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Severe Acute Maternal Morbidity Arulmozhi Ramarajan

PART I: ISSUES IN THE MANAGEMENT OF NEAR MISS IN OBSTETRICS
CHAPTER 1:AN INTRODUCTION TO NEAR MISS IN OBSTETRICS
- DEFINITIONS
  - There Are Various Definitions of Near Miss, All of Which Express The Same Thing
- METHODS OF IDENTIFYING SEVERE MATERNAL MORBIDITY
  - There Are Essentially Three Methods of Identifying Severe Maternal Morbidity
- CLINICAL CRITERIA RELATED TO A SPECIFIC DISEASE ENTITY
- MORTALITY INDEX
  - Maternal Deaths—Beyond the Numbers
CHAPTER 2:ESSENTIAL OBSTETRIC CARE
- ESSENTIAL OBSTETRIC CARE
CHAPTER 3:SOCIOCULTURAL AND ECONOMIC ISSUES IN SAMM*
- INTRODUCTION
- CASE SCENARIO
  - This Happened in a City Hospital
- ISSUES THAT BEG TO BE ADDRESSED
- INFLUENCE OF SOCIOCULTURAL MATTERS ON MATERNAL HEALTH
  - Delay in Deciding to Seek Care (Phase 1 Delay)
- CASE SCENARIO
  - Delay in Identifying and Reaching a Health Facility (Phase 2 Delay)
    - Lack of Transportation
  - Delay in Receiving Adequate and Appropriate Care (Phase 3 Delay)
- STEPS TOWARDS SAFER MOTHERHOOD
- CONCLUSION
CHAPTER 4:CRITICAL CARE IN OBSTETRICS
- INTRODUCTION
- IDENTIFY THE PATIENT REQUIRING CRITICAL CARE
- PRINCIPLES OF MANAGEMENT
- CONCLUSION
CHAPTER 5:THE OBSTETRIC HIGH-DEPENDENCY UNIT (HDU)
- LEVELS OF CARE AND THE CONCEPT OF HIGH-DEPENDENCY UNIT
- message
CHAPTER 6:AUDIT IN OBSTETRIC NEAR-MISS SITUATIONS
- WHAT IS AUDIT?
- WHAT IS CLINICAL AUDIT?
- CLINICAL AUDIT IN OBSTETRIC NEAR-MISS SITUATIONS
- WHO SHOULD CONDUCT CLINICAL AUDITS?
  - Documentation
  - The Importance of Documentation
CHAPTER 7:COMMUNICATION IN NEAR-MISS SITUATIONS
- COMMUNICATION
  - Communicating Risks
    - Situation 1
  - Communication in an Emergency
    - Situation 2
- Communication—Who and How?
CHAPTER 8:MEDICOLEGAL ISSUES AND LITIGATION IN OBSTETRIC MORBIDITIES
- MEDICOLEGAL ISSUES
  - From the Perspective of the Judicial Authorities
  - The Informed Consent
- LEGAL REDRESS
PART II: OBSTETRIC HEMORRHAGE
CHAPTER 9:Antepartum Hemorrhage
- PLACENTA PREVIA
- ABRUPTIO PLACENTAE
- KEY POINTS IN APH
- Advice
  - Advice to Women Who Have Been Diagnosed to Have Placenta Previa
CHAPTER 10:POSTPARTUM HEMORRHAGE
- PRACTICAL ISSUES IN POSTPARTUM HEMORRHAGE
- PREDISPOSING FACTORS AND CAUSES
- MANAGEMENT OF POSTPARTUM HEMORRHAGE
- PREVENTION OF POSTPARTUM HEMORRHAGE AT VAGINAL DELIVERY
  - Active Management of the Third Stage of Labor (AMTSL)
  - Systematic Review of Effects of AMTSL Components
- PREVENTION OF POSTPARTUM HEMORRHAGE AT CESAREAN DELIVERY
  - Measures That Can Help
- MANAGEMENT OF POSTPARTUM HEMORRHAGE AT VAGINAL DELIVERY
- MANAGEMENT OF POSTPARTUM HEMORRHAGE AT CESAREAN DELIVERY
  - Newer Developments in the Management of Postpartum Hemorrhage
  - PPH: KEY RECOMMENDATIONS
- FURTHER MEASURES TO PREVENT POSTPARTUM HEMORRHAGE
CHAPTER 11:CASE SCENARIOS IN POSTPARTUM HEMORRHAGE (PPH)
- CASE 1. ATONIC POSTPARTUM HEMORRHAGE FOLLOWING NORMAL DELIVERY
  - Message
- CASE 2. TRAUMATIC POSTPARTUM HEMORRHAGE FROM AN EPISIOTOMY
  - Message
- CASE 3. PPH FOLLOWING REPEAT LSCS: INFERIOR EPIGASTRIC VESSEL RUPTURE
  - Message
- CASE 4. POSTPARTUM HEMORRHAGE IN PLACENTA PREVIA—OBSTETRIC HYSTERECTOMY
  - Message
- CASE 5. ATONIC POSTPARTUM HEMORRHAGE IN TWIN GESTATION: CONDOM TAMPONADE
  - Message
- CASE 6. PLACENTA PREVIA—POSTPARTUM HEMORRHAGE ON TABLE
  - Message
- CASE 7. A CASE OF DISSEMINATED INTRAVASCULAR COAGULATION
  - Message
- CASE 8. MASSIVE HEMORRHAGE DURING LOWER SEGMENT CESAREAN SECTION
  - Message
CHAPTER 12:SERIOUS HAZARDS OF TRANSFUSION (SHOT)
- INTRODUCTION
- INCORRECT BLOOD COMPONENT TRANSFUSION
- ACUTE TRANSFUSION REACTIONS
  - Clinical Features of Adverse Transfusion Reaction
- DELAYED TRANSFUSION REACTIONS
- POST-TRANSFUSION PURPURA (PTP)
- TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)
- POST-TRANSFUSION GVHD
- CONCLUSION
PART III: HYPERTENSION AND ECLAMPSIA
CHAPTER 13:COMPLICATIONS OF SEVERE PRE-ECLAMPSIA
- INTRODUCTION
- SYSTEMIC DERANGEMENTS
- COMPLICATIONS
- PREVENTION OF COMPLICATIONS
- CONCLUSION
CHAPTER 14:CASE SITUATIONS IN PREGNANCY-INDUCED HYPERTENSION (PIH)
- CASE 1. ECLAMPSIA IN ALL ITS FLORIDITY
  - What are The Lessons Learnt?
- CASE 2. MULTIPLE COMPLICATIONS—ECLAMPSIA/HELLP/DIC/OLIGURIA/PRES/PANCREATITIS
  - Could This SAMM be Avoided? Where and How Did The Errors Creep in? What Can be Done?
CHAPTER 15:ECLAMPSIA
- A CASE OF ECLAMPSIA
CHAPTER 16:THE ECLAMPSIA DRILL
- AIMS
- SEVERE PRE-ECLAMPSIA/IMMINENT ECLAMPSIA
- MANAGEMENT OF ECLAMPSIA
- ECLAMPSIA KIT
- FURTHER MANAGEMENT OF ECLAMPSIA
- INVESTIGATIONS
- FLUID MANAGEMENT
- DELIVERY
- SHIFTING TO TERTIARY CARE CENTER
  - Indications
    - Rural Area
    - Urban Area
  - How to Shift?
PART IV: SEPSIS
CHAPTER 17:SEPSIS IN RELATION TO ABORTIONS
- THE PROVIDERS
- THE PROCEDURE
- SEPTIC ABORTION
- ADVANTAGES OF MEDICAL METHOD OF ABORTION18
- STRATEGIES TO REDUCE UNSAFE ABORTIONS
CHAPTER 18:PUERPERAL SEPSIS
- INTRODUCTION
- PUERPERAL SEPSIS
- CONCLUSION
PART V: OBSTRUCTED LABOR
CHAPTER 19:DYSFUNCTIONAL LABOR
- COMMON CAUSES OF DYSFUNCTIONAL LABOR
- USE OF OXYTOCIN
- CASE SITUATIONS OF DYSFUNCTIONAL LABOR
- CASE 1. PROLONGED LABOR, CPD
  - Lessons Learnt
  - What Would Have Helped?
- CASE 2. RUPTURE UTERUS IN TRIAL OF LABOR AFTER CESAREAN (TOLAC)
  - Lessons Learnt
  - What Would Have Helped?
- CASE 3: SHOULDER DYSTOCIA
  - Lessons Learnt
  - What Would Have Helped?
- CASE 4. UNDIAGNOSED BREECH
  - Lessons Learnt
  - What Would Have Helped?
- CASE 5: INSTRUMENTAL DELIVERY
  - Lessons Learnt
  - What Would Have Helped?
- PRACTICE RECOMMENDATIONS
CHAPTER 20:OBSTETRIC DRILLS
- THE PARTOGRAM
- FORCEPS AND VENTOUSE
- SHOULDER DYSTOCIA
- VAGINAL BREECH DELIVERY
CHAPTER 21:RUPTURE OF THE UTERUS
- ETIOLOGY
- CLASSIFICATION
- INCIDENCE
- CLINICAL PRESENTATION
- Differential Diagnosis
- SITE OF RUPTURE
- COMPLICATIONS
- MORTALITY
- CASE SCENARIOS
- CASE I
  - Discussion
- CASE 2
  - Discussion
CHAPTER 22:CESAREAN SECTION
- CAUSES FOR SAMM IN CESAREAN SECTION
  - Causes for Severe Bleeding
- CASE HISTORY 1
- PLACENTA PREVIA AND ABNORMAL PLACENTAL INVASION (API)
- CESAREAN DELIVERY OF A VERY PRETERM FETUS
  - Management
- CASE HISTORY 2
- CASE HISTORY 3
  - Complications in Pregnancy Due to Fibroid
  - Surgical Considerations
    - Skin Incision
    - Uterine Incision
- CASE HISTORY 4
  - Management
  - Risk Factors for Rupture
- CESAREAN HYSTERECTOMY
PART VI: BOLT FROM THE BLUE
CHAPTER 23:AMNIOTIC FLUID EMBOLISM (Anaphylactoid Syndrome of Pregnancy)
- INTRODUCTION
  - Clinical criteria3,5,8
- PATHOPHYSIOLOGY
- CLINICAL PRESENTATION
- CASE 1
- CASE 2
- CLINICAL INDICATORS OF SEVERE ACUTE MATERNAL MORBIDITY
- DIFFERENTIAL DIAGNOSIS
- KEY INVESTIGATIONS
- TREATMENT
- CONCLUSION
CHAPTER 24:THROMBOEMBOLISM IN PREGNANCY
- INTRODUCTION
- CASE 1
- CASE 2
- PATHOPHYSIOLOGY
- INCIDENCE
- SEQUELAE
- RISK FACTORS
- PREVENTION
- CLINICAL FEATURES
- DIAGNOSIS
- MANAGEMENT
- CONCLUSION
CHAPTER 25:ANESTHETIC NEAR MISSES IN OBSTETRICS
- CHALLENGES
  - ‘Nightmares’ for the Obstetric Anesthesiologist
- COMMON OBSTETRIC PRESENTATIONS
- CASE 1
  - Emergency Lower Segment Cesarean Section
  - Problem: General Anesthesia on Full Stomach—Aspiration
    - Preventive Measures
- CASE 2
  - Traumatic Postpartum Hemorrhage on Table
  - Problem: Hemorrhage, Traumatic
    - Preventive Measures
- CASE 3
  - Supine Hypotension Syndrome
  - Problem: Supine Hypotension and Cardiac Arrest
    - Preventive Measures
- CASE 4
  - Cardiac Arrest Following Subarachnoid block
  - Problem: Peripartum Cardiomyopathy and Cardiac Arrest
    - Preventive Measures
- CASE 5
- LABOR ANALGESIA (LA)
  - Pain Relief
- CASE 6
  - Labor Analgesia—Post Dural Puncture Headache (PDPH)
  - Problem: Post Dural Puncture Headache
    - Prevention
- GENERAL ANESTHESIA
  - Special Concerns for the Anesthetist
  - Power Pearls for the Obstetrician

INDEX

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Chapter Notes