Obstatrics emergency

• 1. Obstetric EmergenciesBy: Hayelom MichaelSeptember,2014By:Hayelom Michael1 10/1/2014

2. Out line1.INTRODUCTION2.ABORTION3.ECTOPIC PREGNANCY4.PREECLAMPSIA/ECLAMPSIA5.CORD PROLAPSE2 10/1/2014 3. INTRODUCTION Obstetrical emergencies are life-threatening medicalconditions that occur in pregnancy or during or after laborand delivery. There are a number of illnesses and disorders ofpregnancy that can threaten the well-being of both motherand child. Obstetrical emergencies may also occur during activelabor, and after delivery (postpartum).3 10/1/2014 4. ABORTION Abortion: is the process of termination or expulsion ofthe pregnancy before the 28th completed weeks ofgestation or less than 1000gm weight (in Eth & UK).When the abortion occurs spontaneously, the term "miscarriage" is often used. Abortion is one of the leading cause of maternalmortality 15% of clinically evident pregnancies end inspontaneous abortion and a further 10-60% areterminated by an induced abortion.4 10/1/2014 5. More than 80 % of spontaneous abortions are in the first12 weeks Unsafe abortion is a leading cause of maternal mortality:13% - worldwide17% - east Africa5 10/1/2014 6. CausesSpontaneous abortion The causes of abortion can conveniently be divided in tothree groups :-fetal-maternal-paternal.6 10/1/2014 7. Fetal causes- Chromosomal abnormality or disease of the fertilizedovum may account for 60% of spontaneous, first trimesterabortions.- Malformation of the trophoblast and poor implantation ofthe blastocyst may result in placental separation withconsequent hypoxia and impaired embryonic development.7 10/1/2014 8. Maternal causes Disease acquired during pregnancy such as rubella orinfluenza, especially if they are accompanied by acutefever, interfere with transplacental oxygenation and mayprecipitate abortion. Chronic disorders, for example renal disease accompaniedby hypertension, may have a similar effect. Drugs :- large doses of any drug are poisonous and shouldbe avoided - ABO incompatibility between mother and embryo may result in abortion.8 10/1/2014 - 9. Local disorders of the genital tract A retroverted uterus which is unable to rise out of thepelvis may occasionally predispose to abortion. Physical defects of the uterus, such as sub mucosalleiomyomas, uterine polyps, or uterine malformationsmay prevent implantation adequate to support fetaldevelopment Cervical incompetence9 10/1/2014 10. Paternal causesSince the paternal spermatozoon gives to the ovumhalf of its chromosomes, defects may result inabortions,particularly if both partners share many common HLAantigen10 10/1/2014 11. Clinically1. Threatened abortion2. Missed abortion3. Inevitable abortion4. Incomplete abortion5. Complete abortion6. Septic abortion7. Recurrent abortion11 3/23/2013 12. 1. Threatened abortion It is presumed that a pregnancy is threatening to abortwhen vaginal bleeding occurs before the 24th week vaginal bleeding (light). cramping lower abdominal pain Uterus softer than normal but correct size for date cervix is closed U/S essential & Shows the presence of fetal heartactivity There is chance of continuing the pregnancy toviability.12 13. 2.Missed Abortion This is the term to the fetus w/c is died is retained itsplacenta in the uterus for at least 4 weeks. Usually history of threatened abortion preceding it Why the pregnancy is not expelled is not known. Early ultrasonic scan may identify missed abortionbefore the mother experiences any symptoms.13 14. Pain and bleeding may cease but the mother mayexperience a residual brown vaginal discharge ashaving an odor of decaying matter and it can beoffensive and distressing.All other physiological signs of pregnancy willregress, uterine enlargement will cease and apregnancy test will prove negative14 10/1/2014 15. .3. Inevitable abortionWhen it is impossible for the pregnancy to continue it istermed as inevitable abortionHeavy vaginal bleeding.Severe cramping lower abdominal pain which followsthe bleedingCervix is open/dilated, effaced, membrane rupturedUterus corresponds to datesTender uterusBut No expulsion of products of conceptionNo chance of continuing the pregnancy to viability.15 17/9/2014 16. 4. Incomplete Abortion When the products of conception are onlypartially evacuated during abortion.Bleeding is profuse but the abdominal pain andback ache may cease.The cervix will be soft and purplish in color andwill be partly closed.Prolonged retention of the tissues predisposesthe woman to infection and immediate medicalintervention is needed16 Hayelom Michael 17/9/2014 17. 5. Complete abortionA complete abortion is more likely to occur prior tothe 8th week of pregnancy and constitutes theexpulsion of the embryo, placenta and intactmembranesLight bleedingClosed cervix Uterus smaller than datesUterus softer than normalHistory of expulsion of products of conceptionLight cramping/lower abdominal pain 18. 6. Recurrent abortionThree or more consecutive pregnancy losses at 28weeks or less or with fetal weights less than 1000gram primary recurrent miscarriageno successfulpregnanciessecondary recurrent miscarriageone prior live birth18 3/23/2013 19. 7. Septic abortion Septic abortion is manifested by fever, malodorousvaginal discharge, pelvic and abdominal pain, andcervical motion tenderness. Peritonitis and sepsis may be seen. Trauma to the cervix or upper vagina may berecognized if there has been a criminal abortion. Ultrasound may be helpful in ruling out retainedproducts of conception.19 3/23/2013 20. ECTOPIC Pregnancy Is implantation of fertilized ovum outside theendometrial cavity. Is the leading cause of pregnancy related death in the 1sttrimester. >1 in 100 pregnancies Recent evidence indicates that it is increasing in manycountries USA -5 fold UK -2 fold Recurrence rate 15% after 1st 25% after 2 ectopics 21. Etiology Risk Factors for Ectopic Pregnancy:High risk Moderate risk Slight riskTubal surgery Infertility Previous pelvic/abdominalsurgerySterilization Previous genital infections Cigarette smokingPrevious ectopic pregnancy Multiple sexual partners Vaginal douchingIn utero exposure todiethylstilbestrolEarly age at first intercourse(< 18 years)Use of IUDDocumented tubal pathology 22. 22 10/1/2014 23. 95% is tubalAmpula>55%Isthmus-25%Fimbria-17 %Cornual-2 % Cervix