Emergency in obstetric and gynecology

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Emergency in obstetricsand gynecology .
33 .
G1P0 GA 40 weeks by date ANC x6 x5.
Serology all negativeTWG 10 6 kg CC 2 00 3 30 PTA PI 3 hr 30 min PTA .
PH .
terval 28 30 daysDuration 5 days History .
GA 7 weeks 47 kg 150 c .
Urine Albumin and Sugar all negatall negative Rh ANC GA 30 wk PSM R O.
Valvular Heart Disease Refer ANC .
Cardiologist normal physiologyHemoglobin 9 8 g Hct 27 7 9 8 fl anemia 1 anisocytosis 1 m Hb typing zygous Hb E VS Beta Thalassemi.
normal Hb typingGA 36 wk 56 8 56 USG USGGA 32 4 wk by USG.
Fetal Cardiac Pulsation positiveAFI 8 36EFW 2106 gmPlacental Grading 2FL AC 24 08.
Complete Breech lem Listght loss during pregnancymozygous Hb E vs Beta Thalassememia with anisocytosis and microc.
mplete breech presentation Sign BT 37 C PR 80 min RR 16 BP 120 80 mmHger PE normal.
us Height of Fundus 3 4 OBack of Fetus RightPresentation BreechFHS positiveEFW 2800 gm.
Pelvis adequate Cervix consistency soft Effacement 90 Dilatation 4 cm Membrane intact.
DATE INT DUR EFF DIL STA POSITION MEMB FHS BP PR5 30 90 4 1 Intact 132 R 120 80 726 15 3 45 90 4 2 Transverse Intact 150 R 120 80 80Diagnosis G1P0 GA 40 wk with.
transverse lie confirmed by USG USG single alivefetus transverse lie placental site at fundus.
grade 2 3 term fetus BPD 9 2 cm FL 7 2 cm plan LT C S set OR for LT C S spontaneous rupture of membrane.
6 26 FHS .
6 26 clear amniotic fluid grossly leakagincomplete breech with prolapsed co.
140 R 100 R Definition the cord lies besidethe presenting.
part occult cord or the membranes are diagnosis Palpation of the cord or cordpulsation on vaginal examination.
visualization of the cord outside thefetal bradycardia or variablethe membrane rupturedecelerationand any of the foregoing.
predisposing factor arepresent PV should be performed Fetal BradycardiaDefinition FHR 120 beats min for 2 min or longer Prolong bradycardia sudden drop from normal.
FHR to value below 120 esp 80 minCause decrease in maternal oxygen tension eg apnea of seizure decrease in umbilical blood flow eg excessive uterine contraction maternal.
hypotension cord compression abruptio placentae fetal hemorrhage eg vasa previa Pathophysiology ofprolapsed cord.
1 Umbilical cord prolapses2 Follows rupture of membrane3 Occurs when presenting partis ill fitting ood supply obstructed when cord out.
temperaturem of umbilical vesselssion between pelvic brim and presen Risk factors Any conditionwhich interfere presenting.
Malpresentationpart engagement in the pelvis Transverse or oblique lie Breech esp footling Unengaged vertex.
polyhydramnios Multiple pregnancy Grand multiparity anterioruterine obliquity Prematurity.
Pracenta previa Uterine fibroids Amniotomy with unengagepresenting part How to manage .
IV fluid notified anesthetist andpediatrist.
C S emergency Management .
C S 10 cord prolapse 1 Remain calm call for.
2 Counseling3 Turn off syntocinonIf cord prolapse is4 4 1 .
4 2 Trand 4 3 NSS 500 750 ml .
clamp full bladder5 Intrauterine resuscitation NSS 1000 ml IV.
facial O2 100 via face mask ing and grouping PRC 2 units LT C S .
vasoconstriction .
1 FHS 2 pulse cord 3 ultrasound .
spontaneous vaginal delivery .
F E V E C S prolapsed cord second stage of labor .
1 Manage as for general management2 Prepare for vaginal delivery OR .
Episiotomy F E Breechextraction Operative noteDiagnosis G1P0 GA40 wk.
with incomplete breech andprolapsed cordOperation low transversecesarean section Anesthetics .
formed lower uterineA term baby incompletebreech presentation APGAR1min 1 Endotrachialtube O2 therapy .
5min 4 10min 7 byneonatalogist then transferNormal placenta located at 6 30 6 37 prolapsed cord 11.
Newborn male alive weight 2975 gm score 1min 1 5min Placenta normal placenta weight.
length 40 cm Complication of prolapsed cordIncreased maternal morbidity mortality dueto the following complication from operative intervention.
eg anaesthetic complication maternal tissuetrauma complication postpartum hemorrhage sepsisFetal complications depend on .
Fetal gestation Duration of prolapse prior to delivery Strength of contractions State of labor when prolapse occurred Rapidity of diagnosis and rapidity and.
efficiency of first aid management Rapidity and efficiency of deliveryFetal blood supply obstructed when cord out of uterus Drops in temperature Vasospasm of umbilical vessels Compression between pelvic brim and presenting part Malpresentation Transverse or oblique lie Breech esp. footling CPD Unengaged vertex polyhydramnios Risk factors:Any condition which interfere presenting part engagement in the pelvis ...

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