high risk pregnancy and labour final 1218615420038327 9
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8/3/2019 High Risk Pregnancy and Labour Final 1218615420038327 9
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High Risk Pregnancy And Labour
y Dr. Jasmine Mehta
y FTG,Cl-1
y G.K.G.H.,Bhuj
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High risk pregnancy and Laboury Pregnancy and labour is physiological
y Yet, high risk pregnancy may end into pathological
status.leading toy Maternal and Neonatal mortality
y Goal of FOGSI-BETI BACHAO,BETI P ADHAO
y Goal of RCH- Safe motherhood
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Statisticsy W orld wide-
y 6 lakh maternal death
per yeary Every min one mother
dies
y 99% in developing
countriesy 80% r preventable
y India-
y MMR is 480 per `1 lakh
live child birthy Maternal morbidity is 16
times that of mortality
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Causes of maternal Mortality
Direct cause-
75%
Hemorrhage 25%
Sepsis 15%
Unsafe abortion 13%
Eclampsia 12%
Obstructedlabour
5%
Indirect-25% Anemia 20%
Cardiac
disease,
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Maternal mortality in our Hospital
y Total deliveries in last year-1451
y Total maternal
mortality-11
y MMR-750 per one lakhLCB
Cause No
PPH 6
Eclampsia 3
APH 1
Anemia 1
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Abortion
Ectopic pregnancy 0.66%
Vesicular mole 0,25%Multiple pregnancy 1.25%
PET 10%
Placenta pravia 0.5 -1%
Abruptio placenta 0.5-1%
Anemia
Cardiac disease- MC is MS(80%) 1%
Diabetes
Jaundice 0.04
HIV <0.5%
Rh negative mother 5-10%
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High risk LABOURy Preterm labour-5-10%
y Post term labour 10%
yPrevious LSCS 10-12%
y CPD 20%
y Malposition MC-Breech
y Prolonged labour 2-4%
y Obstructed labour 1-2%s
y Shoulder dystocia
y PPH-1%
y Retained placentay inversion of uterus
y Rupture uterus
y Perineal tear
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High risk pregnancy and Labour
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ABORTIONy Threatened
y Complete bed rest
y Inj. calmpose im staty Inj. RL/DNS
y Analgesics
y Progesterone support
y Inevitable/Incompleteabortion
y
Replace blood loss withiv fluids and BT
y Antibiotics
y <12wks:e&c,
Misoprost 4tabInj. Prostodin
>12wks:Inj pitocin
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Ectopic Pregnancy
y Diagnose the iceberg by
11/2 to 2mth of amenorrhea
Mild bleeding p/v severe abd pain and
tenderness
UPT+ve
Severe pallor/shockManagement:o2inhalatiion,iv
fluids,antibiotics,and BT
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APH
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Pregnancy Induced Hypertentiony Diagnosis
y High risk consent
y
Antihypertensive medicationy Iv line
y Sedation
y No inj methargin after delivery
yInj. calmpose +Inj. lasix after delivery
y Bed side clotting test,<7min.
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Warning Signs Of Eclampsiay Headache
y Blurring of vision
y Vomitingy Oliguria
y Rt sided abd pain
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Eclampsiay Gc poor sign
y O2inhalation and suction
y Inj. Mgso4:4gm iv diluted over 5min
5gm imRt buttock
5gm imlt buttock
2gm iv diluted if conv.againMonitor:u/o>100ml in 4hrs,knee jerk+,Resp.
rate >16/min.
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Eclampsiay Antihypertensive
y Foleys catheterization &strict u/o chart
y No inj methargin after del.y Inj. lasix after del.
y W /F shock after del.
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Anemiay Mild to moderate in early preg.
y Treat with oral iron therapy
y Severe anaemia at term/labour
inj BT
dont overload with iv fluids
strict asepsis and antibiotic cover
inj metergin im
del. In squatting position
inj prostodin/T.misoprost after del.
strict w/f PPH
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Cardiac Diseasey Pregnancy
regular Digitalis and suppt. Med.
correct anaemia &any inf. vigilance for ccf
Adequate rest/hospitalization
LabourInj. abs coverage for 5 days,bed rest,
lt lat.post.
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Cardiac Diseasey Avoid overloading of iv fluids <75ml/hr
y O2 inhalation sos 5-6lit/min
y Strictly monitor pulse & spo2,p>110
y Vaccum del./forcep del
y No inj methergin after del.give T.misoprost
y Inj. lasix after dely Strictly w/f PPH,CCF
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Cardiac Disease
y Squating or head up position is favourable incardiac patients
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Diabetesy Inj. plain insulin infusion slowly y u/s every 2 hourly y
Antibiotic coverage &strict asepsisy Strict FHS monitoringy w/f hypoglycemiay Vigilance for shoulder dystocia,pphy P
ostpartum antibiotics & feedingy Look for 3cord vessely Pediatric opinion.
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Rh Negetive Mothery Regular anc care and USG
y Clamp cord early
y Avoid manual removal of placentay No inj methargin
y Baby BgRh and paed opinion
y Inj. Anti-D in 72 hrs if baby BgRh is+ve
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Jaundice in Pregnancyy Rule out DIC
y Strict FHS monitoring
y Universal precaution during del.y No inj methargin
y Inj. vit K prior to del.
y Hepatitis B vaccine and Ig to baby
y Other STD
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PPHy Atonic: severe bleeding, uterus atonic
y Traumatic: fresh bleeding, uterus contracted
y DIC: bleeding from all sites, 5ml bed side bloodclotting test positive
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Atonic PPHy Call for helpy 2 iv line wide bore/BT/iv inf.y
Bimenual massagey Inj. methargin iv,repeat every 15 min ,max3y Inj. pitocin 30units at rate of 30drops/min,max 3
pintsy Inj. prostodin im,repeat after 15min.,max5,
never iv.T.misoprost 5tab P/R.
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Atonic PPH
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Retained placenta
y Inj.. pitocin 30 unit in one pint
y Inj.. Prostodin IM stat
y Tab. Misoprost 3 tab P/R
y Inj.. Pitocin 1 amp in cord vein
y Manual removal of placenta
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Obstructed labor
y Do not miss prolonged labor - moulding and caput,bandles ring hot vagina
y Do foleys catheter
y IV anti biotics
y Keep one BT ready
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Previous LSCS
yW atch for scar tenderness
y
Signs of imminent scar rupture: scar tenderness,tachycardia, fetal distress, blood in urine
y Do stop bearing down inj tidilan inj BT
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Shoulder dystocia
y Do not be panicky
y Do not give tractionhead
y Do not apply fundalpressure
y Do give supra pubic
pressure withabduction of thighs
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Shoulder dystocia
y Rotate posterior arm toanterior position
y Extraction of posterior
arm
y All procedures shouldnot take more than fiveminutes
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Inversion of uterus
y Do not employ any method to expelplacenta while uterus is
relaxedy Do not pull cord while
uterus is relaxed.
y Ask pt to not to cough,
sneeze or bear down while uterus is relaxed
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Inversion of uterusy Management
y Inj.. atropine
y Iv fluidsy Sedatives
y Reposition of uterus
y Uterine packing
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