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Emergency Obstetrical Skills
With complements to and permission of the American Academy of Family Physicians and the developers of
Advanced Life Support in Obstetrics- ALSO -
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Normal Delivery
What is the birth attendant’s responsibility in a normal,
uncomplicated vaginal delivery?
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Normal Delivery• Assure a clean, warm, well-lit setting• Monitor progress of labor and potential complications• Provide sterile, safe cutting of the cord• Prepare for newborn care• And don’t let the baby fall on the floor!
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Two Powerful Interventions To Improve Reproductive Health
Major modes of decreasing maternal morbidity and mortality continue to be:
• Reduce family size
• Provide quality obstetric care at time of delivery
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Provide Quality Obstetric CareBeyond contraception/family planning, the best opportunity to improve maternal outcomes lies in quality obstetrical care.
What are the most essential elements of quality obstetrical care?
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Provide Quality Obstetric CareWHO recommends essential obstetrical care include:
• Monitored labor• Labor-induction & augmentation capability• Recognition of common complications• Treatment for shock, hemorrhage, sepsis, anemia, and HTN• Manual procedures for breech, shoulder dystocia, twins, & vacuum extraction• Anesthesia and surgical delivery capability• Resuscitation for neonates
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Intervention To Improve Maternal Outcomes
Research shows that even
providing some of these elements
can result in major improvements in birth outcomes.
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Question
What are the leading causes of maternal death?
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What Are The Potential Causes Of Post-Partum Hemorrhage?
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Potential Causes Of Post-Partum Hemorrhage
• Tone: Uterine atony (70%)• Trauma: Laceration of cervix, vagina, perineum; uterine inversion (20%)• Tissue: Retained placenta (10%)• Thrombin: Coagulopathy (uncommon)
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What Are The Steps To Evaluate Post-Partum Hemorrhage?
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Steps To EvaluatePost-Partum Hemorrhage
• Palpation of uterus: boggy or firm?
• Inspection of the vagina, cervix and perineum for lacerations, and for uterine inversion
• Sweep of the uterine cavity for retained tissue
• Evaluation for blood clotting
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What Is The Single Most Essential Emergency
Treatment For Uterine Atony?
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Question
What medications are useful to treat uterine atony?
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Medications for Uterine Atony
• Oxytocin 10 U IV or IM (routine)
• Cytotec (misoprostal) 800 mcg rectally
• Methergine (methylergonovine) 0.2 mg IM (caution in HTN, seizures)
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Question
In order, the steps to control post partum hemorrhage are:
A. Repair laceration, check for uterine inversion, check and give medication for uterine tone, explore the uterus for retained placentaB. Check and give medicine for uterine tone, check for uterine inversion, repair laceration, explore the uterus for retained placentaC. Check for uterine tone and treat, inspect for laceration and uterine inversion, explore for retained placenta, repair lacerationD. Explore the uterus for retained placenta and inversion, repair laceration, check for and treat atony.
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Answer
In order, the steps to control post partum hemorrhage are:
A. Repair laceration, check for uterine inversion, check and give medication for uterine tone, explore the uterus for retained placentaB. Check and give medicine for uterine tone, check for uterine inversion, repair laceration, explore the uterus for retained placentaC. Check for uterine tone and treat, inspect for laceration and uterine inversion, explore for retained placenta, repair lacerationD. Explore the uterus for retained placenta and inversion, repair laceration, check for and treat atony.
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What Are the Risk Factors for Shoulder
Dystocia?
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What Are The Potential Complications Of
Shoulder Dystocia?
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What Are The Signs That Shoulder Dystocia Has
Occurred?
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What Is The Management Of
Shoulder Dystocia?
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What Are The Maneuvers Of Last
Resort?
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Malpresentations
Occiput Posterior Presentation
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What Is the Management of Occiput Posterior
Presentation?
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Manual Rotation of OP• Flex fetal head
• Attempt rotation during contraction, with maternal pushing
• Gently rotate shortest distance (clockwise or counterclockwise) to achieve occiput anterior position
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Malpresentations
Breech Presentation
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26A
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What Is the Management of Breech Presentation?
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BONUS
• This obese 92-yr-old woman has chronic abdominal fullness (40+ years!) after an MVA
• What is your diagnosis?
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