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Caesar Census July 2017
Caesar Census July 2017
ABD 1 EMLSCS 11
INSTRUMENTAL 15 SEMI-LSCS 3
1. VACUUM 15
2. FORCEPS 0
TOTAL DELIVERIES: 303
3 1
0.9% 0.3%
65
21.4%
SVD
VACUUM
11 ELLSCS
3.6% EMLSCS
15 208 SEMI ELLSCS
4.9% 69%
ABD
EPISIOTOMY RATE: 32%
32%
EPISIOTOMY
VAGINAL DELIVERIES
68%
Episiotomy: Primigravida vs Multigravida
32%
68% PRIMIGRVIDA
MULTIGRAVIDA
ELLSCS VS EMLSCS VS SEMI-ELLSCS
4%
14%
ELLSCS
82% EMLSCS
SEMI-ELLSCS
INSTRUMENTAL DELIVERIES
16
14
12
10
8
15 Series 1
6
0
VACUUM
COMPLICATED VS UNCOMPLICATED
VAGINAL DELIVERIES
12%
COMPLICATED
UNCOMPLICATED
88%
COMPLICATED VAGINAL DELIVERIES
3.80%
PPH
SHOULDER DYSTOCIA
96.20%
PPH IN VAGINAL DELIVERIES
Series 1
80%
72%
70%
60%
50%
40%
30%
20%
20%
10% 8%
0%
>500CC >1000-1500CC >1500CC
COMPLICATED VAGINAL DELIVERIES
TOTAL 208 BLOOD LOSS NO OF CASES
500-1000cc 18
UNCOMPLICATED 182 • Primigravida 5
• Para 2-4 11
COMPLICATED 26
• >Para 5 2
>1000-1500cc 5
COMPLICATED 26 • Primigravida 2
• Para 2-4 3
PPH 25
500-1000cc 18 • >Para 5 0
>1500cc 2
>1000-1500 5 • Primigravida 0
• Para 2-4 2
>1500 2
• >Para 5 0
SHOULDER 1
DYSTOCIA
PPH BREAKDOWN
PPH RETAINED UTERINE MULTIPLE THROMBIN
PLACENTA ATONY VAGINAL
WALL TEAR
500-1000cc 3 12 3 0
1 2 2 0
1000-1500cc
>1500cc 1 1 0 0
SHOULDER DYSTOCIA
• CASE 1
– EBW : 3.2-3.4kg
- BW by scan : 3.4kg
- BW : 3.1KG
ELECTIVE LSCS: 11
CAUSES NO OF CASES
2 PREVIOUS SCAR 1
BREECH PRESENTATION 4
2 cases with 1 prev scar
1 with oligo
1 fail ecv
DCDA TWINS 1
TRANSVERSE LIE 1
SEMI- ELSCS: 3
CAUSES NO OF CASES
TRANSVERSE LIE 1
MACROSOMIC BABY 2
EMERGENCY LSCS : 65
CAUSES NO OF CASES
FETAL DISTRESS 15
POOR PROGRESS 14
FAILED IOL 6
BREECH IN LABOR 9
SECONDARY ARREST 9
UNSTABLE LIE IN LABOR 1
PP TYPE II IN LABOR 1
PP TYPE III IN LABOR 1
REFUSED TRIAL OF SCAR in labor 4
2 PREVIOUS SCAR IN LABOR 4
MCMA TWINS IN LABOR 1
EMLSCS DATE DELIVERED ELLSCS DATE GIVEN
2 PREVIOUS SCAR IN LABOR 20/7/2017 @36W2D 2/8/2017
13
CTG
CTG + MECONIUM 2
SEMI ELLSCS for suspected macrosomic
baby
• Case 1
-EFW : 3.6-3.8kg
- BW by scan : 3.88kg
-BW : 4.2kg
• Case 2
– EFW: 3.8-4.0kg
– BW by scan : 4.23kg
– BW :2.95
ADMISSION TO SCN
INDICATION NO OF CASES
TTN 16
POST VACUUM 6
MAS 5
MACROSOMIC BABY 2
GBS +VE MOTHER 3
PREMATURITY 8
SHOULDER DYSTOCIA 1
LBW 4
UNBOOKED UNSCREENED 1
MATERNAL PYREXIA 1
MOTHER GDM ON INSULIN 1
ADVERSE BABY OUTCOME
TYPE NO OF CASES
IUD 2
LOW AS 3
Case Presentation 1
• Date of admission: 2/7/17
• 31 year old G2P1 @ 32w2d POG admitted for
placental abruption
• ANC: uneventful
Case Presentation 1
2/7/17 Patient came in PAC @ 1630H with complaint of contraction pain since
1700H 1000H associated with PV bleeding @ 1000H and reduced fetal movement.
PAC She perceived her last fetal kick @ 1000H.
Otherwise she had no LL, no hx of trauma/ fall/massage, no anemic sx
Upon arrival to PAC, her vital signs was normotensive, not tachycardic.
However she appeared pallor (clinically Hb 6) (booking Hb 15)
Vital sign Bp:113/69, Hr:87, T:37, Sp02:99% RA
Cvs:DRNM
Lungs:clear
P/A: tense tender abdomen
ut @ 36w
S C 3/5
EFW 2.4-2.6kg
Liqour adequate
FH absent
Case Presentation 1
Per speculum revealed blood oozing from os
TAS: S C
FH absent
Placental Anterior with retroplacental clots
parameter 32-33w
AFI 9.8cm
EFW 2.13kg
VE: VV NAD
cx 0.5cm
os 2cm
MI
St -2
vx
no cord,no placenta
Urine albumin 2+
Case Presentation 1
FBC/RP/Coag taken STAT on admission
ABG: pH 7.47/pCO2 29/pO2 111/lact 1.1/Hco3 23/ Hb 7.6
Plan:
1) To send pt to LR for ARM and pitocin augmentation
2) To transfuse 2pint PC and 1 cycle DIVC
3) 2 large bore branulla
4) Insert CBD for strict I/o
5) V/s monitoring every 15mins
6) Run 1 pint NS/ 1 hour
Case Presentation 1
2//7/17 Patient transferred from PAC to LR.
1715H Blood products not yet available.
LR
Vital sign: bp 113/6, hr71
VE: VV NAD
cx 0.5cm
os 2cm
MI -> ARM -> 500cc blood stained liquor
St -2
vx
no cord,no placenta
Case d/w Dr Suhana regarding pt’s utricaria rashes likely seondary to blood
transfusion reaction.was informed that as long as no respiratory failure
and vital sign stable,may continue blood transfusion with iv hydrocortisone
coverage with strict vital sign monitoring every 15mins
VE: VV NAD
cx effaced
os 3cm
MA->blood stained liquour
St -2
vx
no cord,no placenta
TAS: S C, FH absent
Huge retroplacental clot from right lateral towards fundal
Case Presentation 1
Plan: 1) NRVE as planned @ 2125H
2) To transfuse 3rd pint pc and 2 unit FFP
3) repeat fbc and coagulation 1H post total transfusion
4) aim for delivery within 6-8H
5) w/o for worsening blood transfusion reaction or fluid
overload symptoms
Case Presentation 1
• CTG @ 1900H
• Toco 3:10
Case Presentation 1
2/7/17 2 ½ H in labour and augmented, contraction 5:10:45
2045H Completed 1 cycle DIVC+ 2 u FFP, ongoing 2nd pint pc transfusion
LR Clinically pallor
Vital signs stable BP 115/66 HR 74 T 37 SpO2 100% RA
p/a: tense and tender
ut @ 36w
S C 2/5
efw 2.4-2.6kg
VE: VV NAD
cx effaced
os 5cm
MA->blood stained liquour
St -1
vx
no cord,no placenta
VE: VV NAD
cx not felt
os fully
MA->blood stained liquour
St +2
vx
no cord,no placenta
Total EBL 3L
EBL 3L
Hb 7.9 -> 8.0
WBC 17 -> 15.6
PLT 115 -> 69
No calf tenderness
EBL 3L
Hb 7.9 -> 8.0 -> 5.8
WBC 17 -> 15.6 ->12
PLT 115 -> 69 ->76
EBL 3L
Hb 7.9 -> 8.0 -> 5.8 -> 6.0 Total transfusion: 4 pint pc
WBC 17 -> 15.6 ->12 ->8.3 4 u platelets
PLT 115 -> 69 ->76 ->96 6 unit ffp
6 unit cryo
Pt remained comfortable,no anemic sx, no giddiness, no IE sx
Clinically not pale
Vital sign BP 136/89 HR 64 T 37 SpO2 100% RA
Cvs: DRNM
Lungs Clear
p/a: soft non tender
ut @ 16w contracted
No calf tenderness
Plan: 1) for iv venofer 200mg OD for 3/7
Case Presentation 1
7/7/17 32 year old para 2 ( 1 living child)
1530H ∆ 1) D4+ post SVD complicated with APH and PPH for grade 4 placental
W9 abruption and uterine atony with IUD
∆ 2) treat as PE
EBL 3L
Hb 7.9 -> 8.0 -> 5.8 -> 6.0->6.3 -> 7.3 Total transfusion: 4 pint pc
WBC 17 -> 15.6->12 ->8.3 ->8.3 ->9.1 4 u platelets
PLT 115 -> 69->76 ->96 ->137 ->201 6 unit ffp
6 unit cryo
*completed 3 doses of iv venofer*
Pt remained comfortable,no anemic sx, no giddiness, no IE sx
Clinically not pale
Vital sign BP 136/89 HR 64 T 37 SpO2 100% RA
Cvs: DRNM
Lungs Clear
p/a: soft non tender
ut @ 16w contracted
No calf tenderness
Perineal check:
Noted bleeding from right vaginal wall tear, bleeding secured with
hemostatic suture.
Left vaginal wall tear and episiotomy suture done.
∆ 28 year old para 1 post VAD for fetal bradycardia and shoulder
dystocia with episiotomy complicated with primary PPH secondary to
uterine atony and multiple vaginal wall tear
EBL: 800cc
Case Presentation 2
11/7/17 ∆ 28 year old para 1 Day2 post VAD for fetal bradycardia and shoulder
1000H dystocia with episiotomy complicated with primary PPH secondary to
W10 uterine atony and multiple vaginal wall tear
EBL 800cc
preHb 11.8 -> 9.2
WBC: 10.8 -> 22.6
Plt:248 -> 243
Pt comfortable, no anemic sx, tolerating orally, ambulating, +PU, +passing
flatus