EMS DISPATCHING IN OB

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EMS DISPATCHING IN OB GYN

• 240308
• WIMOL

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ABNORMAL VAGINAL BLEEDING

• Active vaginal bleeding need immediate
  evaluation and treatment.
• - pregnancy related.
• - non pregnancy causes

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ACUTE COMPLICATIONS OF PREGNANCY

• PROBLEMS IN - Early pregnancy
• - Late pregnancy

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Complications in Early Pregnancy

• Abortion
• Ectopic pregnancy
• Molar pregnancy

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ABORTIONBEFORE 20 ( 28 ) WKS

• RISKS - Increase maternal and paternal
• age ( 26 of maternal age gt 40 yrs )
• - Increase parity
• - Increase vaginal bleeding

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Clinical features

• Amenorrhea
• Increase bleeding per vagina, clots
• Pelvic pain or cramp

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ASSESSMENT

• Consciousness
• Vital signs
• Amount of vaginal bleeding
• Tissue from vagina with villi / vesicles

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Ectopic pregnancy
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ECTOPIC PREGNANCY

• Implantation of fertilized ovum outside uterine
  cavity
• Leading cause of maternal death in first trimester

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CLINICAL FEATURES

• Abnormal mens ( few ? unaware of pregnancy)
• Irregular bleeding ? no bleeding
• Pain gt no pain
• Palor
• Cold sweating
• syncope

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• RISKS - History of tubal pregnancy
• tubal infection
• tubal surgery
• - IUD insertion

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• Vaginal bleeding and pain
• is considered to be ectopic pregnancy till to
  be R / O.

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MANAGEMENT

• Vital signs assessment
• Oxygenation
• Adequate fluid infusion
• NPO till proven of no surgery needed
• Blood grouping X-matching for blood transfusion

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MOLAR PREGNANCY

• Incident 2 3 per 1000 live birth
• Previous molar pregnancy
• Maternal age gt 35 years
• Race ?
• Nutrition ?

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MOLAR PREGNANCY

• Abnormal proliferation of chorionic villi
• Absence of fetal tissue complete
• hydatidiform mole
• Presence of fetal tissue with trophoblastic
• hyperplasia incomplete hydatidiform
• mole
• 15 ? neoplastic gestational disease
  

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Clinical features

• Hyperemesis gravidarum
• Intermittent bleeding or bloody discharge per
  vagina
• FHS negative in GA. 20 28wks
• Passage of grapelike hydatid vesicles
• Uterus size gt gestation age

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Hydatid vesicles
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COMPLICATION of MOLAR PREGNANCY

• PIH
• Eclampsia
• Pulmonary embolism
• Liver congestion

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COMPLICATIONS OF LATE PREGNANCY

• GA gt 20 (28) WEEKS

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Vg. Bleeding in late pregnancy

• 4 of pregnancy
• Placenta previa
• Abruptio placenta
• Uterine rupture
• Vasa previa
• Postpartum haemorrage

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PLACENTA PREVIA

• Painless
• Or very little pain
• Fresh brisk vaginal bleeding
• NO VAGINAL EXAMINATION

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ABRUPTIO PLACENTA

• Uterine tenderness and cramping.
• Back pain
• Dark variable bleeding.
• (20 no bleeding)
• Fetal distress

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ABRUPTIO PLACENTA

• RISKS
• - Advanced maternal age
• - Hypertension ( PIH )
• - Smoking
• - Drugs use
• - Abdominal trauma

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UTERINE RUPTURE

• Uterine tenderness without contraction
• Brisk blood per vagina
• Previous uterine surgery
• Induction of labour
• Boggy uterine fundus
• URGENT

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Uterine rupture in recent pregnancy(CT SCAN)
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VASA PREVIA

• Labor pain
• Abrupt onset
• rupture of membrane
• Bright red bleeding gt bloody show
• Decrease fetal movement

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POSTPARTUM HEMORRHAGE

• Within 24 hrs post delivery
• Mild pain
• Fresh bleeding and clots
• Tender abdomen, uterine atony
• Pale
• Decrease BP. Increase pulse

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POSTPARTUM HEMORRHAGE-2

• Extended uterus
• ( eg. Multiple pregnancy)
• Prolong labor
• Difficult delivery
• Vaginal laceration
• DIC

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NON PREGNANCY CAUSES

• Trauma
• Neoplasm,polyps
• malignancy
• DUB

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ABNORMAL VAGINAL BLEEDING

• HISTORY
• - Child bearing age ? possible pregnancy
• - Past history of vaginal bleeding
• - Recent abnormal period
• - Unprotected SI
• - Symptoms of early pregnancy

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ABNORMAL VAGINAL BLEEDING

• HISTORY-2
• - Trauma
• - Sexually or body assault
• - Past history of vaginal bleeding
• medical disorder

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AVERAGE MENSTRUAL CYCLE

• Interval 21 30 days
• Duration of 5 7 days
• Amout 35 mls

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ABNORMAL VAGINAL BLEEDINGDUB

• Irregular menstral cycle
• - lt25 interval gt30 days
• - Metrorrhagia 21 days
• - Menorrhagia
• - Heavy bleeding
• - Duration gt7 days
• - gt 80 mls per cycle
• soak pads,clots

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DUB

• 90 related to anovulatory cycle
• Medical complication,
• bleeding disorder

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UTERINE DISORDERS

• Uterine myoma
• Uterine polyps
• Carcinoma
• Foreign body
• IUDs
• Infections

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EMERGENCY DELIVERY

• ASSESSEMENT
• - Gravidity,parity,abortion
• - LMP, EDC
• - Vaginal discharge watery or blood
• amount, duration
• - Any illness
• - Consciousness
• - appearance

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CHARACTERISTICS OF LABOR

• TRUE LABOR
• - Regular interval pain
• - Gradually shorten interval
• - Gradually increased pain intensity
• - Vaginal discharge watery / blood
• FALSE LABOR
• - Irregular interval / intensity

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TO DELIVER OR NOT TO DELIVER

• ANY SYMPTOM
• - The uncontrollable urge to push
• - A desire to open her bowel
• - Evidence of CROWNING
• (presenting part on view)
• IF YES Assist with home childbirth
• NO Transport to LR

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NO GO!
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DURING TRANSIT

• Reassure the mother to be
• Position in lateral posture
• Equipments preparation
• Observe - uterine contraction
• - perineum
• Notify to the nearest or ANC hospital

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YESHOMEDELIVERY
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HOME DELIVERY

• Position the mother to be supine with Flexed knee
• Clean perineum with soap and clean water
• Put sterile/clean towel under her buttocks
• Instruct the mother to breath and push
• until the baby delivered
• Clean the babys face
• Aspirate mouth and nose

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UMBILICAL CORD

• DO NOT PULL THE CORD
• Apply one cord clamp 20 cms. away from the NB
• A second clamp 5 cms apart
• Apply antiseptic solution

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HOME DELIVERY - 2

• Record time of delivery
• Check the abdomen of the mother
• To R/O multiple pregnancy
• Check bleeding
• Clean and keep mother and child warm and dry
• Assessement of vital signs of mother
• and NBs APGAR score

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NUCHAL CORD

• Slip the cord over the head of the baby
• Apply two cord clamps and cut between
• Instruct the mother to push
• Check Apgar score
• Resuscitate in case of low Apgar score and
  transport

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BREECH PRESENTATION

• DO NOT PULL
• Transport to hospital immediately with the
  mothers buttocks and thighs elevated
• Delivered by supporting the baby s body slowly
  pushed down by the mother

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PROLASED CORD

• PROM
• Place the mother in prone knee- chest position
• Push the presenting part upward
• by inserting fingers in the vagina
• Transport to hospital immediately

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PREGNANCY INDUCED HYPERTENSION

• Abnormality mild
  severe
• Diastolic BP 100 mm Hg 100 mm Hg
• (proteinuria trace 2 )
• Headache -
• Visual disturbance -
• Upper abdominal pain -
• Oliguria -
• IUGR -
• Convulsion -

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RISK FACTORS OF HT DISEASE IN PREGNANCY

• Nulliparity
• Advanced age
• Race, low socioeconomic group
• Previous HT (25)
• DM.,obesity,renal disease
• Family Hx.
• Hydatidiform mole
• Multiple pregnancy

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COMPLICATION OF HT IN PREGNANCY

• Abruptio placenta
• Preterm, IUGR
• Maternal or fetal death
• Neurological damage from convulsion
• - Cerebral hemorrhage
• DIC

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MANAGEMENT

• Oxygenation
• Anticonvulsants, MgSO4
• Left lateral position
• Antihypertensive hydrazine 5 -10 mg IV.

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THANK YOU
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