OBSTETRICAL EMERGENCIES
ANTENATAL EMERGENCIES Placenta previa Placenta accreta/increta/percreta Placental abruption Uterine rupture Ectopic pregnancy Preeclampsia/eclampsia Premature rupture of membranes (prom
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Obstetrical emergencies during labor and delivery
Amniotic fluid embolism Inversion or rupture of uterus Placenta accreta. Prolapsed umbilical cord Shoulder dystocia
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POST PARTUM EMERGENCIES
Retained placenta Uterine atony Uterine inversion Birth trauma/laceration Postpartum hemorrhage and infection
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ANTEPARTUM: Umbilical cord prolapse Umbilical cord compression Uteroplacental insufficiency AT DELIVERY: Shoulder dystocia Vaginal breech delivery (head entrapment)
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PLACENTA PREVIA
1 in 200-250 deliveries Complete, partial or marginal Most diagnosed early resolve by third trimester ETIOLOGY: Unknown Previous uterine scar Previous placenta previa Advanced maternal age Multiparity
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Painless vaginal bleeding-third trimester Vaginal bleeding in 3rd trimester should be considered previa until proven otherwise Ultrasound has eliminated the need of double set up to diagnose previa as in the past Cesarean delivery Expectant management if fetus immature and no active bleeding Urgent/emergent cesarean delivery for active or persistent bleeding or fetal distress Regional/GETA
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PLACENTA ACCRETA/ INCRETA/PERCRETA
Linearly related to number of previous scars in presence of placenta previa PP+unscarred uterus-5 % risk of accreta PP+one previous C/D-24% risk of accreta PP+two previous C/D-47% risk of accreta PP+three previous C/D-40% risk of accreta PP+four previous C/D-67% risk of accreta Combination of placenta previa and previous C/DDangerous
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PLACENTA ACCRETA/ INCRETA/PERCRETA
Placenta accreta, increta and percreta difficult to diagnose antepartum Usually diagnosed when placenta doesnt separate after cesarean or vaginal delivery Color Doppler imaging or magnetic resonance imaging may diagnose the condition antepartum Preoperative balloon catheters in internal iliac can be considered in cases diagnosed antepartum. Prompt decision for hysterectomy Percreta may require surgeons skilled in pelvic dissection
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PLACENTA ACCRETA/ INCRETA/PERCRETA
GETA/Regional (CSE) Good IV access/ A line Level 1 or equivalent warmer Cross matched blood FFP/Cryo/Factor VII/Platelets Emergency hysterectomy more blood loss than elective hysterectomy Hemodilution/red cell salvage can be considered in Jehovahs witness Regional may be associated with reduced blood loss but may complicate treatment of hypotension in a bleeding patient. 9/11/2013 Free Template from www.brainybetty.com
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PLACENTAL ABRUPTION
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I in 77 to 1 in 86 deliveries ETIOLOGY: Cocaine Hypertension: Chronic or pregnancy induced Trauma Heavy maternal alcohol use Smoking Advanced age and parity Premature rupture of membranes History of previous abruption
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UTERINE ATONY
Most common cause of postpartum hemorrhage Follows 2-5% deliveries ETIOLOGY: Multiparity Polyhydramnios Macrosomia Chorioamnionitis Precipitous labor or excessive oxytocin use during labor Prolonged labor Retained placenta Tocolytic agents Halogenated agents >0.5 MAC
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