OBSTETRICS EMERGENCIES

1. Post-partum haemorrhage2. Shoulder dystocia3. Cord prolapse4. Eclampsia5. Uterine rupture6. Uterine inversion7. Fetal distress8. APH9. Delivery of the 2nd twin10. Retained placenta

RUPTURE UTERUS INCIDENCE: 1:200

1:5000 deliveries CAUSES: a. Uterine scar 1. Caesarean section

2. Hysterotomy 3. Myomectomy 4. Uteroplasty 5. Previous perforation 6. Cervical scarring 7. Salpingectomy with cornual resection

Cont... Causes

b. Excessive Uterine Action

1. Oxytocic drugs

2. Neglected obstructed labour

Cont.. Causesc. Trauma 1. Internal version and breech extraction 2. Forceps delivery 3. Manual removal of the placenta 4. Fetal destructive operations 5. Shoulder dystocia 6. Fundal pressure 7. Criminal abortion 8. Direct trauma

Cont… Causes

d. Miscellaneous

1. Multiparity

2. Uterine anomalies

3. Placenta increta and percreta

4. Cornual pregnancy

5. Severe concealed abruptio placenta

6. Gestational trophoblastic disease

CORD PROLAPSE INCIDENCE:

1:200

1:500 deliveries

Cord prolapse vs. cord presentation

UTERINE INVERSION

FAST FACTS

1/25,000 deliveries more common multips often iatrogenic

SHOULDER DYSTOCIA

DEFINITION:

Failure of the shoulders to deliver spontaneously with usual methods, secondary to impaction of the anterior shoulder behind the symphysis pubis.

INCIDENCE:

0.5-2.9% of all deliveries RISK FACTORS:

Maternal obesity diabetes, b/o macrosomic infant.

COMPLICATIONS:

Erb’s palsy Fracture clavicle humerus, cervical spine Asphyxia brain damage Fetal death Internal organ damage (liver, spleen)