High Risk Pregnancy and Labour Final 1218615420038327 9

8/3/2019 High Risk Pregnancy and Labour Final 1218615420038327 9

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High Risk Pregnancy And Labour

y Dr. Jasmine Mehta

y FTG,Cl-1

y G.K.G.H.,Bhuj



High risk pregnancy and Laboury Pregnancy and labour is physiological

y Yet, high risk pregnancy may end into pathological

status.leading toy Maternal and Neonatal mortality

y Goal of FOGSI-BETI BACHAO,BETI P ADHAO

y Goal of RCH- Safe motherhood



Statisticsy W orld wide-

y 6 lakh maternal death

per yeary Every min one mother

dies

y 99% in developing

countriesy 80% r preventable

y India-

y MMR is 480 per `1 lakh

live child birthy Maternal morbidity is 16

times that of mortality



Causes of maternal Mortality

Direct cause-

75%

Hemorrhage 25%

Sepsis 15%

Unsafe abortion 13%

Eclampsia 12%

Obstructedlabour

5%

Indirect-25% Anemia 20%

Cardiac

disease,



Maternal mortality in our Hospital

y Total deliveries in last year-1451

y Total maternal

mortality-11

y MMR-750 per one lakhLCB

Cause No

PPH 6

Eclampsia 3

APH 1

Anemia 1



Abortion

Ectopic pregnancy 0.66%

Vesicular mole 0,25%Multiple pregnancy 1.25%

PET 10%

Placenta pravia 0.5 -1%

Abruptio placenta 0.5-1%

Anemia

Cardiac disease- MC is MS(80%) 1%

Diabetes

Jaundice 0.04

HIV <0.5%

Rh negative mother 5-10%



High risk LABOURy Preterm labour-5-10%

y Post term labour 10%

yPrevious LSCS 10-12%

y CPD 20%

y Malposition MC-Breech

y Prolonged labour 2-4%

y Obstructed labour 1-2%s

y Shoulder dystocia

y PPH-1%

y Retained placentay inversion of uterus

y Rupture uterus

y Perineal tear



High risk pregnancy and Labour



ABORTIONy Threatened

y Complete bed rest

y Inj. calmpose im staty Inj. RL/DNS

y Analgesics

y Progesterone support

y Inevitable/Incompleteabortion

y

Replace blood loss withiv fluids and BT

y Antibiotics

y <12wks:e&c,

Misoprost 4tabInj. Prostodin

>12wks:Inj pitocin



Ectopic Pregnancy

y Diagnose the iceberg by

11/2 to 2mth of amenorrhea

Mild bleeding p/v severe abd pain and

tenderness

UPT+ve

Severe pallor/shockManagement:o2inhalatiion,iv

fluids,antibiotics,and BT



APH



Pregnancy Induced Hypertentiony Diagnosis

y High risk consent

y

Antihypertensive medicationy Iv line

y Sedation

y No inj methargin after delivery

yInj. calmpose +Inj. lasix after delivery

y Bed side clotting test,<7min.



Warning Signs Of Eclampsiay Headache

y Blurring of vision

y Vomitingy Oliguria

y Rt sided abd pain



Eclampsiay Gc poor sign

y O2inhalation and suction

y Inj. Mgso4:4gm iv diluted over 5min

5gm imRt buttock

5gm imlt buttock

2gm iv diluted if conv.againMonitor:u/o>100ml in 4hrs,knee jerk+,Resp.

rate >16/min.



Eclampsiay Antihypertensive

y Foleys catheterization &strict u/o chart

y No inj methargin after del.y Inj. lasix after del.

y W /F shock after del.



Anemiay Mild to moderate in early preg.

y Treat with oral iron therapy

y Severe anaemia at term/labour

inj BT

dont overload with iv fluids

strict asepsis and antibiotic cover

inj metergin im

del. In squatting position

inj prostodin/T.misoprost after del.

strict w/f PPH



Cardiac Diseasey Pregnancy

regular Digitalis and suppt. Med.

correct anaemia &any inf. vigilance for ccf

Adequate rest/hospitalization

LabourInj. abs coverage for 5 days,bed rest,

lt lat.post.



Cardiac Diseasey Avoid overloading of iv fluids <75ml/hr

y O2 inhalation sos 5-6lit/min

y Strictly monitor pulse & spo2,p>110

y Vaccum del./forcep del

y No inj methergin after del.give T.misoprost

y Inj. lasix after dely Strictly w/f PPH,CCF



Cardiac Disease

y Squating or head up position is favourable incardiac patients



Diabetesy Inj. plain insulin infusion slowly y u/s every 2 hourly y

Antibiotic coverage &strict asepsisy Strict FHS monitoringy w/f hypoglycemiay Vigilance for shoulder dystocia,pphy P

ostpartum antibiotics & feedingy Look for 3cord vessely Pediatric opinion.



Rh Negetive Mothery Regular anc care and USG

y Clamp cord early

y Avoid manual removal of placentay No inj methargin

y Baby BgRh and paed opinion

y Inj. Anti-D in 72 hrs if baby BgRh is+ve



Jaundice in Pregnancyy Rule out DIC

y Strict FHS monitoring

y Universal precaution during del.y No inj methargin

y Inj. vit K prior to del.

y Hepatitis B vaccine and Ig to baby

y Other STD



PPHy Atonic: severe bleeding, uterus atonic

y Traumatic: fresh bleeding, uterus contracted

y DIC: bleeding from all sites, 5ml bed side bloodclotting test positive



Atonic PPHy Call for helpy 2 iv line wide bore/BT/iv inf.y

Bimenual massagey Inj. methargin iv,repeat every 15 min ,max3y Inj. pitocin 30units at rate of 30drops/min,max 3

pintsy Inj. prostodin im,repeat after 15min.,max5,

never iv.T.misoprost 5tab P/R.



Atonic PPH



Retained placenta

y Inj.. pitocin 30 unit in one pint

y Inj.. Prostodin IM stat

y Tab. Misoprost 3 tab P/R

y Inj.. Pitocin 1 amp in cord vein

y Manual removal of placenta



Obstructed labor

y Do not miss prolonged labor - moulding and caput,bandles ring hot vagina

y Do foleys catheter

y IV anti biotics

y Keep one BT ready



Previous LSCS

yW atch for scar tenderness

y

Signs of imminent scar rupture: scar tenderness,tachycardia, fetal distress, blood in urine

y Do stop bearing down inj tidilan inj BT



Shoulder dystocia

y Do not be panicky

y Do not give tractionhead

y Do not apply fundalpressure

y Do give supra pubic

pressure withabduction of thighs



Shoulder dystocia

y Rotate posterior arm toanterior position

y Extraction of posterior

arm

y All procedures shouldnot take more than fiveminutes



Inversion of uterus

y Do not employ any method to expelplacenta while uterus is

relaxedy Do not pull cord while

uterus is relaxed.

y Ask pt to not to cough,

sneeze or bear down while uterus is relaxed



Inversion of uterusy Management

y Inj.. atropine

y Iv fluidsy Sedatives

y Reposition of uterus

y Uterine packing

High Risk Pregnancy and Labour Final 1218615420038327 9

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