Obstetric Emergencies In The I

Obstetric Emergencies In The I

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  OBSTETRIC EMERGENCIES INTHE I.C.U PROF. DR. SAKINA JAFFERY MBBS, MCPS, FCPS CONSULTANT ANAESTHESIOLOGIST & INTENSIVIST.
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  ICU receives obstetricpatients with medical & surgical emergencies as well as specific obstetric complications. Proportion of obstetric patients in most ICUs is low Relative inexperience in management & team-work between intensivist & obstetrician.
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  BASIC PRINCIPLES FOROBSTETRIC EMERGENCIES. Physiological changes in pregnancy modify: Presentation of the problem Normal physiological variables Response to treatment Both mother & fetus are affected by the pathology & subsequent treatment. Mother’s welfare always takes precedence over fetal concerns --- Fetal survival is usually dependant on optimal maternal management.
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  PHYSIOLOGICAL CHANGES INPREGNANCY
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  After 20 weeksaorto-caval compression. Complicated tracheal intubation due to edematous tissues, delayed gastric emptying & increased oxygen consumption. Prophylaxis for thrombo-embolism with low molecular weight heparin & elastic compression stockings
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  CARDIO-PULMONARY ARREST Cardiacarrest rare in pregnancy (1 in 30000 deliveries) Usually associated with particular obstetric complications like amniotic fluid embolism, drug toxicity from Magnesium sulphate & local anesthetics.
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  Technique for externalcardiac massage: External cardiac massage in non-obstetric patient provides 30% cardiac output. After 20 weeks reduced further due to veno-caval compression. Relief of aorto-caval compression part of BLS: left lateral tilt --- decreased efficacy of compressions wedge 27 0 angle allows 80% of maximal force to be dissipated rescuer’s thigh as wedge. Sodium bicarbonate controversial as it leads to fetal acidosis but pH has to be kept above 7.30 to prevent uterine vasoconstriction. International Liaison Committee on Resuscitation (ILCOR) “ if there is no response to ALS, peri-mortem caesarean delivery should be made within 5 minutes of arrest”
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  TRAUMA Occurs in6-7% of all pregnancies. Hospital admissions only 0.3- 0.4 % of all pregnancies. 1% of all trauma cases are pregnant. Maternal deaths associated most commonly with head injuries & severe hemorrhage. Fetal deaths associated with placental abruption & maternal death. Initial resuscitation should follow normal plan of ABC. Hypotension may not be present until 35% or more blood volume is lost.
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  Aorto-caval compression releaseRule out pelvic fractures, uterine injury & retro-peritoneal hemorrhage Fetal monitoring with cardio-tocographic monitor & USG. Rh immunoglobulin – within 72 hours. Radiation hazards: 1 st trimester >5 cGy Chest x-ray < 5 cGy Pelvic film <1 cGy Abdomino-pelvic CT scan 5-10 cGy
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  BURNS Increased levelsof prostaglandins predispose to pre-term labour. Replacement of fluids vis-à-vis increased volumes in pregnancy. Inhalational injury- hypoxia & carbon monoxide poisoning Infections- prophylactic antibiotics controversial Topical Povodine iodine- affects fetal thyroid functions
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