OBSTERIC EMERGENCIES

OBSTERIC EMERGENCIESPHASE 4 LECTUREDR HAKIM GHARIB BILALUNIKL RCMP

Cord prolapse Definition, predisposing factors, fetal complications, management including prevention.Shoulder dystocia Definition, incidence, associated factors, complications to mother and fetus, management including preventionUterine inversions Types, causes, symptoms & sign of uterine inversion, complications to mother, management (manual reduction, hydrostatic and surgical method) and prevention.Diagnosis and management of cord prolapse, shoulder dystocia and uterine inversion

LEARNING OBJECTIVESAim: To guide students to understand obstetrics emergencies (e.g. cord prolapsed, shoulder dystocia & uterine inversion) Objectives:To discuss and recognize obstetric emergencies (cord prolapsed, shoulder dystocia & uterine inversion)To manage cases accordingly and know the complications

SHOULDER DYSTOCIAIt is defined as the need for additional obstetric maneuvers to release the shoulders after gentle downward traction has failed (RCOG)

Risk factorsMaternal: GDM, Short stature, Previous shoulder dystocia, ObesityFetal : Macrosomia, post maturityIntrapartum: Prolong labour, intrumental delivery

PathophysiologySize discrepancy between fetal shoulders and maternal pelvic inletMacrosomiaLarge chest:BPDAbsence of truncal rotationFetal shoulders remain A-P or descent simultaneously

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Risk FactorsAntepartumMacrosomia (>4500g)DM/GDM (increases overall risk by 70%)MultiparityIntrapartumProlonged deceleration phase of laborProlonged 2nd stageProtracted descentOperative delivery (vacuum>forceps)

Risk factors contNo evidence based data:MaleAMAShort maternal statureAbnormal pelvic shape/size

Unpredictable25-50% have no defined risk factor!50% of cases occur in infants whose birth weight is