Presentation on theme: "Obstetrical Emergency Natalie Collins, BSN. Objectives Quick review of normal changes Maternal Abnormalities Risks to the baby Hemorrhage Treatment Resuscitation."— Presentation transcript:
Obstetrical Emergency Natalie Collins, BSN
Objectives Quick review of normal changes Maternal Abnormalities Risks to the baby Hemorrhage Treatment Resuscitation Guidelines
Acknowledgements Thank you to MOANA for their continuous support of the students Thank you to Webster University, the administration, my professors and classmates. For Hire: Webster University Class of 2013
Normal Anatomical and Physiological Changes Hematologic –Dilutional Anemia –Increased Blood Volume –Hypercoaguable state –Decline in serum cholinesterase activity Cardiovascular –Increased Cardiac Output –Supine Hypotension Syndrome –EKG Changes
When is the decision made for an emergency C-section? Collaborative effort Differences in opinion of appropriate Decision to Delivery Interval (DDI) Increased risk of hemorrhage
The Royal College of Obstetricians and Gynecologists. Classification of Urgency of Casearean Risk Good Practice (11).
What has to be done between decision to deliver and delivery Informed consent: Consent form signed Intravenous access Blood samples to be taken Blood forms to be filled in Bloods to laboratory Intravenous fluids running Premedication to be got from drug cupboard Premedication drawn up Premedication injected Anaesthetist informed Operating department assistant informed Consultant to be informed Anaesthetist to arrive Operating department assistant to arrive Intravenous lines to be secured Fetal scalp clip to be removed Theatre to be set: Scrub nurse to scrub Packs to be opened Sutures to be opened Woman to be moved to theatre: Woman to be moved on to theatre table Spinal: Spinal drugs to be drawn up Monitoring to be attached Spinal anaesthesia Wait for block to work: Paediatrician to be present Catheter Shave Surgeons to scrub Skin preparation Skin incision Peritoneum opened Uterine incision
Indications for General Anesthesia Fetal distress without epidural in place Acute maternal hypovolemia Coagulopathy Inadequate regional anesthesia Maternal refusal of regional anesthesia
General Anesthesia 15% of all C-sections Aspiration risk Attach monitors, place parturient in left uterine displacement, preoxygenate, wait until surgeon is ready to cut. Difficult airway preparation RSI
General Anesthesia Agents Propofol 2.5mg/kg Succinylcholine 1-1.5mg/kg Inhalational Maintenance After delivery medications Extubate Awake!
Frequency of Postpartum Hemorrhage in Maternal Mortality 10.5% of all live births are associated with obstetrical hemorrhage. Primary and Secondary hemorrhage 7 year study AMTSL
Fluid resuscitation Susceptibility of massive blood loss When to transfuse What about crystalloids? Hemorrhagic changes in coagulopathy Cations Cell Salvage
Blood Components ComponentMin Amount Administe red VolumeEstimated EffectsIndications Packed RBC1 units ml per unit Each raises 1gm/dl Hg concentration Correct anemia Fresh Frozen Plasma 1 unit in 1 bag 200ml per bag 10-15ml/kgCorrect PT, aPTT Platelets4-6 units of whole blood platelets in 1 bag ml per bag Each unit increases ,000/ul platelet concentration increases 30, ,000 Correct thrombocytopenia from transfusions or dilutional effects Crypoprecipitate10 pooled units ml/10 pool units Each 10 pooled units increases fibrinogen by mg/dl Correct hypofibrinogenmia
Conclusions Identify risks for hemorrhage Be prepared for general anesthesia in all situations Intervene early to reduce complications Effective communications with team members and obstetrician during all emergencies.
Thank you! QUESTIONS??
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