Soumettre la recherche
Mettre en ligne
Obstetric emergencies
•
Télécharger en tant que PPTX, PDF
•
64 j'aime
•
22,707 vues
Dr Nupur Gupta High Risk Obstetrician
Suivre
Emergencies in obstetrics need immediate attention and comprehensive care
Lire moins
Lire la suite
Santé
Signaler
Partager
Signaler
Partager
1 sur 98
Télécharger maintenant
Recommandé
Antepartum hemorrhage
Antepartum hemorrhage
Snigdha Gupta
Cord prolapse
Cord prolapse
Priyanka Gohil
Obstetrical shock
Obstetrical shock
Priyanka Gohil
Eclampsia
Eclampsia
Zahidul Alam
03 Active management of third stage of labour
03 Active management of third stage of labour
Prabir Chatterjee
post partum haemorrhage
post partum haemorrhage
farranajwa
Placenta praevia
Placenta praevia
Fahad Zakwan
abruptio placenta
abruptio placenta
Snehlata Parashar
Recommandé
Antepartum hemorrhage
Antepartum hemorrhage
Snigdha Gupta
Cord prolapse
Cord prolapse
Priyanka Gohil
Obstetrical shock
Obstetrical shock
Priyanka Gohil
Eclampsia
Eclampsia
Zahidul Alam
03 Active management of third stage of labour
03 Active management of third stage of labour
Prabir Chatterjee
post partum haemorrhage
post partum haemorrhage
farranajwa
Placenta praevia
Placenta praevia
Fahad Zakwan
abruptio placenta
abruptio placenta
Snehlata Parashar
Ante partum haemorrhage
Ante partum haemorrhage
Dr Zharifhussein
Fetal distres
Fetal distres
adinugraha24
Occipito posterior position
Occipito posterior position
Priyanka Gohil
Post partum Haemorrhage
Post partum Haemorrhage
Dr Zharifhussein
Eclampsia ppt
Eclampsia ppt
Abhilasha verma
Shoulder dystocia
Shoulder dystocia
Aboubakr Elnashar
Obstetrical shock
Obstetrical shock
drmcbansal
Cord Prolapse
Cord Prolapse
Kattey Kattey
Ectopic Pregnancy
Ectopic Pregnancy
Mononita Bhattacharjee
Rupture of the uterus
Rupture of the uterus
Fahad Zakwan
Malposition
Malposition
Prativa Dhakal
POST PARTUM HEMORRHAGE(PPH)
POST PARTUM HEMORRHAGE(PPH)
PRANATI PATRA
Inversion Of Uterus
Inversion Of Uterus
Abhishek Joshi
Shoulder dystocia
Shoulder dystocia
Shrooti Shah
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its management
sunil kumar daha
Puerperal Pyrexia
Puerperal Pyrexia
Farjad Baig
Third stage of labour
Third stage of labour
Deepthy Philip Thomas
management of placenta previa
management of placenta previa
Srinivasan Gunasekaran
PUERPERAL SEPSIS
PUERPERAL SEPSIS
TriptiSharma72
Occipito posterior positition
Occipito posterior positition
imanswati
High risk pregnancy
High risk pregnancy
Dr Nupur Gupta High Risk Obstetrician
Maternal screening in Pregnancy (Double & quadruple marker)
Maternal screening in Pregnancy (Double & quadruple marker)
Dr Nupur Gupta High Risk Obstetrician
Contenu connexe
Tendances
Ante partum haemorrhage
Ante partum haemorrhage
Dr Zharifhussein
Fetal distres
Fetal distres
adinugraha24
Occipito posterior position
Occipito posterior position
Priyanka Gohil
Post partum Haemorrhage
Post partum Haemorrhage
Dr Zharifhussein
Eclampsia ppt
Eclampsia ppt
Abhilasha verma
Shoulder dystocia
Shoulder dystocia
Aboubakr Elnashar
Obstetrical shock
Obstetrical shock
drmcbansal
Cord Prolapse
Cord Prolapse
Kattey Kattey
Ectopic Pregnancy
Ectopic Pregnancy
Mononita Bhattacharjee
Rupture of the uterus
Rupture of the uterus
Fahad Zakwan
Malposition
Malposition
Prativa Dhakal
POST PARTUM HEMORRHAGE(PPH)
POST PARTUM HEMORRHAGE(PPH)
PRANATI PATRA
Inversion Of Uterus
Inversion Of Uterus
Abhishek Joshi
Shoulder dystocia
Shoulder dystocia
Shrooti Shah
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its management
sunil kumar daha
Puerperal Pyrexia
Puerperal Pyrexia
Farjad Baig
Third stage of labour
Third stage of labour
Deepthy Philip Thomas
management of placenta previa
management of placenta previa
Srinivasan Gunasekaran
PUERPERAL SEPSIS
PUERPERAL SEPSIS
TriptiSharma72
Occipito posterior positition
Occipito posterior positition
imanswati
Tendances
(20)
Ante partum haemorrhage
Ante partum haemorrhage
Fetal distres
Fetal distres
Occipito posterior position
Occipito posterior position
Post partum Haemorrhage
Post partum Haemorrhage
Eclampsia ppt
Eclampsia ppt
Shoulder dystocia
Shoulder dystocia
Obstetrical shock
Obstetrical shock
Cord Prolapse
Cord Prolapse
Ectopic Pregnancy
Ectopic Pregnancy
Rupture of the uterus
Rupture of the uterus
Malposition
Malposition
POST PARTUM HEMORRHAGE(PPH)
POST PARTUM HEMORRHAGE(PPH)
Inversion Of Uterus
Inversion Of Uterus
Shoulder dystocia
Shoulder dystocia
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its management
Puerperal Pyrexia
Puerperal Pyrexia
Third stage of labour
Third stage of labour
management of placenta previa
management of placenta previa
PUERPERAL SEPSIS
PUERPERAL SEPSIS
Occipito posterior positition
Occipito posterior positition
Similaire à Obstetric emergencies
High risk pregnancy
High risk pregnancy
Dr Nupur Gupta High Risk Obstetrician
Maternal screening in Pregnancy (Double & quadruple marker)
Maternal screening in Pregnancy (Double & quadruple marker)
Dr Nupur Gupta High Risk Obstetrician
Cervical cancer Awareness 3.3.19 Cann Win
Cervical cancer Awareness 3.3.19 Cann Win
Dr Nupur Gupta High Risk Obstetrician
Be Breast Aware 2020
Be Breast Aware 2020
Dr Nupur Gupta High Risk Obstetrician
International Women's day 7.3.19
International Women's day 7.3.19
Dr Nupur Gupta High Risk Obstetrician
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
College of Medicine, Sulaymaniyah
Well Woman Clinic and What we do
Well Woman Clinic and What we do
Dr Nupur Gupta High Risk Obstetrician
Teenage problems
Teenage problems
Dr Nupur Gupta High Risk Obstetrician
Antepartumhaemorrhage 121128013531-phpapp02
Antepartumhaemorrhage 121128013531-phpapp02
Krupa Meet Patel
antepartumhaemorrhage-121128013531-phpapp02.pptx
antepartumhaemorrhage-121128013531-phpapp02.pptx
anilrawat684816
Instrumental Delivery- Decision is the Ultimate Power.pptx
Instrumental Delivery- Decision is the Ultimate Power.pptx
drpadmashukla
Instrumental Delivery.pptx
Instrumental Delivery.pptx
drpadmashukla
Bleeding in early pregnancy
Bleeding in early pregnancy
abdulrahman suliman
Thrombo
Thrombo
pushpalatha57
Antepartum haemorrhage
Antepartum haemorrhage
Hui Pheng Neoh
Urinary tract infection in females
Urinary tract infection in females
Dr Nupur Gupta High Risk Obstetrician
Thromboprophylaxis need of hour for indian women
Thromboprophylaxis need of hour for indian women
Lifecare Centre
Ectopic pregnancy
Ectopic pregnancy
Zeeshan Khan
antepartumhaemorrhage-121128013531-phpapp02 (1).pdf
antepartumhaemorrhage-121128013531-phpapp02 (1).pdf
AnilaKhan41
Pp h
Pp h
ahmed afify
Similaire à Obstetric emergencies
(20)
High risk pregnancy
High risk pregnancy
Maternal screening in Pregnancy (Double & quadruple marker)
Maternal screening in Pregnancy (Double & quadruple marker)
Cervical cancer Awareness 3.3.19 Cann Win
Cervical cancer Awareness 3.3.19 Cann Win
Be Breast Aware 2020
Be Breast Aware 2020
International Women's day 7.3.19
International Women's day 7.3.19
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
Well Woman Clinic and What we do
Well Woman Clinic and What we do
Teenage problems
Teenage problems
Antepartumhaemorrhage 121128013531-phpapp02
Antepartumhaemorrhage 121128013531-phpapp02
antepartumhaemorrhage-121128013531-phpapp02.pptx
antepartumhaemorrhage-121128013531-phpapp02.pptx
Instrumental Delivery- Decision is the Ultimate Power.pptx
Instrumental Delivery- Decision is the Ultimate Power.pptx
Instrumental Delivery.pptx
Instrumental Delivery.pptx
Bleeding in early pregnancy
Bleeding in early pregnancy
Thrombo
Thrombo
Antepartum haemorrhage
Antepartum haemorrhage
Urinary tract infection in females
Urinary tract infection in females
Thromboprophylaxis need of hour for indian women
Thromboprophylaxis need of hour for indian women
Ectopic pregnancy
Ectopic pregnancy
antepartumhaemorrhage-121128013531-phpapp02 (1).pdf
antepartumhaemorrhage-121128013531-phpapp02 (1).pdf
Pp h
Pp h
Plus de Dr Nupur Gupta High Risk Obstetrician
Lets Talk Menopausal Health in Women.pptx
Lets Talk Menopausal Health in Women.pptx
Dr Nupur Gupta High Risk Obstetrician
Nutrition in pregnancy & lactation.pptx
Nutrition in pregnancy & lactation.pptx
Dr Nupur Gupta High Risk Obstetrician
Diet during & after pregnancy.pptx
Diet during & after pregnancy.pptx
Dr Nupur Gupta High Risk Obstetrician
Vitamin D & Women Health
Vitamin D & Women Health
Dr Nupur Gupta High Risk Obstetrician
Menstrual pain or Period Pain or Menstrual Carmps: Home Remedies
Menstrual pain or Period Pain or Menstrual Carmps: Home Remedies
Dr Nupur Gupta High Risk Obstetrician
Emotional Changes during Pregnancy: Mood swings in Mommy Brain
Emotional Changes during Pregnancy: Mood swings in Mommy Brain
Dr Nupur Gupta High Risk Obstetrician
Labour epidural myths
Labour epidural myths
Dr Nupur Gupta High Risk Obstetrician
Getting Pregnant at 35: What to Expect?
Getting Pregnant at 35: What to Expect?
Dr Nupur Gupta High Risk Obstetrician
Polycystic Ovaries (PCOS) & Fertility
Polycystic Ovaries (PCOS) & Fertility
Dr Nupur Gupta High Risk Obstetrician
Dental Health in Pregnancy: Problems & Solutions
Dental Health in Pregnancy: Problems & Solutions
Dr Nupur Gupta High Risk Obstetrician
Unwanted hair (hirsutism) and polycystic ovaries
Unwanted hair (hirsutism) and polycystic ovaries
Dr Nupur Gupta High Risk Obstetrician
Poweream health wellness
Poweream health wellness
Dr Nupur Gupta High Risk Obstetrician
HPV vaccination against Cervical Cancer
HPV vaccination against Cervical Cancer
Dr Nupur Gupta High Risk Obstetrician
Better Health For Women 30s 40s 50s
Better Health For Women 30s 40s 50s
Dr Nupur Gupta High Risk Obstetrician
Vitamin D and Women's Health [autosaved]
Vitamin D and Women's Health [autosaved]
Dr Nupur Gupta High Risk Obstetrician
Women Healthy Living in 30s & 50s: Health Goals
Women Healthy Living in 30s & 50s: Health Goals
Dr Nupur Gupta High Risk Obstetrician
Mirena: An emerging tool in managing abnormal uterine bleeding
Mirena: An emerging tool in managing abnormal uterine bleeding
Dr Nupur Gupta High Risk Obstetrician
Boostrix: An Update on Tdap Vaccine in Pregnancy
Boostrix: An Update on Tdap Vaccine in Pregnancy
Dr Nupur Gupta High Risk Obstetrician
Mirena: AN ALTERNATIVE TO HYSTERECTOMY
Mirena: AN ALTERNATIVE TO HYSTERECTOMY
Dr Nupur Gupta High Risk Obstetrician
Dienogest in endometriosis
Dienogest in endometriosis
Dr Nupur Gupta High Risk Obstetrician
Plus de Dr Nupur Gupta High Risk Obstetrician
(20)
Lets Talk Menopausal Health in Women.pptx
Lets Talk Menopausal Health in Women.pptx
Nutrition in pregnancy & lactation.pptx
Nutrition in pregnancy & lactation.pptx
Diet during & after pregnancy.pptx
Diet during & after pregnancy.pptx
Vitamin D & Women Health
Vitamin D & Women Health
Menstrual pain or Period Pain or Menstrual Carmps: Home Remedies
Menstrual pain or Period Pain or Menstrual Carmps: Home Remedies
Emotional Changes during Pregnancy: Mood swings in Mommy Brain
Emotional Changes during Pregnancy: Mood swings in Mommy Brain
Labour epidural myths
Labour epidural myths
Getting Pregnant at 35: What to Expect?
Getting Pregnant at 35: What to Expect?
Polycystic Ovaries (PCOS) & Fertility
Polycystic Ovaries (PCOS) & Fertility
Dental Health in Pregnancy: Problems & Solutions
Dental Health in Pregnancy: Problems & Solutions
Unwanted hair (hirsutism) and polycystic ovaries
Unwanted hair (hirsutism) and polycystic ovaries
Poweream health wellness
Poweream health wellness
HPV vaccination against Cervical Cancer
HPV vaccination against Cervical Cancer
Better Health For Women 30s 40s 50s
Better Health For Women 30s 40s 50s
Vitamin D and Women's Health [autosaved]
Vitamin D and Women's Health [autosaved]
Women Healthy Living in 30s & 50s: Health Goals
Women Healthy Living in 30s & 50s: Health Goals
Mirena: An emerging tool in managing abnormal uterine bleeding
Mirena: An emerging tool in managing abnormal uterine bleeding
Boostrix: An Update on Tdap Vaccine in Pregnancy
Boostrix: An Update on Tdap Vaccine in Pregnancy
Mirena: AN ALTERNATIVE TO HYSTERECTOMY
Mirena: AN ALTERNATIVE TO HYSTERECTOMY
Dienogest in endometriosis
Dienogest in endometriosis
Dernier
Bihar Sharif Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Bihar Sharif Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
only4webmaster01
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
palanpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
palanpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Call Girl in Indore 8827247818 {Low Price}👉 Nitya Indore Call Girls * ITRG...
Call Girl in Indore 8827247818 {Low Price}👉 Nitya Indore Call Girls * ITRG...
mahaiklolahd
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Jalna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Jalna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Kochi call girls Mallu escort girls available 7877702510
Kochi call girls Mallu escort girls available 7877702510
Vipesco
bhopal Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
bhopal Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Erode Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Erode Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
mahaiklolahd
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
Ahmedabad Call Girls
neemuch Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
neemuch Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Ozhukarai Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ozhukarai Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girls Service
Vip Call Girls Makarba 👙 6367187148 👙 Genuine WhatsApp Number for Real Meet
Vip Call Girls Makarba 👙 6367187148 👙 Genuine WhatsApp Number for Real Meet
Ahmedabad Call Girls
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
indiancallgirl4rent
Gorgeous Call Girls Mohali {7435815124} ❤️VVIP ANGEL Call Girls in Mohali Punjab
Gorgeous Call Girls Mohali {7435815124} ❤️VVIP ANGEL Call Girls in Mohali Punjab
Sheetaleventcompany
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
indiancallgirl4rent
Best Lahore Escorts 😮💨03250114445 || VIP escorts in Lahore
Best Lahore Escorts 😮💨03250114445 || VIP escorts in Lahore
Deny Daniel
Dernier
(20)
Bihar Sharif Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Bihar Sharif Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
palanpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
palanpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girl in Indore 8827247818 {Low Price}👉 Nitya Indore Call Girls * ITRG...
Call Girl in Indore 8827247818 {Low Price}👉 Nitya Indore Call Girls * ITRG...
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Jalna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Jalna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Kochi call girls Mallu escort girls available 7877702510
Kochi call girls Mallu escort girls available 7877702510
bhopal Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
bhopal Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Erode Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Erode Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
neemuch Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
neemuch Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ozhukarai Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ozhukarai Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Vip Call Girls Makarba 👙 6367187148 👙 Genuine WhatsApp Number for Real Meet
Vip Call Girls Makarba 👙 6367187148 👙 Genuine WhatsApp Number for Real Meet
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Gorgeous Call Girls Mohali {7435815124} ❤️VVIP ANGEL Call Girls in Mohali Punjab
Gorgeous Call Girls Mohali {7435815124} ❤️VVIP ANGEL Call Girls in Mohali Punjab
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
Best Lahore Escorts 😮💨03250114445 || VIP escorts in Lahore
Best Lahore Escorts 😮💨03250114445 || VIP escorts in Lahore
Obstetric emergencies
1.
1Copyright © 2014
Well Woman Clinic. All rights reserved. 1 A holistic approach to Woman’s health Dr Nupur Gupta Dept of Obstetrics & Gynecology Paras Hospital, Gurgaon Obstetric Emergencies
2.
2Copyright © 2014
Well Woman Clinic. All rights reserved. 2 Our Team
3.
3Copyright © 2014
Well Woman Clinic. All rights reserved. 3 Emergency Obstetric Care To Avert Death and Disability… …We Need to Ensure that Women have Access To Emergency Obstetric Care (EmOC)
4.
4Copyright © 2014
Well Woman Clinic. All rights reserved. What is an Obstetric emergency? A suddenly developing pathologic condition in a patient, due to accident or disease, which requires urgent medical or surgical therapeutic intervention There are 2 patients; fetus is very vulnerable to maternal hypoxia
5.
5Copyright © 2014
Well Woman Clinic. All rights reserved. But we do know that of any population of pregnant women at least 15% will experience an obstetric complication … How Do We Know Which Women Will Experience Complications? WE DON’T
6.
6Copyright © 2014
Well Woman Clinic. All rights reserved. 6
7.
7Copyright © 2014
Well Woman Clinic. All rights reserved. 7
8.
8Copyright © 2014
Well Woman Clinic. All rights reserved. Hyperdynamic , hypervolumic , maternal circulation Cardiac output increases by 50% , blood volume by 45% (peak at 32-34 wks) 30% loss of fluid may be tolerated without any tachycardia PREGNANCY CHANGES
9.
9Copyright © 2014
Well Woman Clinic. All rights reserved. Obstetric Emergencies Maternal Fetal Both maternal & fetal High Mortality rate
10.
10Copyright © 2014
Well Woman Clinic. All rights reserved. Maternal Complications of Pregnancy First Trimester Second Trimester Third Trimester
11.
11Copyright © 2014
Well Woman Clinic. All rights reserved. First Trimester 1. Ectopic pregnancy 2. Abortion 3. Molar Pregnancy 4. Uterine rupture Second Trimester 1. Abortion Third Trimester 1. Placenta Praevia 2. Placenta Accreta 3. PPH 4. Uterine rupture 5. Inversion 6. Hypertensive crisis
12.
12Copyright © 2014
Well Woman Clinic. All rights reserved. Hypertensive Complications Haemorrhage Topics of Discussion
13.
13Copyright © 2014
Well Woman Clinic. All rights reserved. Pregnancy and hypertension/Toxaemia/PIH Single largest cause of maternal death worldwide Incidence- 7-12% ( 2nd most common cause after anaemia) Pre-eclampsia - HTN + proteinuria with or without edema > 20 weeks Eclampsia - preeclampsia with seizure
14.
14Copyright © 2014
Well Woman Clinic. All rights reserved. Pregnancy and hypertension Chronic hypertension - diagnosed pre-pregnancy or before 20 weeks or persisting > 6 weeks post-partum Gestational or late transient HTN - high BP in latter half of pregnancy or 24hrs after delivery without any signs of eclampsia & disappears within 10 days post-partum
15.
15Copyright © 2014
Well Woman Clinic. All rights reserved.
16.
16Copyright © 2014
Well Woman Clinic. All rights reserved. 16
17.
17Copyright © 2014
Well Woman Clinic. All rights reserved. SBP > 140 (or +20 from baseline or DBP >90 (or +10 from baseline) Proteinuria .3g/24h +/- Edema No Oliguria No Associated symptoms Normal lab No IUGR BP>160/90 Proteinuria >5g/24h Edema Present Oliguric Visual sym, abd pain, pulm. edema Lab (dec. plts, inc. LFT, inc. bili, inc. creatinine, increased uric acid) IUGR Mild Severe HYPERTENSION & PROTEINURIA IS THE HALLMARK Preeclampsia
18.
18Copyright © 2014
Well Woman Clinic. All rights reserved. Management Goals Safety of mother & newborn Prevent Eclampsia Guidelines Hospitalization Definitive treatment being delivery Expectant management depends on maternal & fetal status, labour & gestational age
19.
19Copyright © 2014
Well Woman Clinic. All rights reserved. Antihypertensive drugs in PIH Antihypertensive drugs ↙ ↓ ↓ ↘ Nifedipine Hydralazine Labetalol Captopril ↓ ↓ ↓ ↓ Acts in 3 min. Arterial vasodilator rapid action Sublingual 25mg Peak at 1 hr. I/V bolus 5 mg I/V 10 mins acts in 5 min Oral (Sublingual) Oral 25 mg oral- 1 hr only used in post Upto 120 mg/day partum cases Divided 6 hrly Nitroglycerine drip
20.
20Copyright © 2014
Well Woman Clinic. All rights reserved. General Measures for management of Eclampsia Foley’s catheter, I/O chart Urine Albumin 4 hrly Vitals Eye pads Change of position 2hrly Fetal assessment Antibiotic cover Deep tendon reflexes Shift to ICU Railing cot Nasal O2 I/V 5% Dextrose or RL Investigations Mouth Gag Suction Slight head low position
21.
21Copyright © 2014
Well Woman Clinic. All rights reserved.
22.
22Copyright © 2014
Well Woman Clinic. All rights reserved. Eclampsia to treat convulsions: Magnesium Sulphate
23.
23Copyright © 2014
Well Woman Clinic. All rights reserved. Eclampsia to treat convulsions
24.
24Copyright © 2014
Well Woman Clinic. All rights reserved. Eclampsia to treat convulsions
25.
25Copyright © 2014
Well Woman Clinic. All rights reserved. Eclampsia to treat convulsions Next dose should be repeated (after checking the parameters) every 4 hrs 5gm I/M & continue till 24 hrs after delivery or after the last convulsion To prevent fit in severe pre-eclampsia give only I/M dose Other drugs- Diazepam, Pethidine, Promethazine, Chlorpromazine
26.
26Copyright © 2014
Well Woman Clinic. All rights reserved. Delivery within 12 hours of onset of convulsions
27.
27Copyright © 2014
Well Woman Clinic. All rights reserved.
28.
28Copyright © 2014
Well Woman Clinic. All rights reserved.
29.
29Copyright © 2014
Well Woman Clinic. All rights reserved. HELLP SYNDROME
30.
30Copyright © 2014
Well Woman Clinic. All rights reserved. 30 HAEMORRHAGIC/HYPOVOLUMIC SHOCK IN OBSTETRICS Antenatal - Ruptured ectopic pregnancy, APH, Incomplete abortion, Uterine perforation during evacuation, Uterine rupture, Abdominal wall hematoma Intranatal - uterine rupture Postnatal - PPH (primary, secondary) - Atonic,Traumatic, Retained tissue, Thrombosis, Acute uterine inversion
31.
31Copyright © 2014
Well Woman Clinic. All rights reserved. Ruptured Ectopic Pregnancy: A Surgical Emergency of Pregnancy One of the leading causes of first trimester maternal death Usually 5-8 weeks after LMP High Risk: History of ectopic, tubal surgery or sterilization procedure, Known tubal scarring or pathology
32.
32Copyright © 2014
Well Woman Clinic. All rights reserved.
33.
33Copyright © 2014
Well Woman Clinic. All rights reserved. INCOMPLETE/INEVITABLE ABORTION
34.
34Copyright © 2014
Well Woman Clinic. All rights reserved.
35.
35Copyright © 2014
Well Woman Clinic. All rights reserved.
36.
36Copyright © 2014
Well Woman Clinic. All rights reserved. CAUSES
37.
37Copyright © 2014
Well Woman Clinic. All rights reserved. PLACENTA PRAEVIA
38.
38Copyright © 2014
Well Woman Clinic. All rights reserved.
39.
39Copyright © 2014
Well Woman Clinic. All rights reserved.
40.
40Copyright © 2014
Well Woman Clinic. All rights reserved. Vaginal bleeding – bright red, painless & recurrent Soft pain free uterus Easy to feel uterus (floating head, breech or transverse No fetal distress AVOID INTERNAL EXAMINATION PLACENTA PRAEVIA SYMPTOMS & SIGNS Management is conservative – transfuse blood & prolong pregnancy till 36 weeks Delivery vaginal – anterior placenta & ARM, LSCS for posterior placentation
41.
41Copyright © 2014
Well Woman Clinic. All rights reserved. Placenta Praevia Ultrasound is highly accurate in making diagnosis (PPV 93%, NPV 98%)
42.
42Copyright © 2014
Well Woman Clinic. All rights reserved. 4 types according to distance from internal os - Partial - Low Lying - Marginal - Major or Complete
43.
43Copyright © 2014
Well Woman Clinic. All rights reserved.
44.
44Copyright © 2014
Well Woman Clinic. All rights reserved.
45.
45Copyright © 2014
Well Woman Clinic. All rights reserved.
46.
46Copyright © 2014
Well Woman Clinic. All rights reserved.
47.
47Copyright © 2014
Well Woman Clinic. All rights reserved. Abdominal pain Severe shock not proportionate to bleeding Vaginal bleeding, usually old blood Shock Uterus tense & spasmodic Tenderness Fetal parts are hard to feel Often fetal heart not heard SYMPTOMS SIGNS ABRUPTIO PLACENTAE ANTEPARTUM HAEMORRHAGE
48.
48Copyright © 2014
Well Woman Clinic. All rights reserved. It is a death threat to the fetus & a hazard to the mother Placental separation – blood clot – release of PGs – spasm – alters placental perfusion – blood tracks into the myometrium – serosa – pain & shock – uterine muscle spasm ABRUPTIO……..Mechanism & Pathology ABRUPTIO……..Emergency treatment Treat the shock – large bore IV line, Haemaccel, cross match blood Treat DIC – FFP, PRBCs Deliver the fetus - Emergency Caesarean if fetus is alive & mature - Vaginal delivery if cervix is favourable & fetus dead
49.
49Copyright © 2014
Well Woman Clinic. All rights reserved. Abruptio Placentae
50.
50Copyright © 2014
Well Woman Clinic. All rights reserved.
51.
51Copyright © 2014
Well Woman Clinic. All rights reserved.
52.
52Copyright © 2014
Well Woman Clinic. All rights reserved.
53.
53Copyright © 2014
Well Woman Clinic. All rights reserved. Abruption Delivery DIC occurs in 4-10% of cases and usually is apparent by 8 hours after onset Renal failure is the most common cause of maternal mortality
54.
54Copyright © 2014
Well Woman Clinic. All rights reserved.
55.
55Copyright © 2014
Well Woman Clinic. All rights reserved. Placenta Accreta Absence of decidua basalis and imperfect formation of the fibrinoid layer (Nitabuch) Increta in myometrial invasion Percreta the placenta goes through to the serosa Risk Factor - previous LSCS, D&C,
56.
56Copyright © 2014
Well Woman Clinic. All rights reserved.
57.
57Copyright © 2014
Well Woman Clinic. All rights reserved. Post-partum Haemorrhage: Primary Estimated blood loss > 500ml in normal & > 1000ml in LSCS Change in Haematocrit by 10% Any amount of blood loss that threatens woman’s haemodynamic stability In a woman with PIH, Anaemia, Dehydration, GDM, even small amount of blood loss can alter the situation
58.
58Copyright © 2014
Well Woman Clinic. All rights reserved. Primary PPH : Third Stage/True PPH
59.
59Copyright © 2014
Well Woman Clinic. All rights reserved. Post-partum Haemorrhage: Secondary
60.
60Copyright © 2014
Well Woman Clinic. All rights reserved. PPH: INCIDENCE Complicates 3.9% of vaginal deliveries & 6.4% of C-section deliveries 1/1000 deliveries in developing countries versus 1/100000 in developed countries
61.
61Copyright © 2014
Well Woman Clinic. All rights reserved. PPH: Incidence Cause Lacerations Atony Abruption Retained placenta Praevia Accreta Rupture Inversion Incidence 1:8 1:20-1:50 1:80-1:150 1:100-1:160 1:200 1:2000 1:2500 1:6400
62.
62Copyright © 2014
Well Woman Clinic. All rights reserved. Etiology of PPH: The 4 Ts to remember Tone - uterine atony Tissue - Retained tissue/clots Trauma - lacerations, rupture or inversion Thrombin - Coagulopathy
63.
63Copyright © 2014
Well Woman Clinic. All rights reserved. Risk factors for Haemorrhage H/O PPH in previous pregnancy APH Multiple pregnancies PIH (Pre-eclampsia, eclampsia, HELLP) Chorioamnionitis Hydramnios Fetal death Anaemia, Multiparity Uterine myoma Operative or assisted delivery Prolonged labour Precipitate labour Induction or augmentation Chorioamnionitis Shoulder dystocia Internal podalic version Acquired coagulopathy Antepartum Intrapartum
64.
64Copyright © 2014
Well Woman Clinic. All rights reserved. Risk factors for Haemorrhage Lacerations or extended episiotomy Retained placenta or placental abnormalities Uterine rupture Uterine inversion Acquired coagulopathy Postpartum
65.
65Copyright © 2014
Well Woman Clinic. All rights reserved. Prevention of PPH ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR Identifying risk factors & managing them accordingly Correct anaemia Effective management of High risk patients at tertiary care centre I/V access or blood transfusion Restrictive use of episiotomy
66.
66Copyright © 2014
Well Woman Clinic. All rights reserved. Active management of third stage Within one min. of birth give uterotonic (Inj. Oxytocin) Early clamping & cutting of cord Controlled traction on umbilical cord while applying counter traction on uterus Massage the uterus after delivery of placenta
67.
67Copyright © 2014
Well Woman Clinic. All rights reserved. Prevention of PPH during Caesarean Identify high risk patients Arrange and cross match blood Precautions during surgery to minimize blood loss Wait for spontaneous expulsion of placenta rather than manual shearing Rapid closure of uterine incision
68.
68Copyright © 2014
Well Woman Clinic. All rights reserved.
69.
69Copyright © 2014
Well Woman Clinic. All rights reserved.
70.
70Copyright © 2014
Well Woman Clinic. All rights reserved.
71.
71Copyright © 2014
Well Woman Clinic. All rights reserved. Uterine atony It complicates 1 in 20 deliveries – most common cause Etiology Over distended uterus Uterine exhaustion Intra-amniotic infection Functional or anatomic distortion of uterus
72.
72Copyright © 2014
Well Woman Clinic. All rights reserved. Uterine atony Clinical risk factors Polyhydramnios Multiple gestation Macrosomia Induced labour Prolonged or rapid labour High parity Fever/PROM Fibroid uterus Placenta praevia
73.
73Copyright © 2014
Well Woman Clinic. All rights reserved. Uterine atony- management General management Obtain help Adequate venous access Foley’s catheter Monitor adequate renal perfusion Volume replacement- infuse crystalloid, FFP, platelets or cryoprecipitate Bimanual compression
74.
74Copyright © 2014
Well Woman Clinic. All rights reserved. Bimanual Compression
75.
75Copyright © 2014
Well Woman Clinic. All rights reserved.
76.
76Copyright © 2014
Well Woman Clinic. All rights reserved. Uterine atony- Oxytocin Specific treatment Oxytocin infusion- first line treatment for PPH I/V bolus can cause severe hypotension & CVS side effects Dilute oxytocin prepared by adding 20-40 U to 1 lit. of crystalloid & infusion at rate 10 ml/min (200mu/min) up to 100-500 mu/min might be used
77.
77Copyright © 2014
Well Woman Clinic. All rights reserved. Uterine atony- oxytocin analogues Carbetocin synthetic analog of oxytocin with a half life 4-10 times longer than that of Oxytocin used as a single dose injection can be given I/V or I/M It appears to be more effective than continues infusion of oxytocin with similar safety profile Buctocin, Des- amnio-oxytocin
78.
78Copyright © 2014
Well Woman Clinic. All rights reserved. Ergometrine (Methyl ergonovine maleate) Ergot alkaloid Oral/IM/IV 0.2 mg onset of action within 10 mins. I/M or I/V 1-3 min SE- nausea, vomiting, weakness, paresthesias, chest pain CI - sepsis, HTN, heart disease, peripheral vascular diseases, liver & kidney diseases Can be repeated every 2-4 hrs up to maximum of 5 doses
79.
79Copyright © 2014
Well Woman Clinic. All rights reserved. Syntometrine Combination of oxytocin 5U & ergometrine 0.5 mg I/M No important clinical difference in effectiveness between syntometrine & I/V oxytocin in prevention of PPH Associated with higher risk of HTN & vomiting
80.
80Copyright © 2014
Well Woman Clinic. All rights reserved. Prostaglandin: PROSTODIN 15 Methyl PGF2a- I/M or intramyometrial, 250mcg Controls refractory PPH C/I- Asthma due to broncho-constriction activity, cardiac, renal & hepatic diseases S/E- nausea, vomiting, diarrhoea & pyrexia
81.
81Copyright © 2014
Well Woman Clinic. All rights reserved. Prostaglandin: MISOPROSTOL Synthetic PGE1 analogue Oral, P/V,/P/R, Sublingual Adverse affect- nausea, vomiting, diarrhoea, abdominal pain, chills, shivering, fever Routine oral 600 - 800mcg as effective as 10 u oxytocin Sublingual is as effective as I/V infusion of oxytocin
82.
82Copyright © 2014
Well Woman Clinic. All rights reserved. Surgical procedures for PPH Uterine packing Aortic compression using the pressure between the fist and vertebral column Stimulate uterine contraction - PGF2α injected locally in to the uterus or IM Balloon tamponade Suture techniques Internal iliac artery ligation Angiographic embolisation
83.
83Copyright © 2014
Well Woman Clinic. All rights reserved. 83 B Lynch Suture
84.
84Copyright © 2014
Well Woman Clinic. All rights reserved. Lacerations: Traumatic PPH First thing to be ruled out in bleeding post partum woman with a firm uterus Careful examination of the entire genital tract Rarely results in massive blood loss May be life threatening if extends to the retro peritoneum
85.
85Copyright © 2014
Well Woman Clinic. All rights reserved.
86.
86Copyright © 2014
Well Woman Clinic. All rights reserved. Rupture Uterus A potential obstetric catastrophe A major cause of maternal death Incidence: 1 in 1148 to 1 in 2250 Complete (Spontaneous & Traumatic) Incomplete
87.
87Copyright © 2014
Well Woman Clinic. All rights reserved.
88.
88Copyright © 2014
Well Woman Clinic. All rights reserved.
89.
89Copyright © 2014
Well Woman Clinic. All rights reserved.
90.
90Copyright © 2014
Well Woman Clinic. All rights reserved.
91.
91Copyright © 2014
Well Woman Clinic. All rights reserved.
92.
92Copyright © 2014
Well Woman Clinic. All rights reserved.
93.
93Copyright © 2014
Well Woman Clinic. All rights reserved.
94.
94Copyright © 2014
Well Woman Clinic. All rights reserved.
95.
95Copyright © 2014
Well Woman Clinic. All rights reserved. Inversion Usually occurs when the placenta is fundally implanted Prompt replacement is generally easier. Halothane or nitroglycerine are effective agents Uterotonics then needed to contract the uterus
96.
96Copyright © 2014
Well Woman Clinic. All rights reserved. AMNIOTIC FLUID EMBOLISM The initial response of the pulmonary vasculature to the presence of amniotic fluid is intense vasospasm resulting in severe pulmonary hypertension and hypoxaemia Amniotic fluid contains lipid-rich particulate material which stimulates a systemic inflammatory reaction. Leads to capillary leak & DIC
97.
97Copyright © 2014
Well Woman Clinic. All rights reserved. AMNIOTIC FLUID EMBOLISM Respiratory support – Oxygen (FiO2 0.6–1.0). CPAP or mechanical ventilation Cardiovascular support - controlled fluid loading and ionotropic support Haematological management - blood product therapy Treatment with cryoprecipitate
98.
98Copyright © 2014
Well Woman Clinic. All rights reserved. What can we do as Clinicians: THE WAY FORWARD? Establish obstetric emergency response teams 5 situations – PPH, APH, Shoulder dystocia, Emergency Caesarean, Eclampsia Conduct Obstetric Skills & Drills Training Labour Ward Drills IMPROVED TEAMWORK
Télécharger maintenant