Obstetrical emergencies

1. OBSTETRICAL EMERGENCIES

2. OBSTETRICAL EMERGENCIES
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Pre-eclampsia and eclampsia
HELLP syndrome
Post-partum haemorrhage
Amniotic fluid embolus

3. Pre-eclampsia and eclampsia
• The hallmark of pre-eclampsia is hypertension
with proteinuria. It is considered mild if
proteinuria is 0.25–2g/l and severe if >2g/l.
• Eclampsia is the same condition associated
with seizures.

4. Management
Circulatorymanagement
• To Treat High BP use controlled plasma
volume expansion as the first line treatment.
• Fluid management.
• Anti-hypertensives such as labetalol,
nifedipine or hydralazine.

5. Convulsions
• Convulsions are best avoided by good blood
pressure control.
• Benzodiazepines to control seizure
• Magnesium sulphate is the treatment of choice
for eclamptic convulsions. Magnesium levels
should be monitored and kept between 2.53.75mmol/l. Above 3.75mmol/l toxicity with
possible cardiorespiratory arrest may be seen.
• Prophylactic anticonvulsant therapy with
magnesium for pre-eclampsia.
• Elective intubation, mechanical hyperventilation
and further anticonvulsant therapy.

6. Early fetaldelivery
• If fetal maturity has been reached immediate
delivery after control of seizures and hypertension is necessary.

7. Drug dosages
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Labetolol
Nifedipine
Hydralazine
Magnesium

8. HELLP syndrome
• HELLP syndrome is a pregnancy related
disorder associated with haemolysis, elevated
liver function tests and low platelets.

9. Clinical features
• Epigastric or right upper quadrant pain with
malaise.
• Nausea and vomiting.
• Generalised oedema is usual but hypertension
is less common. Presentation may occur postpartum.

10. Criteria for diagnosis of HELLP
syndrome
• Haemolysis
– Abnormal blood film
– Hyperbilirubinaemia
– LDH >600U/l
• Elevated liver enzymes
– AST >70U/l
• Thrombocytopenia
– Platelets <100×109/l

11. Management
• Resuscitation and exclusion of hepatic
haemorrhage or ruptured liver.
• In case of ruptured liver an early Caesarean
section and definitive surgical repair are
urgent.
• Treat Microangiopathic haemolysis and
thrombocytopenia using plasma exchange and
fresh frozen plasma infusion.
• Platelet transfusions only in case of an active
bleeding.

12. Post-partum haemorrhage
• Resuscitation
• Aortic compression using the pressure
between the fist and vertebral column
• Stimulated uterine contraction-Prostaglandin
F2α injected locally in to the uterus or IM
• Arterialocclusion-Angiographic embolisation
or internal iliac artery ligation

13. Amniotic fluid embolus
• 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. Hence it leads to capillary leak and
disseminated intravascular coagulation.

14. Management
• Respiratory support – Oxygen (FiO2 0.6–1.0).
• CPAP or mechanical ventilation.
• Cardiovascular support-controlled fluid
loading and inotropic support.
• Haematological management-blood product
therapy.
• Treatment with cryoprecipitate.

15. Thank you