1. OBSTETRIC EMERGENCY Dr. Miada Mahmoud Rady

2. NOTE: To change the image on this slide, select the picture and delete it. Then click the Pictures icon in the placeholder to insert your own image. COMPLICATION DURING LABOUR

3. Premature rupture of membranes  Definition : opening or rupture of amniotic sac 1 hour before labour.  Fate :  The sac may self-seal and heal itself.  More commonly, labor will begin within 48 hours.  Complication : Infection if not near term.  Management :  Emotional support and rapid transport to hospital

4. Preterm labor  Definition : Labor that begins after the 20th week but before the 37th week.  Complication : premature birth is a threat to the unborn fetus ( breathing problem, low birth weight, and visual disorders).  Signs and symptoms: are the same as regular labor.  Fate : either progress or stop.  Management : transport the hospital for medication, bed rest, and monitoring.

5. Fetal distress  Many conditions may cause fetal distress, including: I. Hypoxia II. Nuchal cord III. Trauma IV. Abruptio placenta V. Fetal developmental abnormalities. VI. Prolapsed cord  Presentation : usually patient complain of decreased fetal movement.  difficult to assess in prehospital setting, main rule is transport.

6. Uterine rupture  Occurs during active labour.  Risk factors : Grand multipara, Scarring of uterus from previous C.S or operation.  Clinical picture :  Sudden tearing pain which may not be so sever.  Cessation of uterine contraction.  Signs of hypovolemic shock.  Fetal distress ( bradycardia and deceleration ) and palpation of fetus outside uterus.

7.  Management : 1.Address ABCS: treatment of shock. 2.Close fetal monitoring 3.Rapid transport to hospital

8. HIGH-RISK PREGNANCY CONSIDERATIONS

9. Precipitous labor and birth  Means the newborn has been delivered prior to paramedic arrival.  Uncommon in primigravida, common in multipara and risk increases with increase in the number of deliveries.  More common in women with previous precipitous labour.  The entire labor time and birth usually occurs in less than 3 hours.  Contractions are usually more intense and more effective.

10.  Fetal adverse affects are usually minor and includes Facial bruising and more than usual misshaped head  Management : a. Address ABCs. b. Mange shock. c. Fetal monitoring. d. Rapid transport.

11. Post-term pregnancy  Definition : The fetus has not been born after 42 weeks.  Risk factors include: a.Previous post term pregnancy. b.Irregular menstrual cycles (increased chance of due date miscalculation).  Complication : a.Malnutrition of the fetus due to impaired function of placenta. b.Meconium aspiration. c.Longer labour and complicated delivery. d. C.S is usually the method of delivery

12. Meconium staining  Definition : abnormal staining of amniotic fluid with meconium at time of delivery.  Meconium : first stool of the baby, Odorless, greenish-black, with a tar-like consistency and sterile.  Pathophysiology : 1.The fetus passively ingests elements while in utero (mucus, amniotic fluid) which become baby's first stool 2.In fetal distress, or from the stress of labor and delivery, meconium may be voided into the amniotic fluid.

13. 3.Know only after rupture of amniotic sac. 4.Color : Yellow tint suggests meconium in the amniotic fluid for some time. Greenish-black color suggests recent meconium passage (sign of danger).

14. 5.Complication : May cause chemical pneumonia in the newborn : Meconium viscosity can partially or completely block the airway  The respiratory tract may be irritated  If respiratory depression is seen with meconium in the airway, perform tracheal suctioning through an endotracheal tube.

15. Fetal macrosomia Definition : known as “big baby syndrome;” refers to a large fetus that weighs more than 4,500 grams. Risk factors include: 1.Gestational diabetes or diabetes that is not properly controlled. 2.Male fetus and some genetic conditions in the fetus. 3.Post term pregnancy. 4.Obesity and excessive weight gain during pregnancy.

16. Treatment should focus on: 1.Supporting the woman and providing rapid transport for possible cesarean section 2.If field delivery:  Encourage breastfeeding.  Check newborn’s blood glucose level because of the increased risk of hypoglycemia.

17. Multiple gestation Delivery of more than one baby. Consider the possibility of multiples if: 1.The first newborn is small. 2.The abdomen is still large after the birth. The second newborn is usually born within 45 minutes, with contractions beginning about 10 minutes after the first birth.

18. Management 1. Always prepare for more than one resuscitation and call for assistance. 2. The procedure is the same as a single birth : a. Clamp and cut the cord of the first newborn as soon as delivery is complete. b. The second newborn may or may not deliver before the placenta. c. Check if there are one or two cords coming out of the placenta when it delivers : If there are two cords in one placenta, the twins are identical. If there is one cord in the placenta, there will be another placenta, and the twins are non identical.

19. 3.Record the time of birth for each newborn.  Multiples may be so small that they look premature.  Identify the first newborn delivered as “Baby A,” loosely tying an extra length of tape around a foot.

20. Thank you