Obstetrical emergencies
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This document discusses obstetric emergencies and the role of nurses. It begins by defining obstetric emergencies as life-threatening conditions that occur during pregnancy, labor, delivery or postpartum. It then lists some common causes like postpartum hemorrhage, eclampsia, obstructed labor and discusses their management. It emphasizes the importance of recognizing early signs, performing life-saving interventions and timely referral. It outlines essential life-saving skills for nurses including managing hemorrhage, infection prevention and using a partograph. It concludes by stressing the need for nurses to anticipate problems, communicate well with doctors and be prepared for emergencies.
Obstetrical emergencies
- 1. OBSTETRICAL EMERGENCIES Dr. Latha Venkatesan Principal, Apollo COLLEGE OF NURSING, CHENNAI
- 3. Introduction • Obstetrical emergencies are life-threatening medical conditions that occur in pregnancy or during or after labor and delivery. • Magnitude, Incidence • Why its happening? • Where is it happening? • Who is responsible for it? • How can we reduce it? Some tools…. • What is our role as Midwives?
- 4. Do you know?
- 5. Impossible To Predict ! Rapidness Of The Diagnosis !
- 6. Causes of Maternal Death
- 7. MATERNAL DEATH YEAR WISE
- 8. SDG goals and EPMM strategies • Between 1990 and 2015, the global maternal mortality ratio (MMR) decreased by 44%, from 385 to 216 maternal deaths per 100,000 live births. • Despite this progress, the world still fell far short of the Millennium Development Goals target of a 75% reduction in the global MMR by 2015. • Maternal mortality reduction remains a priority under “Goal 3: Ensure healthy lives and promote well-being for all at all ages” in the new Sustainable Development Goals (SDGs) agenda through 2030. • In February 2015, the World Health Organization published “Strategies toward ending preventable maternal mortality (EPMM)” (EPMM Strategies), a direction-setting report outlining global targets and strategies for reducing maternal mortality under the SDGs
- 9. • Which is the MMR in TamilNadu? • Type your answer in chat box
- 11. ANTE - PARTUM PERIOD INTRA PARTUM PERIOD POST PARTUM PERIOD • Ante partum hemorrhage • Eclampsia • Ectopic pregnancy • Vasa previa • Uterine Inversion • Cord prolapse • Obstructed labour • Uterine Rupture • Shoulder dystocia • Amniotic fluid embolism • Post partum hemorrhage • Retained placenta • Obstetrical shock • Puerperal sepsis IMPORTANT CONDITIONS IN OBSTETRIC EMERGENCIES
- 12. Placenta Previa 1in 300 deliveries Obstructed labour 1 to 2 % in referral hospitals Abruptio placenta 1 in 200 deliveries Shoulder dystocia 0.2 to 1 % deliveries Eclampsia 1 in 500 to 1 in 30 pregencies Cord Prolapse 1 in 300 deliveries Ruptured Uterus I : 1500 to 2000 births Postpartum hemorrhage 4 to 6 % INCIDENCE
- 13. Poll time Why maternal deaths are happening due to Obstetrical emergencies? Go to menti.com and enter the code 2165388
- 14. Current Indian population The current population of India is 1,382,419,165 as of Saturday, September 5, 2020, based on Worldometer elaboration of the latest United Nations data.
- 15. RURAL HEALTH STATISTICS 2018-19 Sub centres Functioning Without ANM, HW
- 16. • Sixty per cent of primary health centers (PHCs) in India have only one doctor while about five per cent have none. • According to the Economic Survey 2018-19, tabled in the Parliament on July 4, 2019.
- 17. PHCs without doctors, Pharmacist,Lab tech
- 18. Shortfall of Specialists at CHCs
- 19. Three Delays contribute to many maternal deaths 1. Delay in deciding to seek care 2. Delay in reaching appropriate care 3. Delay in receiving care at the health facility
- 21. Emergency Obstetric Care (EmOC) Emergency Obstetric Care is often discussed in terms of basic and comprehensive care that is provided to a women with obstetric complications.
- 22. • For every 500,000 population, there should be at least four basic and one comprehensive EmOC facilities. • 100% of women estimated to have obstetric complications are treated in EmOC facilities.. The WHO, UNICEF and the UN Population Fund (UNFPA) recommended :
- 23. • India Readies A New Cadre Of Certified Midwives To Improve Maternal, Infant Care (Sunaina Kumar February 7, 2019) • 83% of all maternal deaths and newborn deaths could be averted with midwifery care, (WHO ,2018). • When midwives were the main providers of care during pregnancy, women were less likely to give birth prematurely or lose their babies before 24 weeks of gestation, research by the WHO has shown. • Women attended on by midwives needed fewer epidurals, fewer assisted births and fewer episiotomies, and were less likely to have caesarean births. • Midwifery-led care is based on the principles of dignity, privacy and compassion for women and respectful maternal care. • The new guidelines on midwifery in India, released in December 2018, state that a cadre of Nurse Practitioner in Midwifery (NPM) will be created that will be skilled in accordance with International Confederation of Midwives standards. The NPM will be a registered nurse-midwife with an additional 18 months of post-basic training in midwifery. Independent Nurse Midwifery Practitioner
- 24. Improve clinical decision making of nurses
- 26. • It is important that obstetrician–gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff. Having such systems in place may reduce or prevent the severity of medical emergencies. • Schuler, L Katz (2019) conducted a descriptive study to evaluate the modified early obstetric warning system (MEOWS) in women after pregnancies in a tertiary hospital in Brazil. The study was conducted with 705 hospitalized women. Vital signs (systolic and diastolic blood pressure, heart rate, respiratory rate, temperature) and lochia were registered on medical records and transcribed into the MEOWS chart of physiological parameters. • On the graphic chart, the presence of at least one red alert or two yellow alerts were triggered to indicate the need for medical evaluation. Although abnormalities were found in the physiological parameters of 49.8% of the women identified from MEOWS triggers, medical evaluation was only requested for three patients (0.8%). • The study concluded that the application of this tool would result in a better care because critical situations would be recognized and corrected quickly, avoiding unfavorable outcomes. Modified Early Obstetric Warning System(MEOWS)
- 27. Safe Child Birth checklist Prevention and Early identification WHO “safe Child Birth Check List” Danger Signs – be alert and watchful • Excessive bleeding • Severe abdominal Pain • Severe Head ache or visual disturbances • Breathing difficulty • Fever or chills • Difficulty in emptying bladder • Foul smelling vaginal discharge
- 28. The golden rules of obstetric emergencies Oxygen administration Left lateral position Resuscitation and transfer of the mother, as the infant is safer in utero.
- 29. Standards - Basic EmOC Functions Performed in a health centre without the need for an operating theatre • IV/IM antibiotics • IV/IM oxytoxics • IV/IM anticonvulsants • Manual removal of placenta • Assisted vaginal delivery • Removal of retained products
- 30. Standards – Comprehensive EmOC Functions • All six Basic EmOC functions plus: • Caesarean section • Blood Transfusion Requires an operation theatre and is performed in hospitals
- 31. CONDITIONS NEEDING EMOC Ectopic pregnancy Eclampsia Umbilical cord prolapse Shoulder dystocia Amniotic fluid embolism Obstetric Hemorrhage (APH & PPH)
- 32. Management of Ectopic Pregnancy High flow O2 Treat for shock IV access Surgical intervention usually required
- 33. Management of Eclampsia Turn on side to avoid aortocaval compression. Insert an airway and give high-flow O2 (e.g.6 l/min) Give 4g MgSO4 over 10-15 minutes Consider urgent delivery Set up a 1g/h IV infusion of MgSO4 and manage as severe pre- eclampsia
- 34. Management of Umbilical cord prolapse (Arrange in Correct order) 1. Supportive Treatment, Keep the cord moist( wrap it with sterile moist towel) 2.Elevate presenting part/ Fill bladder(500-750ml) 3.Keep the pt in knee/chest position or elevate buttock 4.Emergency C/S 5.Relieve pressure on cord
- 35. Management of Umbilical cord prolapse 1. Keep the pt in knee/chest position or elevate buttock 2. Relieve pressure on cord 3.Elevate presenting part/ Fill bladder(500-750ml) 4. Supportive Treatment, Keep the cord moist( wrap it with sterile moist towel) 5.Emergency C/S
- 36. Management of Shoulder Dystocia McRoberts Maneuver Episiotomy Suprapubic pressure, Internal rotation ,Try recovering posterior arm Extreme measures (fracture the clavicle, symphysiotomy, push the baby's head up and do L.S.C.S (Zavanelli manoeuvre)
- 38. Amniotic Fluid Embolism Amniotic fluid embolism (AFE) is a rare obstetric emergency in which the amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing cardio respiratory collapse.
- 39. Management of Amniotic Fluid Embolism • Administer oxygen to maintain normal saturation. • Intubate if necessary. • Initiate cardiopulmonary resuscitation (CPR) if the patient arrests. If she does not respond to resuscitation, perform a perimortem cesarean delivery. • Treat hypotension with crystalloid and blood products
- 41. Scenario • A woman with 36 weeks of gestation arrives at labour room with bleeding per vagina…. • How can u differentiate Placenta previa or Abruptio placenta with a single question?
- 42. PLACENTA PREVIA
- 44. Management of APH • Confirm the diagnosis( Placenta previa/ Abruptio placenta) • Placenta previa---Avoid per vaginal examination • Abruptio placenta----- Avoid abdominal palpation • Bed rest • Follow ABC( Airway, Breathing and Circulation) principle • If severe bleeding - IV Ringer Lactate - Blood grouping and cross matching -Delivery irrespective of gestational age usually Cesarean section
- 45. Management of Uterine Rupture
- 46. CAUSES OF POST PARTUM HAEMORRHAGE T- Tone T-Trauma T-Tissue T-Thrombosis T- Torsion
- 47. Initial action….
- 48. Call for help Give oxygen, IV fluids Group& x match Treat the cause Immediate Management of PPH
- 49. •a.Oxytocin •a. Bi manual compression 1. Retained Placenta •b. Fresh blood 2. Laceration/Tear •c. Reposition - Johnson' maneuver/hydrostatic pressure/ contract with oxytocin 3. Atonic Uterus •d. Remove 4. Uterine inversion •e. Repair 5. Coagulation Defects Management of PPH (Match the following)
- 50. •d. Remove 1.Retained Placenta •e.Repair 2.Laceration/Tear •a. Oxytocin •Bi manual compression 3.Atonic Uterus •c. Reposition - Johnson' maneuver/hydrostatic pressure/ contract with oxytocin 4.Uterine inversion •b. Fresh blood 5.Coagulation Defects Management of PPH
- 51. ROLE OF A NURSE IN OBSTETRICAL EMERGENCY • Recognize the early signs of major obstetric complications • Perform essential life-saving interventions • Refer as appropriate and • Provide high-quality, culturally appropriate, and considerate care, including follow-up and linkages with other services.
- 52. Essential life –saving skills needed for Nurse • Prevent infection by ensuring safe, clean delivery • Diagnose and manage causes of antepartum and postpartum haemorrhage • Stabilization and referral • Performance of manual procedures
- 53. Essential life –saving skills needed for Nurse-Cont. • Use a partograph, identify prolonged or obstructed labour,and take appropriate, timely action. • Identify elevated blood pressure and proteinuria as signs of eclampsia, provide emergency care, and refer.
- 54. It’s Game time
- 59. • Anticipate problem • Cultivate a good relationship communicate with your obstetricians • Be available and prepared: Emergency O.R. set-up Transfusion and monitoring CONCLUSION