ABCDE Acronym Blood Transfusion 231 Major Trauma 234 Maternal
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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. -
Ask the Experts Amniotic Fluid Embolism Steven L. Clark, MD
Ask the Experts Questions have been written by: Amniotic Fluid Embolism Angela K. Hardyk, MD Mount Nittany Physician Group Ob/Gyn Steven L. Clark, MD State College, PA (Obstet Gynecol 2014;123:337–48) Responses have been written by: Steven L. Clark, MD Hospital Corporation of America Nashville, TN Question 1: How would you counsel a patient about a future pregnancy if she has been lucky enough to survive an amniotic fl uid embolism (AFE)? Would there be any special precautions she would need to take for her next pregnancy? Response from Dr. Clark: The available data in this area consist only of several very small series and case reports. These data suggest that the risks of recurrence are low. In addition, a pathophysiologic mechanism of disease that hinges on a maternal reaction to a specif- ic set of fetal antigens would suggest that recurrence ought to be uncommon. On the other hand, having dodged one bullet, is it really wise to spin the wheel again? My counseling goes something like this: “Available data suggest that the risk of recurrence is low, and there are a number of reports of successful pregnancy outcome after AFE survival. However, given the potential severity of AFE if it does recur, and a lack of really good data regarding risks, I advise you to undertake another pregnancy only if you are willing to accept a small risk of catastrophic outcome including death.” If a patient chooses to undertake pregnancy, I do not alter my management in any way, other than delivery in a tertiary center. -
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. -
Ante Partum Haemorrhage
Ante Partum Haemorrhage Sara Alhaddab Alanood Asiri Ante Partum Haemorrhage (APH): Bleeding in early pregnancy (first 20 weeks of gestation) causes: Affects 3-5 % of pregnancies. • - Miscarriage • Bleeding from or into the genital tract. - Ectopic pregnancy • Occurring from 20 weeks of pregnancy and prior - Molar pregnancy to the birth of the baby. - Local causes: tumor, trauma etc. Causes: Landmark of fetal viability is 20 weeks. • Placenta previa. • Placenta abruption. • Local causes (cervical or vaginal lesions, lacerations). Trauma, tumor and infections. • Unexplained (SGA, IUGR). SGA: small for gestational age. • Vasa previa. • Uterine rupture. - APH is the leading cause of prenatal and maternal morbidity and prenatal mortality (mainly prematurity). - Obstetrics hemorrhage remains one of the major causes of maternal death in the developing countries. Management: In the hospital maternity unit with facilities for resuscitation such as: Source: Essentials of Obstetrics and Gynecology. § Anesthetic support. § Blood transfusion resources. § Performing emergency operative delivery. § Multidisciplinary team including (midwifery, obstetric staff, neonatal and anesthetic). Investigations: • Tests if suspecting vasa previa are often not applicable • Tocolysis: shouldn’t be used in: v Unstable patient. v Fetal compromise. v Major APH. It’s a decision of a senior obstetrician. Senior (consultant) anesthetic care needed in high-risk hemorrhage. • Risk of PPH: patient should receive active management of 3rd stage of labor using syntometrine (in absence of high BP). Syntometrine → active uterine contraction after delivery to prevent PPH. • AntiD Ig should be given to all non sensitized RH –ve if the have APH, at least 500 IU AntiD Ig followed by a test of FMH if it is more than 40 ml of RBC additional AntiD required. -
Critical Care Issues in Pregnancy
CriticalCritical CareCare IssuesIssues inin PregnancyPregnancy Miren A. Schinco, MD, FCCS, FCCM Associate Professor of Surgery University of Florida College of Medicine, Jacksonville College of Medicine – Jacksonville Department of Surgery EpidemiologyEpidemiology •Approximately .1% of deliveries result in ICU admission • Generally, 75% - 80 % are during the post- partum period College of Medicine – Jacksonville Department of Surgery TopTop causescauses ofof mortalitymortality inin obstetricobstetric patientspatients admittedadmitted toto thethe ICUICU Etiology N (of 1354) Percentage Hypertension 20 21.5 Pulmonary 20 21.5 Cardiac 11 11.8 Hemorrhage 8 8.6 CNS 8 8.6 Sepsis/Infection 6 6.4 Malignancy 6 6.4 College of Medicine – Jacksonville Department of Surgery CriticalCritical illnessesillnesses inin pregnancypregnancy A. Conditions unique to pregnancy: account for 50-80% admissions to ICU(account for > 50% ICU admissions): • Preeclampsia / Eclampsia • HELLP syndrome • Acute fatty liver of pregnancy • Amniotic fluid embolism • Peri-partum cardiomyopathy • Puerperal sepsis • Thrombotic disease • Obstetric hemorrhage College of Medicine – Jacksonville Department of Surgery CriticalCritical illnessesillnesses inin pregnancypregnancy B. Pre-existing conditions that may worsen during pregnancy (account for 20-50% ICU admissions): • Cardiovascular: valvular disease, Eisenmenger’s syndrome, cyanotic congenital heart disease, coarctation of aorta, PPH • Renal: glomerulonephritis, chronic renal insufficiency • Hematologic: sickle cell disease, -
Determinants, Incidence and Perinatal Outcomes of Multiple Pregnancy Deliveries in a Low-Resource Setting, Mpilo Central Hospital, Bulawayo, Zimbabwe
MOJ Women’s Health Review Article Open Access Determinants, incidence and perinatal outcomes of multiple pregnancy deliveries in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe Abstract Volume 8 Issue 2 - 2019 Background: Multiple pregnancies are high risk pregnancies compared to singletons. Solwayo Ngwenya They may result in poor feto-maternal outcomes. Traditionally, these pregnancies Department of Obstetrics and Gynecology, Mpilo Central are associated with anaemia, preeclampsia, preterm deliveries and postpartum Hospital, Zimbabwe haemorrhage. In low-resource settings, these women and their babies may face increased risks of poor perinatal outcomes. The objective of this study was to Correspondence: Solwayo Ngwenya, Department of document for the first time the determinants, incidence and perinatal outcomes of Obstetrics and Gynecology, Mpilo Central Hospital, P.O. Box multiple pregnancies for Mpilo Central Hospital. 2096, Vera Road, Mzilikazi , Bulawayo, Matabeleland, Zimbabwe, Tel +263 9 214965, Email Methods: This was a retrospective descriptive study covering the period between 1 January 2017 and 31 December 2017 in a tertiary teaching hospital. A paper data Received: December 31, 2018 | Published: March 05, 2019 collection sheet was used to collect the information. All twin/triplet deliveries >24 weeks gestation born at the labour ward were included in the study. The data was then analysed. Results: The incidence of multiple pregnancy at Mpilo Central Hospital was 1.7%. The 20-25 year old age group had the highest percentage at 25.5%. Nulliparous women had the highest percentage at 28.4% of the patients. Booked/referred patients constituted the majority at 45.4%, followed by instutional booked at 39.0%. -
Amnioinfusion
Review Article Indian Journal of Obstetrics and Gynecology Volume 7 Number 4 (Part - II), October – December 2019 DOI: http://dx.doi.org/10.21088/ijog.2321.1636.7419.12 Amnioinfusion Alka Patil1, Sayli Thavare2, Bhagyashree Badade3 How to cite this article: Alka Patil, Sayli Thavare, Bhagyashree Badade. Amnioinfusion. Indian J Obstet Gynecol. 2019;7(4)(Part-II):641–644. 1Professor and Head, 2,3Junior Resident, Department of Obstetrics and Gynaecology, ACPM Medical College, Dhule, Maharashtra 424002, India. Corresponding Author: Alka Patil, Professor and Head, Department of Obstetrics and Gynaecology, ACPM Medical College, Dhule, Maharashtra 424002, India. E-mail: [email protected] Received on 20.11.2019; Accepted on 16.12.2019 Abstract potentially at risk. Oligohydramnios is one of the high-risk pregnancy, posing diagnostic challenge Amniotic fluid is a dynamic medium that plays and dilemma in management. These high-risk a significant role in fetal well-being. It is essential pregnancies should be monitored, managed during pregnancy for normal fetal growth and organ and delivered at a tertiary care center for good development. About 4% of pregnancies are complicated pregnancy outcome. by oligohydramnios. It is associated with an increased incidence of perinatal morbidity and mortality due to its Amniotic fl uid is essential for the continued well antepartum and intrapartum complications. Gerbruch being of the fetus and has following functions: and Hansman described a technique of Amnioinfusion • Shock absorber preventing hazardous to overcome these difficulties to prevent the occurrence pressure on the fetal parts of fetal lung hypoplasia in pregnancies complicated by oligohydramnios. Amnioinfusion reduces both • Prevents adhesion formation between fetal the frequency and depth of FHR deceleration. -
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. -
Shoulder Dystocia Abnormal Placentation Umbilical Cord
Obstetric Emergencies Shoulder Dystocia Abnormal Placentation Umbilical Cord Prolapse Uterine Rupture TOLAC Diabetic Ketoacidosis Valerie Huwe, RNC-OB, MS, CNS & Meghan Duck RNC-OB, MS, CNS UCSF Benioff Children’s Hospital Outreach Services, Mission Bay Objectives .Highlight abnormal conditions that contribute to the severity of obstetric emergencies .Describe how nurses can implement recommended protocols, procedures, and guidelines during an OB emergency aimed to reduce patient harm .Identify safe-guards within hospital systems aimed to provide safe obstetric care .Identify triggers during childbirth that increase a women’s risk for Post Traumatic Stress Disorder and Postpartum Depression . Incorporate a multidisciplinary plan of care to optimize care for women with postpartum emergencies Obstetric Emergencies • Shoulder Dystocia • Abnormal Placentation • Umbilical Cord Prolapse • Uterine Rupture • TOLAC • Diabetic Ketoacidosis Risk-benefit analysis Balancing 2 Principles 1. Maternal ‒ Benefit should outweigh risk 2. Fetal ‒ Optimal outcome Case Presentation . 36 yo Hispanic woman G4 P3 to L&D for IOL .IVF Pregnancy .3 Prior vaginal births: 7.12, 8.1, 8.5 (NCB) .Late to care – EDC ~ 40-41 weeks .GDM Type A2 – somewhat uncontrolled .4’11’’ .Hx of Lupus .BMI 40 .Gained ~ 40 lbs during pregnancy Question: What complication is she a risk for? a) Placental abruption b) Thyroid Storm c) Preeclampsia with severe features d) Shoulder dystocia e) Uterine prolapse Case Presentation . 36 yo Hispanic woman G4 P3 to L&D for IOL .IVF Pregnancy .3 -
OBGYN-Study-Guide-1.Pdf
OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test. -
Term Pregnancy with Umbilical Cord Prolapse
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Available online at www.sciencedirect.com Taiwanese Journal of Obstetrics & Gynecology 51 (2012) 375e380 www.tjog-online.com Original Article Term pregnancy with umbilical cord prolapse Jian-Pei Huang a,b,*, Chie-Pein Chen a,c, Chih-Ping Chen a,d, Kuo-Gon Wang a,c, Kung-Liahng Wang a,b,d a Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan b Mackay Medicine, Nursing and Management College, Taipei, Taiwan c Division of High Risk Pregnancy, Mackay Memorial Hospital, Taipei, Taiwan d Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Accepted 10 March 2011 Abstract Objective: To investigate the incidence, management, and perinatal and long-term outcomes of term pregnancies with umbilical cord prolapse (UCP) at Mackay Memorial Hospital, Taipei, from 1998 to 2007. Materials and Methods: For this retrospective study, we reviewed the charts, searched a computerized birth database, and contacted the families by telephone to acquire additional follow-up information. Results: A total of 40 cases of UCP were identified among 40,827 term deliveries, an incidence of 0.1%. Twenty-six cases (65%) were delivered by emergency cesarean section (CS). Of the neonates, 18 had an Apgar score of <7 at 1 minute, 10 of these scores being sustained at 5 minutes after birth, and three infants finally died. Eleven UCPs occurred at the vaginal delivery of a second twin, and nine with malpresentation. All of the infants who had good perinatal outcomes also had good long-term outcomes.