1. Obstetric Emergency

2. Definition: Emergency is term that denotes an unexpected or sudden occurrence demanding prompt action.

3. The list of potential and unexpected obstetric occurrences demands prompt action is extensive. 1.Placental abruption 2.Placental praevia 3.Post-partum haemorrhage * placenta accreta * uterine inversion * puerperal hematoma

4. 4. Uterine rupture 5. Ectopic pregnancy 6. Hypovolaemia due to haemorrhage 7. Eclampcia 8. Amniotic and thromboembolism 9. Obstetric septic shock 10. Acute respiratory failure 11. Pre-Term labour 12. Shoulder dystocia

5. Post- Partum Haemorrhage Definition Increase blood loss during or following the 3rd stage of more than 600cc. Types-: 1. Primary post Partum haemorrhage 2. Secondary post Partum haemorrhage

6. Primary Post-Partum Haemorrahage Aetiology: A. Placental site bleeding I. Atonic post-partum haemorrhage A) The factors of predispoic to: 1. Prolonged labour - exhaustion 2. Antepartum haemorrhage 3. Anaemia +++ 4. Fibroid in uters 5. Full Bladder or rectum B. Trauma: Perineum, vulva, vagina and cervix

7. II. Retention of placenta - partially or complete support III. Hypofibrinogenaemia Clinical Picture A. General examination B. Abdominal Examination C. Vagincal examination

8. Prophylaxis Avoid predisposing factors A) During labour: a. Avoid traumatic delay delivry b. Proper Management of 3rd stage c. Avoid traction on cord d. Examine birth canal e. Bladder should be empty B) The patient should be observed 2 hours after delivery. C) Delivery in good hospital

9. Active Treatment 1. Blood Transfusion 2. Fibrinogen 4-10 gm I.V. 3. Double or triple strength plasma 4. Epsilon Amino caproic acid

10. Secondary Post-partum Haemorrhage Causes: 1. Retained part of placenta 2. Infection. 3. Submucous fibroid 4.Local gynae case - erosion 5. Puerperal inversion 6. Choriocarcinoms 7. Oestrogen withdrawal 8. Choriocarcinoma

11. Retained Placenta

12. Placenta failed to be expelled. A) Aetiology 1. Retention, separllted placenta 2. Atony of uterus 3. Contraction ring – hour glass contraction B. Retention of non-separated placenta 1. Atony of uterus 2. Abnormal adhesion of placenta

13. Clinical Picture 1.Bleeding 2. Atonic uterus 3. Vaginal examination * hour glass * placenta accreta * ruptu of the uterus

14. Treatment A. In case of uterine atony Ergometrine Massage of uterus Manual removal of placenta B. In case of contraction ring Deep anaesthesia Arrange nitrate inhalation C. In case of adherent placenta Manual removal. D. In case of rupture of uterus

15. Acute Puerperal Inversion The uterus is partially or completely turned inside out. Aetiology 1. Usually induced pressing fundus traction or cord 2. Spontaneous a. precipitation labour b.traction of fetus on short cord c. submucous fibroid Degree 1st deg 2nd deg 3rd deg

16. Clinical Picture Shock Bleeding un the placenta attached Pain Treatment A) Prophylaxis B) Active Treatment 1. Anti-shock measures 2. Blood transfusion 3. Reduce invasim

17. Shock in Obstetrics Types of shock Surgical shock Neurogenic Idiopathic obstetric shock Hypovolaemia shock Emdotoxic or septic shock

18. Clinical Picture 1. Hypotension 2. Tachycardia 3. Pallor 4. Cyanosis Treatment of shock

19. Hypofibrinegemia Aetioiogy 1. Concealed accidental haemorrhage 2. IUFD 3. Amniotic fluid embolism Fibrinogen 4 - 16 gm IV Antifibrinolysin EACA 4-6 gm

20. Rupture of Uterus

21. Indication * Malpresentation * Big size baby * Pendulous * Weak uterine muscle * osteomalacia Aetiology: Rupture during pregnancy: Spontaneous 1. Rupture scar (upper segment ea rean section, myomectomy perforation) 2. Severe concealed accidental haemorrhage 3. Anterior sacculation - incarcerated R.V. gravid uterus 4. Rupture rudimentary haemorrhage of bicornuate uterus

22. Clinical Picture A. Rupture of uterus during pregnancy or early or in early in labour 1. Severe abdominal pain + sign and symptoms of internal haemorrhage 2. Abdominal - fetus is easly felt - FHS not heard 3. Vaginally - may be vaginal bleeding B. Rupture of the uterus late in labour 1. Spontaneous rupture due to obstructed labour (1) Before actu.1 rupture - impending rupture 2. When actu.al rupture occurs: a. Severe abdominal Pain - cessation of uterine contraction b. shock c. Abdominal fetus is easly felt

23. Site of Rupture 1. Rupture due to obstructed labour - involve lower uterine 2. Traumatic in late labour involve lower segment and usually incomplete 3. Rupture of upper segment scar - complete 4. Rupture of lower segment scar - complete - incomplete

24. Clinical Conditions allegedly associated with Utrine Rupture Casesarean Section Oxytocin Multipara Epidural anasthesia Abruptio placenta Mid forceps Breech version / extraction External trauma to the abdomen Pertomlon of uterus - D & C

25. Rupture during labour I. Spontaneous 1. Obstructed labour 2. Rupture of uterine scar 3. Idiopathic II. Traumatic 1. IPV after drainage 2. Destructive operdon 3. Forceps application II. Improper use of syntoclnon drugs

26. Types of Rupture 1. Complete 2. Incomplete

27. Clinical signs and symptome associated with uterine rupture 1. Fetal distress 2. Abdominal pain 3. Vaginal bleeding 4. Recession of presenting part 5. Uterine hypertonias 6. Altered uterine contour

28. Treatment Blood transfusion Labarotomy Complications A. Maternal 1. Shock 2. Haernorrhage 3. Sepsis 4. Paralytic ileus 5. Injury to the bladder