Emergamcy of obs

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Emergamcy of obs
Anti partum hemorage

Admision
call for help
put pt on lateral position
maintain of airway give o2
put wide brode canula
Blood grouping and cross matching
and prepare 4 to 6 L of blood
Investigation CBC .. RFT ..LFT coagulation
profile
insertion of catgeter for moniter of urine
output
then start general examinatiom
sign of anemia
and vaginal examination to see if cervix is
open or clpse

The most importat diagnosis to reach to

diagnosis is US

if during ultra sound see

open cervix with fetal ciavle (Invetable
abortion)
if cervix close with no fetues (Ectopic)
if there is snow storm apearnce or hony
coml (Molar pregnancy)

bleeding in late pregnamcy same above +

during examination
of abdomen is soft no tender and can
palbalbe fetal movement its previa

if abdomen is regid and tenderness and

cant palpalte fetues its abrupto

note avoid to do vaginal examination in

bleeding in late pregnancy

incase of placenta previa

if miminal bleeding consermative
mangment
if massive termination of pregnancy

in case of abrupto
2 Post partum hemorage
the most commom cause is utrine atony

other cause trauma

shehan syndrome

call gor help

addmision
ABC
check for airway patency
check for breaching oxygen
Tow wide brode canula
one for IV fluid and blood transfusion and
fresh frozen plasma
inflow give I.V fluid 2 L of crystaloid and
1.5 L of coloid
take blood sample for investigation
LFT ..CBC and RFT and coagulation profile
urine cathertrixation to moniter urine out
put

Reassesment for vital sign

Then palpalble utrues if it is not contracted

the cause is atony
stary by manula masseage
if not control give
oxytoxine loading dose 10 IU and
maintenance dose 40 IU every 4 hr

if nor respond do lapratomy to see for any

tissure inside

if no respond do ligation of utrine artery

or embolization

4 Manamgent of eclamcia

Admision
call for help
pt on lateral position
AbC
chick patency for air ways
give o2 and jnsertion tow wide brode
canila on for iV fluid and one for blood
grouping and cross matching
IV fluod (Ringer lactate 80ml /hour)
catheter for urine out put
give IV 4 to 6 g loading dose of Mg
sulphate and maintenance dose 1- 2g
infusion eveery 4 hr each 24 hr
give antihypertenvue liker .. hydralazine or
lapeletol

take blood sample and make investigation

RFT ..LFT and ciagulation profiles and
blood cross mathcing then prreparre blood
4 to 6 unit

Them start to observation pt

for vital sign .. and fets and reflex
BP amd Tenprature
and any sign of respiratory distress cuz
MG sulphate can affect on respuratory
system
if we want termination and pt is stable with
cervix is fully dilatiom deliver
vaginally
if not deliver CS

anti dotse for MG sulphate I.V calcium

gluconate

5 shoulder dyatocia
Shoulder dystocia impaction of part of
anterior shoulder with symphsis pubis after
deliver the head more than 60 s

also the umblical cord is impaction under

symphsis pubis leading to decrease of pH
leading to fetal diatress and acidosis
Risk factor
The most commom Risl factor is ventous
DM
mothet obise
previois HX of macrosomic baby
Prolon second stage of labour

Managment
( Helperr )
H call for help
E elevate of episiotomy to facilitate
internal manuver
L for leg ( hyperextention and Hyper
abducter ) this manuver called MC Rubert
manuver
p suprapubic pressure Rubin I
 Enternal rotation including wood screw
Doctor put his hand in the side of infant
shoulder which not intact and do ( internal
rotation )

if not reapond repeat the manuver and

except Rubin I

if faild do symphysiotomy
thia indicate only in case of shoulder
dystocia and breach presentation in
obstructed lavour
if not respond do Cleidotomy
if not reapond do finally
Zavenelli manuver ( return back the baby's
head to the normal position in birth canal
then do CS
6 Managment of cord prolapse
Manamget
Call for help
Put pregnant in chest knee position
inflame the bladder to move the presenting
part upward
then infuse the vagina by warm normal
saline then cover the vagina by ventouse
cup then give her tocolytica to stop the
compression part

Deliver baby depend on

Stage of labour
Fetal viability
Bishop score
if the fetal dead by vaginal

Second stage according to Bichop score

if it is favorable deliver Vagina by forecep
and ventouse
if not favorable by CS

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