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Induction of Labor
36 O B .GYN. NEWS • January 1, 2007 M ASTER C LASS Induction of Labor he timing of parturi- nancies that require induction because of medical com- of labor induction, the timing of labor induction, and the tion remains a conun- plications in the mother. advisability of the various conditions under which in- Tdrum in obstetric Increasingly, however, patients are apt to have labor in- duction can and does occur. medicine in that the majority duced for their own convenience, for personal reasons, This month’s guest professor is Dr. William F. Rayburn, of pregnancies will go to for the convenience of the physician, and sometimes for professor and chairman of the department of ob.gyn. at term and enter labor sponta- all of these reasons. the University of New Mexico, Albuquerque. Dr. Ray- neously, whereas another This increasingly utilized social option ushers in a burn is a maternal and fetal medicine specialist with a na- portion will go post term and whole new perspective on the issue of induction, and the tional reputation in this area. E. ALBERT REECE, often require induction, and question is raised about whether or not the elective in- M.D., PH.D., M.B.A. still others will enter labor duction of labor brings with it added risk and more com- DR. REECE, who specializes in maternal-fetal medicine, is prematurely. plications. Vice President for Medical Affairs, University of Maryland, The concept of labor induction, therefore, has become It is for this reason that we decided to develop a Mas- and the John Z. -
OB/GYN EMERGENCIES Elyse Watkins, Dhsc, PA-C, DFAAPA DISCLOSURES
OB/GYN EMERGENCIES Elyse Watkins, DHSc, PA-C, DFAAPA DISCLOSURES I have no financial relationships to disclose. TOPICS Ovarian torsion Postpartum hemorrhage Ruptured ectopic Acute uterine inversion pregnancy Amniotic fluid embolism Acute menorrhagia Placental abruption OVARIAN TORSION OVARIAN TORSION .Tumors (benign and malignant) are implicated in 50-60% of cases of torsion .20% occur during pregnancy (corpus luteum cyst) .Unilateral or bilateral abdominal-pelvic pain, usually sudden onset .Exercise or movement exacerbates pain .Nausea and vomiting 70% .Pathophys: reduced venous return, stromal edema, internal hemorrhage, and infarction → necrosis OVARIAN TORSION .Physical exam variable .Ultrasonography with color Doppler .Surgical referral RUPTURED ECTOPIC PREGNANCY RUPTURED ECTOPIC PREGNANCY .All patients of reproductive age with a hx of missed menses and pelvic pain should be considered to have an ectopic pregnancy until proven otherwise. .A patient with missed menses, irregular vaginal bleeding, pelvic pain, syncope, abdominal pain, and/or dizziness should be managed as a ruptured ectopic pregnancy until proven otherwise. RUPTURED ECTOPIC PREGNANCY .Physical exam of pts with a ruptured ectopic can reveal pelvic tenderness, an adnexal mass, and evidence of hemodynamic compromise. .A transvaginal ultrasound will often show an adnexal mass and/or fluid in the pouch of Douglas. .The serum qualitative βHCG will be > 5 mIu/mL. RUPTURED ECTOPIC PREGNANCY HTTPS://YOUTU.BE/TNN1FPWHOXS RUPTURED ECTOPIC PREGNANCY .Immediately order an H/H, type and cross, and place large bore IV access for fluid support. .Laparotomy is performed when patients are hemodynamically unstable or if visualization during laparoscopy was difficult. .Patients with a ruptured ectopic pregnancy must be managed emergently and surgically! ACUTE MENORRHAGIA ACUTE MENORRHAGIA .Abnormal uterine bleeding (AUB) can result in acute blood loss that causes hemodynamic compromise so prompt evaluation of vital signs is important. -
Uterine Atony: Uterus Soft and Relaxed
Uterine atony: uterus soft and relaxed Placenta not delivered Treat for whole retained placenta If whole placenta still retained ■ Oxytocin ■ Manual removal with prophylactic antibiotics ■ Controlled cord traction ■ Intraumbilical vein injection (if no bleeding) Placenta delivered incomplete Treat for retained placenta fragments If bleeding continues ■ Oxytocin ■ Manage as uterine atony ■ Manual exploration to remove fragments ■ Gentle curettage or aspiration Be ready at all times to transfer to a higher-level facility if the Lower genital tract trauma: Treat for lower genital tract trauma If bleeding continues patient is not responding to the excessive bleeding or shock ■ Repair of tears ■ Tranexamic acid ■ treatment or a treatment cannot contracted uterus Evacuation and repair of haematoma be administered at your facility. Uterine rupture or dehiscence: Treat for uterine rupture or dehiscence If bleeding continues excessive bleeding or shock ■ Laparotomy for primary repair of uterus ■ Tranexamic acid Start intravenous oxytocin infusion ■ Hysterectomy if repair fails and consider: • uterine massage; • bimanual uterine compression; Uterine inversion: Treat for uterine inversion If laparotomy correction not successful • external aortic compression; and uterine fundus not felt ■ Immediate manual replacement ■ Hysterectomy • balloon or condom tamponade. abdominally or visible in vagina ■ Hydrostatic correction ■ Manual reverse inversion Transfer with ongoing intravenous (use general anaesthesia or wait for effect uterotonic infusion. Accompanying -
ABCDE Acronym Blood Transfusion 231 Major Trauma 234 Maternal
Cambridge University Press 978-0-521-26827-1 - Obstetric and Intrapartum Emergencies: A Practical Guide to Management Edwin Chandraharan and Sir Sabaratnam Arulkumaran Index More information Index ABCDE acronym albumin, blood plasma levels 7 arterial blood gas (ABG) 188 blood transfusion 231 allergic anaphylaxis 229 arterio-venous occlusions 166–167 major trauma 234 maternal collapse 12, 130–131 amiadarone, overdose 178 aspiration 10, 246 newborn infant 241 amniocentesis 234 aspirin 26, 180–181 resuscitation 127–131 amniotic fluid embolism 48–51 assisted reproduction 93 abdomen caesarean section 257 asthma 4, 150, 151, 152, 185 examination after trauma 234 massive haemorrhage 33 pain in pregnancy 154–160, 161 maternal collapse 10, 13, 128 atracurium, drug reactions 231 accreta, placenta 250, 252, 255 anaemia, physiological 1, 7 atrial fibrillation 205 ACE inhibitors, overdose 178 anaerobic metabolism 242 automated external defibrillator (AED) 12 acid–base analysis 104 anaesthesia. See general anaesthesia awareness under anaesthesia 215, 217 acidosis 94, 180–181, 186, 242 anal incontinence 138–139 ACTH levels 210 analgesia 11, 100, 218 barbiturates, overdose 178 activated charcoal 177, 180–181 anaphylaxis 11, 227–228, 229–231 behaviour/beliefs, psychiatric activated partial thromboplastin time antacid prophylaxis 217 emergencies 172 (APTT) 19, 21 antenatal screening, DVT 16 benign intracranial hypertension 166 activated protein C 46 antepartum haemorrhage 33, 93–94. benzodiazepines, overdose 178 Addison’s disease 208–209 See also massive -
Incidence of Eclampsia with HELLP Syndrome and Associated Mortality in Latin America
International Journal of Gynecology and Obstetrics 129 (2015) 219–222 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo CLINICAL ARTICLE Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America Paulino Vigil-De Gracia a,⁎, José Rojas-Suarez b, Edwin Ramos c, Osvaldo Reyes d, Jorge Collantes e, Arelys Quintero f,ErasmoHuertasg, Andrés Calle h, Eduardo Turcios i,VicenteY.Chonj a Critical Care Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario de la Caja de Seguro Social, Panama City, Panama b Critical Care Unit, Clínica de Maternidad Rafael Calvo, Cartagena, Colombia c Department of Gynecology and Obstetrics, Hospital Universitario Dr Luis Razetti, Barcelona, Venezuela d Unit of Research, Department of Gynecology and Obstetrics, Hospital Santo Tomás, Panama City, Panama e Department of Gynecology and Obstetrics, Hospital Regional de Cojamarca, Cajamarca, Peru f Department of Gynecology and Obstetrics, Hospital José Domingo de Obaldía, David, Panama g Unit of Perinatology, Department of Gynecology and Obstetrics, Instituto Nacional Materno Perinatal, Lima, Peru h Department of Gynecology and Obstetrics, Hospital Carlos Andrade Marín, Quito, Ecuador i Unit of Research, Department of Gynecology and Obstetrics, Hospital Primero de Mayo de Seguridad Social, San Salvador, El Salvador j Department of Gynecology and Obstetrics, Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador article info abstract Article history: Objective: To describe the maternal outcome among women with eclampsia with and without HELLP syndrome Received 7 July 2014 (hemolysis, elevated liver enzymes, and low platelet count). Methods: A cross-sectional study of women with Received in revised form 14 November 2014 eclampsia was undertaken in 14 maternity units in Latin America between January 1 and December 31, 2012. -
Vitamin D, Pre-Eclampsia, and Preterm Birth Among Pregnancies at High Risk for Pre-Eclampsia: an Analysis of Data from a Low-Dos
HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author BJOG. Author Manuscript Author manuscript; Manuscript Author available in PMC 2021 January 29. Published in final edited form as: BJOG. 2017 November ; 124(12): 1874–1882. doi:10.1111/1471-0528.14372. Vitamin D, pre-eclampsia, and preterm birth among pregnancies at high risk for pre-eclampsia: an analysis of data from a low- dose aspirin trial AD Gernanda, HN Simhanb, KM Bacac, S Caritisd, LM Bodnare aDepartment of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA bDivision of Maternal-Fetal Medicine, Magee-Women’s Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA cDepartment of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA dDepartment of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA eDepartments of Epidemiology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, PA, USA Abstract Objective—To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. Design—Analysis of prospectively collected data and blood samples from a trial of prenatal low- dose aspirin. Setting—Thirteen sites across the USA. Population—Women at high risk for pre-eclampsia. Methods—We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12–26 weeks’ gestation (n = 822). We used mixed effects models to Correspondence: LM Bodnar, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto St, Pittsburgh, PA 15261, USA. -
Policy of Interventionist Versus Expectant Management of Severe
WHO recommendations Policy of interventionist versus expectant management of severe pre-eclampsia before term WHO recommendations Policy of interventionist versus expectant management of severe pre-eclampsia before term WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term ISBN 978-92-4-155044-4 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term. Geneva: World Health Organization; 2018. -
Umbilical Cord Prolapse Guideline
Umbilical Cord Prolapse Guideline Document Control Title Umbilical Cord Prolapse Guideline Author Author’s job title Specialty Trainee in Obstetrics and Gynaecology Directorate Department Women’s and Children’s Obstetrics and Gynaecology Date Version Status Comment / Changes / Approval Issued 1.0 Mar Final Approved by the Maternity Services Guideline Group in 2011 April 2011. 1.1 Aug Revision Minor amendments by Corporate Governance to 2012 document control report, headers and footers, new table of contents, formatting for document map navigation. 2.0 Feb Final Approved by the Maternity Services Guideline Group in 2016 February 2016. 2.1 Apr Revision Harmonised with Royal Devon & Exeter guideline 2019 3.0 May Final Approved by Maternity Specialist Governance Forum 2019 meeting on 01.05.2019 Main Contact ST1 O&G Tel: Direct Dial– 01271 311806 North Devon District Hospital Raleigh Park Barnstaple Devon EX31 4JB Lead Director Medical Director Superseded Documents Nil Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: (list all) Senior obstetricians Senior midwives Senior management team Filename Umbilical Cord Prolapse Guideline v3. 01May 19.doc Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Cord, accidents, prolapse Maternity Services Maternity Page 1 of 11 Umbilical Cord Prolapse Guideline CONTENTS Document Control .................................................................................................... 1 1. Introduction -
Management of Prolonged Decelerations ▲
OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others. -
Ophthalmic Associations in Pregnancy
CLINICAL Ophthalmic associations in pregnancy Queena Qin, Celia Chen, Sudha Cugati PREGNANCY RESULTS in various physiological variation in pregnancy.2 It normally changes in the female body, including in fades slowly after pregnancy and does the eyes. A typical pregnancy results in not need active intervention. Background A range of ocular pathology exists cardiovascular, pulmonary, metabolic, • Cornea – corneal thickness, curvature during pregnancy. Some pre-existing eye hormonal and immunological changes. and sensitivity may be altered during conditions, such as diabetic retinopathy, Hormonal changes occur, with a rise of pregnancy. Corneal thickness and can be exacerbated during pregnancy. oestrogen and progesterone levels to curvature can increase in pregnancy, Other conditions manifest for the first suppress the menstrual cycle.1 especially in the second and third time during pregnancy as a result of The eye, an end organ, undergoes trimesters, and return to normal in complications such as pre-eclampsia changes during pregnancy. Some of the postpartum period.3 Patients who and eclampsia. Early recognition and understanding of the management of these changes exacerbate pre-existing wear contact lenses may experience ophthalmic conditions is crucial. eye conditions, while other conditions intolerance to the use of contact lenses. manifest for the first time during Pregnant women should be advised Objective pregnancy. Early recognition and to delay obtaining a new prescription The aim of this article is to discuss the understanding of management of for glasses or undergoing a contact physiological and pathological changes in the eyes of pregnant women. ophthalmic conditions during pregnancy lens fitting until after delivery. Laser Pathological changes are sub-divided is crucial for the primary care physician. -
Pre-Eclampsia and High Blood Pressure During Pregnancy
Pre-eclampsia and High Blood Pressure During Pregnancy What is high blood pressure? A blood pressure measurement is usually recorded as two numbers, Blood pressure is the force that pushes against your blood vessel such as 120 over 80 (120/80). High blood pressure is also called walls each time your heart squeezes and relaxes to pump the blood hypertension. Hypertension is diagnosed when either the top or the through your body. Blood pressure measurement is a very useful bottom number is higher than normal. way to monitor the health of your cardiovascular system (heart and blood vessels). Why is blood pressure important develops, it does not go away until after the baby is born. Women with pre-eclampsia may require an earlier delivery, during pregnancy? either by labour induction or caesarean section, in order to During pregnancy, very high blood pressure (severe hypertension) protect the health of themselves and their baby. In some cases, can cause complications for both you and your baby, including: pre-eclampsia can develop after childbirth and you should • Poor growth of your baby – due to low nutrition and oxygen alert your doctor or midwife of any concerns you may have supply from the placenta after your baby is born. • Prematurity – if early delivery (before 37 weeks) is required to protect the health of you or your baby • Placental abruption – the placenta may prematurely separate from the wall of the uterus (womb), leading to bleeding and the need for an emergency birth in some cases • Pre-eclampsia – a condition involving high blood pressure and abnormal function in one or more organs during pregnancy What are the different types of high blood pressure that affect pregnant women? 1. -
Cord Prolapse
CLINICAL PRACTICE GUIDELINE CORD PROLAPSE CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and the Clinical Strategy and Programmes Division, Health Service Executive Version: 1.0 Publication date: March 2015 Guideline No: 35 Revision date: March 2017 1 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Table of Contents 1. Revision History ................................................................................ 3 2. Key Recommendations ....................................................................... 3 3. Purpose and Scope ............................................................................ 3 4. Background and Introduction .............................................................. 4 5. Methodology ..................................................................................... 4 6. Clinical Guidelines on Cord Prolapse…… ................................................ 5 7. Hospital Equipment and Facilities ....................................................... 11 8. References ...................................................................................... 11 9. Implementation Strategy .................................................................. 14 10. Qualifying Statement ....................................................................... 14 11. Appendices ..................................................................................... 15 2 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE 1. Revision History Version No.