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
Friday 28 December 2012
Monday 19 November 2012
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.
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.
Friday 16 November 2012
episiotomy reapir
usually we use :
1. safil 2/0
-absorbable
2. cat gut 2/0
-non synthetic
-had allergic reaction
-can cause adhesion
Catgut is a type of cord[1] that is prepared from the natural fibre found in the walls of animal intestines.[2] Usually sheep or goat intestines are used, but it is occasionally made from the intestines of cattle,[3] hogs, horses, mules, or donkeys.
3.vicryl
- same as safil
-is a polysorb
-Vicryl (polyglactin 910) is an absorbable, synthetic, braided suture
It is indicated for soft tissue approximation and ligation. The suture holds its tensile strength for approximately three to four weeks in tissue, and is completely absorbed by hydrolysis within 60 days. Vicryl and other polyglycolic acid sutures may also be treated for more rapid breakdown in rapidly healing tissues such as mucous membrane, or impregnated with triclosan to provide antimicrobial protection of the suture line.
1. safil 2/0
-absorbable
2. cat gut 2/0
-non synthetic
-had allergic reaction
-can cause adhesion
Catgut is a type of cord[1] that is prepared from the natural fibre found in the walls of animal intestines.[2] Usually sheep or goat intestines are used, but it is occasionally made from the intestines of cattle,[3] hogs, horses, mules, or donkeys.
3.vicryl
- same as safil
-is a polysorb
-Vicryl (polyglactin 910) is an absorbable, synthetic, braided suture
It is indicated for soft tissue approximation and ligation. The suture holds its tensile strength for approximately three to four weeks in tissue, and is completely absorbed by hydrolysis within 60 days. Vicryl and other polyglycolic acid sutures may also be treated for more rapid breakdown in rapidly healing tissues such as mucous membrane, or impregnated with triclosan to provide antimicrobial protection of the suture line.
Thursday 15 November 2012
case chorioamnionitis
g2p1 at preterm....
came with fever, leaking, fm good, no show, no abdominal pain
examination-
1. vital signs- 38.5 (high grade fever, )/PR= tachy
2. PA=ut term size, HPA= 5/5
3. SE= os closed, pooling,
3.VE= os closed
impression: PPROM with chorioamnionitis
mx:
1. take hvs during speculum
2. insert iv line green
2. TAS to see fetal condition
3. call MO- consult specialist
4. definitive tx- c-sec regardless of what th gestational age of the baby
came with fever, leaking, fm good, no show, no abdominal pain
examination-
1. vital signs- 38.5 (high grade fever, )/PR= tachy
2. PA=ut term size, HPA= 5/5
3. SE= os closed, pooling,
3.VE= os closed
impression: PPROM with chorioamnionitis
mx:
1. take hvs during speculum
2. insert iv line green
2. TAS to see fetal condition
3. call MO- consult specialist
4. definitive tx- c-sec regardless of what th gestational age of the baby
Thursday 8 November 2012
can give syntometrine in PIH?
Drug interactions
Prostaglandins increase the effect of oxytocin and vice-versa. The contractions should be carefully monitored if oxytocin is given after a prostaglandin dose.
Syntometrine may enhance the blood pressure raising effect of vasoconstrictors (medicines given to constrict the blood vessels).
Some inhaled anaesthetics used for general anaesthesia, such as cyclopropane and halothane, may reduce the effect of oxytocin and ergometrine. There may also be an increased risk of a drop in blood pressure and abnormal heart beats if oxytocin is given with these general anaesthetics.
Oxytocin/ergometrine (trade name Syntometrine) is an obstetric combination drug. The components are synthetically produced oxytocin, a human hormone produced in the hypothalamus, and ergometrine, an alpha-adrenergic, dopaminergic and serotonin (5-HT2) receptor agonist.
Both substances cause the uterus to contract. An injection of syntometrine is given in the third stage of labor, just after the birth of the child, to facilitate delivery of the placenta[1] and to prevent postpartum hemorrhage[1] by causing smooth muscle tissue in the blood vessel walls to narrow, thereby reducing blood flow.
Contraindications
Syntometrine should not be used in:
- Allergy to one or any of its ingredients.[1]
- First stage of labor[1]
- Second stage of labor before crowning of the baby's head[1]
- Uterine atony during labor[1]
- Severe kidney disorders[1]
- Severe liver disorders[1]
- Severe heart disorders[1]
- Vascular diseases[1]
- Severe hypertension[1]
- Pre-eclampsia or eclampsia[1]
- Sepsis[1]
It should be used with caution in:
- Decreased kidney function[1]
- Decreased liver function[1]
- Mild heart disease[1]
- Mild hypertension)[1]
- Porphyria[1]
Side effects
Possible side effects include:
- Nausea and vomiting[1][2]
- Abdominal pain,[1] feeling different than labor pains[2]
- Headache[1][2]
- Dizziness[1][2]
- Skin rashes[1], itching or hives[2]
- Swelling of face, lips, tongue or other body parts[2]
- Hypertension[1]
- Arrhythmias (abnormal heart beats)[1][2]
- Chest pain[1][2]
- Fall in blood pressure (causing dizziness and lightheadedness)[1]
- Difficulty in breathing[1][2]
- Circulatory shock[1]
Wednesday 7 November 2012
obstructed labour
Defining obstructed labour
1. Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier (obstruction) preventing its descent despite strong uterine contractions.
2. The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis.
3. When labour is prolonged because of failure to progress, there is a high risk that the descent of the fetus will become obstructed.
Box 9.1 When is labour classed as prolonged in the different stages of labour?
- Prolonged latent phase of labour: when true labour lasts for more than about 8 hours without entering into the active first stage.
- Prolonged active phase of labour: when true labour takes more than about 12 hours without entering into the second stage.
- Prolonged second stage of labour:
- Multigravida mother: when it lasts for more than 1 hour.
- Primigravida mother: when it lasts for more than 2 hours.
Saturday 3 November 2012
Sunday 21 October 2012
Saturday 7 July 2012
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