Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Save to My Library
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Anaesthetic Management of Bleeding Obstetric Patient

Anaesthetic Management of Bleeding Obstetric Patient

Ratings: (0)|Views: 22 |Likes:
Published by Suresh Kumar

More info:

Categories:Types, Reviews, Book
Published by: Suresh Kumar on Sep 16, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

09/16/2012

pdf

text

original

 
 
Anaesthetic Management of Bleeding Obstetric Patient
Pof.M.Kannan MD DAProfessor Emeritus Tamilnadu MGR Medical UniversityFormer Professor and HOD , Departmrnt of Anaethesiology,Tirunelveli Medical College
Ac
cording to the latest UN Report “
Globally an estimated 287,000 women died in pregnancy andchildbirth in 2010 and India accounting
for nearly 19% (56,000) “
. The report said every ten minutes awoman dies of pregnancy-related complications like severe bleeding after childbirth(38%),infections(11%), high blood pressure during pregnancy (5%),unsafe abortion(8%)and Other Condition(34%) in our country . And our Maternal Mortality Ratio (MMR) has declined to 212 in 2007-2009 asagainst 254 in 2004-2006, recording a fall of 42 points or 17 per cent, as per latest results of the SampleRegistration Survey (SRS). The latest figure of MMR in South India is Kerala- 81,Tamilnadu-97, AndhraPradesh -134 and Karnataka -178. Anaesthesiologist plays a pivotal role in reducing the mortality rate.
 
There are many reasons for Bleeding in Obstetrics patient s. They can be broadly classified intobroad four categories1.Bleeding in early pregnancy2.Antipatum Haemorrhage3.Post partum Haemorrhage4.Non obstetric cause of bleeding during Pregnancy( In this lecture notes I have confide to Antipatum Haemorrhage and Post partum Haemorrhage)
Postpartum Haemorrhage(PPH)
Quite often PPH is life threatening and it is the major cause of maternal mortality world wide and itoccurs nearly in 5% of the deliveries. In our country (India)out of estimated 25 million deliveries 18million deliveries take place in peripheral centers where perinatal care is poor or nonexistent. There forewe should move on a war footing to reduce the MMR.
World Health Organization definition of primary PPH encompasses all blood losses over 500ml.
 
Factors predisposes to PPH
 
Multiple gestation
 
Macrosomia
 
Polyhydramnios
 
Abruption of placenta
 
Adherent Placenta
 
Foetal death
 
High parity
 
Prolonged labor
 
Chorioamnionitis
 
Precipitous labor
 
Augmented labor
 
Uterine Myoma
 
High concentration of a volatile halogenated anesthetic agent
 
Instrumental deliveryThe Causes of PPH may be Primary are Secondary.Primary PPH occurs with in 24 hours.Secondary PPH occurs from 24 hours to 6 weeks.Primary PPH Causes
 
Uterine atony
 
Injury in Genitaltract
 
Retained product
 
Abnormal placenta
 
Coagulopathies
 
Inversion of the UterusSecondary PPH
 
Retained product
 
Infection
 
Subinvolution
 
Anticoagulant
Management of PPH
The management Depend upon the clinical status. The Patient may fall into any one of thecategory. Rapid clinical assessment and treatment should be started with out delay as perthe protocol laid by the Institute.
 
HaemorrhageClassAcute Blood loss Bloodloss in %SymptomIIIIIIIV500-1000ml1000-1500ml1500-2000ml>2000ml10-15%15-25%25-35%>35%Asymptomatic or TachycardiaOrthostatic hypotension or SupineHypotensionMarkedTachycardia/Tachypnea/HypotensionShock/Air hunger/Oliguria/Anuria
Many cases of PPH have no identifiable risk factors. So prevention of PPH is wiser.
 
Active management of the third stage of labour lowers maternal blood loss andreduces the risk of PPH.
 
Prophylactic oxytocics should be offered routinely in the management of the thirdstage of labour in all women as they reduce the risk of PPH by about 60%.
 
For women without risk factors for PPH delivering vaginally, oxytocin (5 iu or 10iu by intramuscular)
 
For women delivering by caesarean section, oxytocin (5 iu by slowintravenousinjection) should be used
 
Methyl ergometrinemay be used in the absence of hypertensionbut increases vomiting.
 
Misoprostol is not as effective as oxytocin but it may be used when the latter is notavailable
 
All women who have had a previous caesarean section must have their placentalsite determined by ultrasound. Where facilities exist, magnetic resonance imaging(MRI)may be a useful tool and assist in determining whether the placenta is accretaor percreta.
 
Women with placenta accreta/percreta are at very high risk of major PPH. If placenta accreta or percreta is diagnosed antenatally, there should be consultant-ledmultidisciplinary planning for delivery.
 
Consultant obstetric and anaesthetic staff should be present, prompt availability of blood, fresh frozen plasma and platelets
 
Access to intensive care.
 
Available evidence on prophylactic occlusion or embolisation of pelvic arteries inthe management of women with placenta accreta is equivocal. The outcomes of prophylactic
 
arterial occlusion require further evaluation.

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->