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Handbook of Obstetric Emergencies
Kamini A Rao
CHAPTER 1:
Differential Diagnosis
PAIN ABDOMEN—EARLY PREGNANCY
Probable Diagnosis
Distinguishing Features
Cystitis
Acute Pyelonephritis
Ovarian Cyst
Appendicitis
PAIN ABDOMEN—LATE PREGNANCY
Probable Diagnosis
PAIN ABDOMEN—POSTPARTUM
Probable Diagnosis
Distinguishing Features
Metritis
Pelvic Abscess
FEVER DURING PREGNANCY
Probable Diagnosis
Distinguishing Features
Septic Abortion
Pneumonia
Malaria
Typhoid
Hepatitis
FEVER—POSTPARTUM
Probable Diagnosis
Distinguishing Features
Breast
Wound Infection
CHAPTER 2:
Abortion
CLINICAL PRESENTATION
Clinical Features (Table 2.1)
Septic Abortion
MANAGEMENT
Threatened Abortion
Inevitable/Incomplete Abortion
Complete Abortion
Missed Abortion
Septic Abortion
General Measures
Specific Measures
Postabortal Care
Evacuation of the Uterus
Preliminaries
Procedure
Uterine Perforation during Curettage
Management at Primary Health Centers
Inevitable Abortion/Incomplete Abortion
Septic Abortion
CHAPTER 3:
Vomiting in Pregnancy
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
Mild
Severe
Management at a Primary Health Center (PHC)
CHAPTER 4:
Ectopic Pregnancy
CLINICAL PRESENTATION
Acute Presentation
Chronic Presentation
DIAGNOSIS
MANAGEMENT
Ruptured Ectopic
Laparotomy
Unruptured Ectopic
Procedures (Figure 4.1)
CHAPTER 5:
Retroverted Gravid Uterus
CLINICAL PRESENTATION
MANAGEMENT
CHAPTER 6:
Hypertension in Pregnancy
CLINICAL PRESENTATION
Proteinuria
Pathological Edema
Mild PE
Severe PE
Laboratory Findings
Eclampsia
MANAGEMENT
PIH
Mild Pre-eclampsia
Severe Pre-eclampsia and Eclampsia
Severe Pre-eclampsia and Eclampsia are Managed Similarly
Management of a Convulsion
General Measures
ANTICONVULSANT THERAPY
Medications
Magnesium Sulfate
DIAZEPAM
ANTIHYPERTENSIVE THERAPY
Parenteral Therapy
Hydralazine
Labetolol
Oral Therapy
Nifedipine
Methyldopa
Labetolol
Hydralazine
Diuretics are Contraindicated
Pregnancy Termination
Eclampsia and Severe Pre-eclampsia with Symptoms
Asymptomatic Severe Pre-eclampsia
Pregnancy Less than 37 Weeks
Management of Labor
Postpartum
Management at a Primary Health Center
CHAPTER 7:
Anemia in Pregnancy
CLINICAL PRESENTATION
Asymptomatic
DIAGNOSIS
MANAGEMENT
Severe Anemia
Iron Deficiency Anemia
Megaloblastic Anemia
Thalassemia
CHAPTER 8:
Heart Disease in Pregnancy
CLINICAL PRESENTATION
PRE—PREGNANCY COUNSELING
ANTENATAL MANAGEMENT
INTRAPARTUM MANAGEMENT
First Stage of Labor
Second Stage of Labor
Third Stage of Labor
POSTPARTUM MANAGEMENT
Management at a Primary Heath Center (PHC)
CHAPTER 9:
Deep Vein Thrombosis (DVT)
CLINICAL PRESENTATION
Classical Features
Enigma
Pulmonary Embolism
Major Emboli
Minor Emboli
Puerperal Onset of Pulmonary Embolism
DIAGNOSIS
Impedance Plethysmography
Ultrasound
Venography
MANAGEMENT
General Measures
Anticoagulant Drugs
Heparin
Warfarin
PROPHYLAXIS
History of Previous Thromboembolism
CHAPTER 10:
HIV Infection in Pregnancy
PROGRESS OF THE DISEASE
Window Period
Stage of Seroconversion
Asymptomatic Period
Persistent Generalized Lymphadenopathy
Symptomatic Disease
WHO Criteria for AIDS
Major
Minor
DIAGNOSIS
ELISA (Enzyme Linked Immunosorbent Assay)
Western Blot Test
CD4 Count
HIV Ribonucleic Acid (RNA) Viral Load
MANAGEMENT
Counseling
Antenatal
Drug Therapy
Antiretroviral Therapy
Chemoprophylaxis to Prevent Vertical Transmission
Prophylaxis against Pneumocystis Pneumonia
Labor
Measures
Mode of Delivery
For Women on Therapy
For Women with no Therapy
Active Management of the Third Stage of Labor
Precautions to Minimize the Risk of Transmission to Health Care Personnel
CHAPTER 11:
Trauma in Pregnancy
CLINICAL PRESENTATION
MANAGEMENT
Blunt Abdominal Trauma
Minor
Major
CHAPTER 12:
Preterm Labor
CLINICAL PRESENTATION
MANAGEMENT
Indications for Termination of the Pregnancy
Maternal Conditions
Fetal Problems
Measures to Stall Labor
TOCOLYTIC THERAPY
Beta-sympathomimetic Drugs
Magnesium Sulphate
Side Effects
Indomethacin
Caution
Contraindications
Nifidepine
CORTICOSTEROIDS
DELIVERY OF THE PRETERM INFANT
General
Analgesia and Anesthesia
Delivery
Management at a Primary Health Center (Fig. 12.1)
Patient Transfer
CHAPTER 13:
Prelabor Rupture of the Membranes
DIAGNOSIS
MANAGEMENT
Active Management
Indications
Measures
Expectant Management—Preterm PROM (Fig. 13.1)
Measures
CHAPTER 14:
Antepartum Hemorrhage (APH)
CLINICAL PRESENTATION
SUSPECT
INITIAL MANAGEMENT
Hemorrhagic (Hypovolemic) Shock
Symptoms
Management
ABRUPTIO PLACENTA
CLINICAL PRESENTATION
MANAGEMENT
Fetal Death
Fetus is Alive
Third Stage of Labor
PLACENTA Previa
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT (Fig. 14.2)
Expectant Management - McAfee's Regimen
Role of Tocolysis
Role of Progesterones
VASA PREVIA
Diagnosis
UNCLASSIFIED HEMORRHAGE
Management
Management at the Primary Health Center of a Case of APH
CHAPTER 15:
Twin Delivery
CLINICAL PRESENTATION
MANAGEMENT
Initial Measures
Delivery of the First Twin
Second Baby
Vertex Presentation
Breech Presentation
Transverse Lie
Third Stage
CHAPTER 16:
Breech Delivery
CLINICAL PRESENTATION
MANAGEMENT (Fig. 16.6)
Antepartum
Intrapartum Management
Indications for Cesarean Section
Conduct of Labor
BREECH DELIVERY
General
Delivery of the Buttocks and Legs
Delivery of the Trunk, Shoulders and Arms
Delivery of the Head-Mauriceau-Smellie-Veit Technique (Fig. 16.3)
Maneuvers’ that may be Employed
Loveset's Maneuver (Fig. 16.4)
Baby's Body cannot be Turned
Back Posterior
Entrapped Head
Forceps Delivery (Fulfill Criteria)
Incompletely Dilated Cervix
Footling Breech
Postdelivery Care
Management at the Primary Health Center
CHAPTER 17:
Cord Prolapse
CLINICAL PRESENTATION
MANAGEMENT
Fetus Alive
Fetus is Dead
Management at a Primary Health Center (Fig. 17.1)
CHAPTER 18:
Shoulder Dystocia
CLINICAL PRESENTATION
MANAGEMENT
Preliminaries
Exaggerated Flexion of the Maternal Hips (McRoberts Maneuver)
Firm Suprapubic Pressure
Pressure on the Posterior Shoulder
Rotation of the Fetal Shoulders
Head Traction
Bring Down the Posterior Arm
Woodscrew Maneuver
CHAPTER 19:
Abnormal Progress of Labor
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
Prolonged Latent Phase
Protracted Active Phase
Secondary Arrest of Cervical Dilatation
Failure of Descent
Prolonged Second Stage
Oxytocin Administration
Complications of Oxytocin
CHAPTER 20:
Obstructed Labor
CLINICAL PRESENTATION
Mother
Fetus
MANAGEMENT
General
Specific
CHAPTER 21:
Labor with a Scarred Uterus
CLINICAL PRESENTATION
MANAGEMENT
General
Specific
Trial for Vaginal Delivery
Favorable Factors
Requisites
Assessment
Use of Oxytocin
Postpartum Examination of the Scar
Signs of Impending Uterine Rupture
Signs
Rupture of the Cesarean Scar
Management at a Primary Health Center
CHAPTER 22:
Rupture of the Uterus
CLINICAL PRESENTATION
MANAGEMENT
Management at a Primary Health Center
CHAPTER 23:
Postpartum Hemorrhage
INTRODUCTION
Delayed PPH
MANAGEMENT
Atonic Uterus
Retained Placental Fragments
Tears of Cervix, Vagina or Perineum
Vaginal Tears
Cervical Tears
Perineal Tears
Delayed PPH
Management at a Primary Health Center (Fig. 23.3)
CHAPTER 24:
Retained Placenta
CLINICAL PRESENTATION
MANAGEMENT
CHAPTER 25:
Acute Uterine Inversion
CLINICAL PRESENTATION
MANAGEMENT
Reposition of the Uterus
Hydrostatic Correction
Post Procedure
Referral to a Tertiary Care Center
Management at a Primary Health Center
CHAPTER 26:
Disseminated Intravascular Coagulation (DIC)
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
CHAPTER 27:
Amniotic Fluid Embolism
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
CHAPTER 28:
Intrauterine Fetal Death
DIAGNOSIS
PLAN DELIVERY
LABOR MANAGEMENT
Induction of Labor
CHAPTER 29:
Cesarian Hysterectomy
EMERGENCY CESAREAN HYSTERECTOMY
PREREQUISITES
OPERATIVE PROCEDURE
CHAPTER 30:
Peripartum Cardiomyopathy
CHAPTER 31:
Puerperal Sepsis-septic Shock
CHAPTER 32:
Acute Fatty Liver of Pregnancy (AFLP)
ACUTE FATTY LIVER OF PREGNANCY (AFLP)
SYMPTOMS, SIGNS AND BIOCHEMICAL TESTS
BIOCHEMICAL TESTS
Imaging Modalities
Management
Postpartum Management
CHAPTER 33:
Resuscitation of the New Born
AIRWAY - (ENSURE AN OPEN AIRWAY)
Proper Positioning of the Infant
Suction of the Mouth First followed by the Nose
BREATHING - (INITIATE BREATHING)
CIRCULATION - (MAINTAIN CIRCULATION)
ENDOTRACHEAL INTUBATION
Drugs
CHAPTER 34:
Anaphylaxis
DEFINITION:
SYMPTOMS
Measures to Handle Anaphylaxis
CHAPTER 35:
Transfusion Reaction
MONITORING AFTER STARTING BLOOD TRANSFUSION
CHAPTER 36:
Sickle Cell Crisis
PAINFUL CRISIS (VASO-OCCLUSIVE PAIN CRISES)
ACUTE HEPATIC OR SPLENIC SEQUESTRATION
APLASTIC CRISIS
Management
Acute Chest Syndrome
Management
AVASCULAR NECROSIS OF THE HIP
Management
Differential Diagnosis for Sickle Cell Crises
Surgical Emergencies
Obstetrical Emergencies
CHAPTER 37:
Diabetic Ketoacidosis in Pregnancy
FACTORS INCREASING THE RISK OF DKA IN PREGNANCY
Insulin Antagonistic State
Accelerated Starvation (Relative State)
Effect of Emesis
Lowered Buffering Capacity
PRECIPITATING FACTORS
FACTORS CONTRIBUTING TO INCREASED FETAL LOSS
POSSIBLE MECHANISMS FOR FETAL LOSS
LONG-TERM EFFECTS ON THE FETUS
SYMPTOMS OF DKA
DIAGNOSIS OF DKA
MONITORING OF DKA
FLUID THERAPY IN DKA
INSULIN MANAGEMENT IN DKA
CHAPTER 38:
Asthma Exacerbation in Pregnancy
MANAGEMENT OF EXACERBATIONS OF ASTHMA
Impeding or Actual Respiratory Arrest
CHAPTER 39:
Epilepsy and Pregnancy
PERICONCEPTIONAL/PRECONCEPTION COUNSELING
Antenatal Care (ANC)
SCANS ADVISED
Intrapartum Care
Postnatal Care
Management of Seizure during Pregnancy
CHAPTER 40:
Pregnancy References Values
NUTRITION
Weight Gain
CARDIOVASCULAR
Blood Pressure
PULMONARY FUNCTION
Arterial Blood Gases
Respiratory Function Tests
Unaffected by Normal Pregnancy
HEPATIC FUNCTION
RENAL FUNCTION
CARbOHYDRATE METABOLISM
Glucose Tolerance Test - 100 g (Carpenter and Coustan Criteria)
HEMATOLOGY
ENDOCRINOLOGY
TESTS FOR COAGULATION AND HEMOSTASIS
Suggested Reading
INDEX
TOC
Index
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