Dr Sue Page
Aboriginal Health
Women's Health
Antenatal Diagnosis of Congenital Abnormality
Emotional aspects of menopause
Endoscopic Surgery in Gynaecology
Obstetric Emergencies - Antepartum
Obstetric Emergencies - Intrapartum
Obstetric Emergenies - Postpartum
Preventable Causes of Congenital Abnormalities
The Principles of Antenatal Care
Table of Contents |
Post-partum haemorrhage
PPH is defined as >500mls in 24hrs after delivery, and the incidence is 2-8%. Risk is increased if multiple pregnancy or excessive liquor, high parity, APH, prior PPH, and coagulopathies (including severe PET). The major causes are:(1) Retained placenta.
(2) Uterine Atony: a flaccid uterus rapidly fills with blood clot, which becomes too large to spontaneously expel. The clot will be primarily in one of the uterine horns and can be expelled by deep and vigorous massage. Resuscitation and an oxytocinon infusion may be needed.
(3) Soft tissue lacerations: acutely, these can be clamped or packed.
(4) Coagulopathies: transfer is usually effected faster than FFP / platelets.
Uterine inversion
This is a profoundly shocking (both by blood loss and
parasympathetic outflow) complication of excessive cord traction, on
a fundally sited placenta, where the uterus is atonic. The inversion
should be reduced (if able to before contractions) even if placenta
still attached, and then maintained with IMI ergometrine followed by
syntocinon infusion.
Resuscitation may be required, including pain relief. If the
inversion cannot be reversed, one method is to hold the body of the
uterus in the vagina while rapidly infusing into it two litres of
warm saline with a urology irrigation set. While effective, unless
performed by experienced staff, expeditious transfer is faster.
Amniotic fluid embolism
While rare, when this occurs mortality is ~80%, so that this is a
significant cause of all maternal deaths. Usually it follows rapid
labours with hypertonic uterine activity, or pregnancies complicated
by excessive liquor. It is also reported following stimulation of the
fundus prior to full separation of the placenta. It should be
considered in any woman who collapses during or immediately after
labour for no apparent reason.
Expect profound shock, cyanosis, dyspnoea, and DIC, and resuscitate
aggressively, including intubation if necessary. Collect blood for
coags and fetal squames, then give IV heparin 10,000U and
hydrocortisone 1g while awaiting transfer.
cf:Amniotic Fluid Embolism
Sue
Page,cmitchel@om.com.au
General Practioner
Lennox Head
NSW
Australia 2477
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