high risk pregnancy and labour final
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High Risk Pregnancy And LabourDr. Jasmine MehtaFTG,Cl-1G.K.G.H.,Bhuj
High risk pregnancy and LabourPregnancy and labour is physiologicalYet, high risk pregnancy may end into
pathological status….leading to…Maternal and Neonatal mortalityGoal of FOGSI-BETI BACHAO,BETI PADHAOGoal of RCH- Safe motherhood
StatisticsWorld wide-6 lakh maternal
death per yearEvery min one
mother dies99% in developing
countries80% r preventable
India-MMR is 480 per `1
lakh live child birthMaternal morbidity
is 16 times that of mortality
Causes of maternal Mortality
Direct cause-75%
Hemorrhage 25%
Sepsis 15%
Unsafe abortion 13%
Eclampsia 12%
Obstructed labour
5%
Indirect-25% Anemia 20%
Cardiac disease,
hepatitis
Maternal mortality in our HospitalTotal deliveries in
last year-1451Total maternal
mortality-11 MMR-750 per one
lakh LCB
Cause No
PPH 6
Eclampsia 3
APH 1
Anemia 1
Abortion 10-20%
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 40-80%
Cardiac disease- MC is MS(80%) 1%
Diabetes
Jaundice 0.04
HIV <0.5%
Rh negative mother 5-10%
Grand multipara 25%
High risk LABOURPreterm labour-5-10%Post term labour 10%Previous LSCS 10-12%CPD 20%Malposition MC-
BreechProlonged labour 2-4%Obstructed labour 1-
2%s
Shoulder dystociaPPH-1%Retained placentainversion of uterusRupture uterusPerineal tear
High risk pregnancy and Labour
ABORTIONThreatened Complete bed rest Inj. calmpose im statInj. RL/DNS AnalgesicsProgesterone support
Inevitable/Incomplete abortion
Replace blood loss with iv fluids and BT
Antibiotics<12wks:e&c, Misoprost 4tab
Inj. Prostodin
>12wks:Inj pitocin
Ectopic Pregnancy
Diagnose the iceberg by11/2 to 2mth of amenorrhea Mild bleeding p/vsevere abd pain and tendernessUPT+veSevere pallor/shock
Management:o2inhalatiion,iv fluids,antibiotics,and BT
APH
Pregnancy Induced HypertentionDiagnosisHigh risk consentAntihypertensive medicationIv lineSedation No inj methargin after deliveryInj. calmpose +Inj. lasix after deliveryBed side clotting test,<7min.
Warning Signs Of EclampsiaHeadacheBlurring of visionVomiting OliguriaRt sided abd pain
Eclampsia Gc poor signO2inhalation and suction
Inj. Mgso4:4gm iv diluted over 5min
5gm imRt buttock5gm imlt buttock2gm iv diluted if conv.again
Monitor:u/o>100ml in 4hrs,knee jerk+,Resp.rate >16/min.
Eclampsia AntihypertensiveFoley’s catheterization &strict u/o chartNo inj methargin after del.Inj. lasix after del.W/F shock after del.
AnemiaMild to moderate in early preg.Treat with oral iron therapySevere anaemia at term/labour
inj BTdon’t overload with iv fluidsstrict asepsis and antibiotic coverinj metergin imdel. In squatting positioninj prostodin/T.misoprost after del.strict w/f PPH
Cardiac DiseasePregnancy
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.
Cardiac DiseaseAvoid overloading of iv fluids <75ml/hrO2 inhalation sos 5-6lit/min
Strictly monitor pulse & spo2,p>110Vaccum del./forcep delNo inj methergin after del.give
T.misoprostInj. lasix after delStrictly w/f PPH,CCF
Cardiac DiseaseSquating or head up position is favourable
in cardiac patients
DiabetesInj. plain insulin infusion slowlyu/s every 2 hourlyAntibiotic coverage &strict asepsis Strict FHS monitoring w/f hypoglycemia Vigilance for shoulder dystocia,pphPostpartum antibiotics & feeding Look for 3cord vessel Pediatric opinion.
Rh Negetive MotherRegular anc care and USGClamp cord earlyAvoid manual removal of placenta No inj methargin Baby BgRh and paed opinionInj. Anti-D in 72 hrs if baby BgRh is+ve
Jaundice in PregnancyRule out DICStrict FHS monitoring Universal precaution during del.No inj metharginInj. vit K prior to del.Hepatitis B vaccine and Ig to babyOther STD
PPHAtonic: severe bleeding, uterus atonicTraumatic: fresh bleeding, uterus contractedDIC: bleeding from all sites, 5ml bed side
blood clotting test positive
Atonic PPHCall for help 2 iv line –wide bore/BT/iv inf.Bimenual massageInj. methargin iv,repeat every 15
min ,max3Inj. pitocin 30units at rate of
30drops/min,max 3 pintsInj. prostodin im,repeat after
15min.,max5, never iv.T.misoprost 5tab P/R.
Atonic PPH
Retained placenta
Inj.. pitocin 30 unit in one pintInj.. Prostodin IM statTab. Misoprost 3 tab P/RInj.. Pitocin 1 amp in cord veinManual removal of placenta
Obstructed labor
Do not miss –prolonged labor- moulding and caput ,bandle’s ring – hot vagina
Do foley’s catheterIV anti bioticsKeep one BT ready
Previous LSCS
Watch for scar tendernessSigns of imminent scar rupture: scar
tenderness, tachycardia, fetal distress, blood in urine
Do –stop bearing down –inj tidilan – inj BT
Shoulder dystociaDo not be panickyDo not give
traction headDo not apply
fundal pressureDo give supra
pubic pressure with abduction of thighs
Shoulder dystociaRotate posterior
arm to anterior position
Extraction of posterior arm
All procedures should not take more than five minutes
Inversion of uterusDo not employ any
method to expel placenta while uterus is relaxed
Do not pull cord while uterus is relaxed.
Ask pt to not to cough, sneeze or bear down while uterus is relaxed
Inversion of uterusManagementInj.. atropineIv fluidsSedativesReposition of uterusUterine packing
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