  (2 ml of pitocin in 20 ml saline)
Manual extraction

27 yr G1P0 is in active labor.  Her pregnancy was uncomplicated.  She was complete at 1300.  At 1415 she delivers an OA Head over an intact perineum.  A “turtle sign” is noted.  You suction the fetal mouth and nose and then assist restitution of the head.  Despite maternal pushing, you are unable to deliver the head over the next minute.

Shoulder Dystocia
Definition:  Delivery in which the anterior shoulder of the baby is impacted against the maternal symphysis pubis and is not deliverable in 60 seconds.
Risk Factors
 Prior shoulder dystocia
 Prolonged gestation
 Fetal macrosomia
 Maternal obesity

Maintenance of good glycemic control in pregnant diabetic women decreases fetal macrosomia
Elective C-section for fetal macrosomia

Third trimester bleeding
Placenta abruption
Placenta previa
Vasa previa
Uterine rupture

Placental Abruption
Painful third trimester bleeding.
1:120 pregnancies, approx. 1%.
Recurrence rate of 10%.
Port wine stained amniotic fluid.

Placenta Previa
Painless third trimester vaginal bleeding
1:200 pregnancies in 3rd trimester
1:50 grand multiparas,1:1500 nulliparas

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