Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

OBSTETRIC EMERGENCIES DR. MEENU NANTHAKUMAR ST5 OG KETTERING GENERAL HOSPITAL NHS FOUNDATION TRUST @BRITISHINDIANMEDICASSOCIATION @BINDIANMEDICS BRITISH INDIAN MEDICAL BIMA ASSOCIATION BIMA Clinical and OSCE series The British Indian Medical Association (BIMA) - The British Indian Medical Association (BIMA) is a national non-profit organisation founded on developing a supportive network amongst students and doctors across the UK - Provides tutorial series, conference events, networking, careers talks, socials and more! - For more information follow us on social media and stay up to date with latest academic events by joining our mailing lists: BIMA Clinical and OSCE series: https://forms.gle/CidGvWAc9YY9WSSs8 BIMA Fundamentals of Medicine & Pathology series: https://forms.gle/KfAgeoX55GPAWqee8 BIMA Clinical and OSCE seriesGENERAL PRINCIPLES TO MINIMIZE RISK ● PROMOTE GOOD ANTENATAL HEALTH- do not forget socioeconomic inequalities and language barriers ● ORGANIZED INTRAPARTUM CARE ● TRIAGE- In maternity it is “ABCF” BIMA Clinical and OSCE seriesHINTS TO KEEP WORKLOAD UNDER CONTROL ● Be aware of the activity happening around you ● Listen to your colleagues ● Prioritize and Allocate ● Get the simple stuff out of the way quickly ● Do not defer decisions unnecessarily ● Recognise your limitations and ask for help when needed ● Go to the problemMANAGING AN EMERGENCY COMMUNICATION AND TEAMWORK ● AIDS TO GOOD COMMUNICATION ○ LEAD ROLE ○ CLARIFY SKILLS OF UNKNOWN STAFF ○ ALLOCATE ROLES TO MATCH SKILL SET ○ AVOID DUPLICATION ○ SCRIBE ○ DO NOT FORGET THE PARTNERMANAGING AN EMERGENCY ● DOCUMENTATION ● RISK MANAGEMENT ● SIMULATION TRAININGOBSTETRIC HAEMORRHAGE ● RECOGNISE MOH ○ Visible blood loss >2L ○ Ongoing blood loss >150ml/hour ○ Rule of 30 ○ Remember bleeding can be concealed ■ Raised fundus ■ Intraabdominal bleeding ■ Uterus shifted to one sideIMMEDIATE RESUSCITATION ○ Head down and lateral tilt ○ Adequate oxygenation ○ 2 large iv cannula 14G ○ Rapid infusion of 2L crystalloids ○ O Negative Blood while awaiting x match blood ○ Urgent investigations- FBC, G&S, Coagulation, U&E ○ Point of care tests to aid transfusion (VBG, Hemocue, TEG) ○ Correct coagulopathyIDENTIFY AND MANAGE SPECIFIC CAUSE ● ANTEPARTUM ○ Placental abruption- expedite delivery, CS if evidence of fetal compromise ○ Placenta previa- Expedite Delivery ○ PPH is almost always inevitable ● INTRAPARTUM ○ Uterine rupture/ Broad ligament haematoma- laparotomy ○ Trauma during CS- surgical haemostasis +/- peripartum hysterectomyPOSTPARTUM HAEMORRHAGE ● 4Ts ● Uterotonics ● Tranexemic Acid ● Uterine tamponade ● Brace sutures ● Interventional radiology ● Peripartum HysterectomyTips to minimize morbidity due to haemorrhage ● APH- ?Suspected placental abruption with fetal compromise- deliver within 20 minutes ● Beware of descriptions like “heavy lochia”/ “she is trickling” ● Continued vaginal bleeding with contracted uterus- take to theatre for EUA ● Hypotension is a late sign ● Petechiae suggest DICMATERNAL COLLAPSE ● Cardiac arrest occurs in approximately 1 in 30,000 pregnancies ● Upto 50% of the subsequent maternal deaths are preventable and due to potentially treatable causes ● Fetal outcome is directly related to effective maternal resuscitation and managementCHALLENGES IN CPR IN A PREGNANT PATIENT ● Difficult Intubation ● Risk of aspiration ● Decreased chest compliance due to splinting of diaphragm ● Reduced venous return due to caval compression ● Deliver by CS if CPR with lateral tilt is ineffective after 5 minutesAMNIOTIC FLUID EMBOLISM ● Rare but often fatal ● Relate to entry of amniotic fluid and fetal debris into the maternal circulation. ● Premonitory signs (restlessness, abnormal behaviour, seizure like activity) ● DIC and haemorrhage is a common sequelae ● MDT ● Supportive ManagementMATERNAL SEPSISANTEPARTUM HAEMORRHAGE ● Pallor, tachycardia, shock ● Painful/ painless bleeding ● Bleeding maybe concealed ● Resuscitation ○ Left lateral tilt and 100% O2SHOULDER DYSTOCIA ● Failure of the shoulders to traverse the pelvis spontaneously after birth of the head. ● Anterior shoulder of baby is wedged above the pubic symphysis ● Risk factors ○ Fetal macrosomia ○ Maternal diabetes ○ High BMI ○ Post dates ○ Operative vaginal delivery ○ Prolonged second stageCORD PROLAPSE ● Cord passes through the cervix alongside (occult) or past the presenting part (overt) in the presence of ruptured membranes. ● Cord presentation- cord felt below the presenting part with intact membranes. ● Malpresentation, Polyhydramnios, High presenting part, prematurity.UTERINE RUPTURE ● 0.05% of all pregnancies ● 0.8% after previous 1 LSCS ● >5% following Classical cesarean ● Symptoms and signs ○ Abdominal pain changes from intermittent to continuous ○ Vaginal bleeding/ heamturia ○ CTG changes ○ VE- loss of presenting part ○ Abdominal palpation of fetal parts ○ PPH with contracted uterus ● Immediate transfer to theatreTHANK YOU FOR LISTENING ANY QUESTIONS INSERT QR CODE FOR FEEDBACK FORM BIMA Clinical and OSCE series