iv hydralazine

Iv hydralazine

Indication:

1.       When bp > 160/110 mmhg or

2.       Mean arterial pressure > 125 mmhg

For rapid control

1.       Iv hydralazine 5mg bolus over 15-20 mins and repeat every 15-20 mins to a maximum cumulative dosage of 20mg.

Maintenance dose using infusion pump

1.       Dilute 50 mg hydralazine in 50cc normal saline <1ml/ml>

2.       Start at 5ml/h infusion of hydralazine

3.       Increase every 15-20 mins by 1ml/h until maximum dose od 10ml/h

4.       Aim to reduce dbp to 90-100

Maintenance dose using infusion drip set

1.       Dilute 50mg hydralazine in 500cc normal saline <0.1mg/ml>

2.       Start at 5dpm of hydralazine <0.025mg/ml>

3.       Increase every 15-20 mins by 5dpm until max dose of 30dpm

4.       Aim to reduce dbp to 90-100 mmhg

5.       Stop infusion if dbp <80mmhg.

Contraindications

1.       Severe tachycardia

2.       Dissecting aortic aneurysm

3.       Heart failure with high cardiac output.

4.       Cor pulmonale

5.       Myocardial insufficiency due to mechanical obstruction

6.       Coronary artery disease

7.       Idiopathic SLE

8.       Patient with recent MI

tas in obstetrics

PPH AFTER CAESER

high bp in pregnancy

case 1
a. bp noted 200/110 x2
plan:
1. give t. nifedipine 10mg stat
2. repeat bp 15 mins after give t. nifedipine

if in case to give hydalazine, can give iv hydralazine 5mg bolus , kiv hydralazine infusion.

case preterm labour

case preterm

23/g1p0 at 28w +2 pog

efw- 1-1.2kg
liquor not demonstrable
ctg reactive
os 3cm

antenatal:
1. cholestatic jaundice with hep b/c screening negative
2. fetal anomaly
3. anemia
4. coagulopathy

plan
1. allow labour if progress
2. for MO paeds to standby during delivery
3. update ventilator

cord prolapse

What is umbilical cord prolapse?

 In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby’s body during delivery. 

What causes an umbilical cord prolapse?

The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:

• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual

What are the consequences of umbilical cord prolapse?

An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.

How is an umbilical cord prolapse detected?

 If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute). The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.

How is an umbilical cord prolapse managed?

 If the doctor finds a prolapsed cord, he or she can move the fetus away from the cord in order to reduce the risk of oxygen loss.

In some cases, the baby will have to be delivered immediately by cesarean section. If the problem with the prolapsed cord can be solved immediately, there may be no permanent injury. However, the longer the delay, the greater the chance of problems (such as brain damage or death) for the baby.

Some practitioners will attempt to reduce pressure on the cord and deliver vaginally right away. Frequently the attempt to resolve the prolapsed cord and deliver the baby vaginally fails, and an emergency caesarean sectionmust be performed immediately.^[3]

 While the patient is being prepared for a caesarean, the woman is placed in the Trendelenburg position or the knee-elbow position,^[4] and an attendant reaches into the vagina and pushes the presenting part out of the pelvic inlet and back into the pelvis to remove the pressure from the umbilical cord.^[5] If attempts to deliver the baby promptly fail, the fetus' oxygen and blood supply are occluded and brain damage or death will occur.

AMNIOTOMY

AMNIOTOMY (Artificial Rupture of Membranes)

 Amniotomy appears to release a local secretion of endogenous prostaglandins.

1. how to do?
need amniotic hook.


Amniotomy, using a
Hollister Amnihook or
other device, may be used
to rupture the membranes
overlying the presenting
part. Care must be taken
not to damage the fetal
tissues. The operation may
be done blindly by passing
the instrument along the
fingers or by direct vision
using a speculum.

2. precaution? what to noted?

The colour and
quantity of the liquor removed should be noted. Prolapse of the umbilical cord should be
excluded at the beginning and end of the procedure.

3.complication


Placental separation (Abruption)
This may be caused by the sudden reduction in the volume of liquor where there has been
polyhydramnios.


Prolapse of the cord
This will only happen with an ill-fitting presenting part. Cord prolapse, occult or frank,
should give warning signs on the Fetal Heart Rate monitor.


Pulmonary embolism of amniotic fluid
This rare condition presents as severe shock of rapid onset, with intense dyspnoea and often
bleeding. It is associated with amniotomy and strong uterine contractions, and must be
distinguished from eclampsia, abruption, ruptured uterus, and acid aspiration. Treatment
must include positive pressure ventilation, and correction of the inevitable coagulation
defect. Post mortem examination of the maternal lungs will show fetal cells and lanugo.