Common OB Complications AND Emergencies

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Common OB ComplicationsAND Emergencies

• Especially in Developing Countries

2
Most Common Complications

• Ectopic Pregnancy
• Post Partum Hemorrhage
• Pregnancy Induced Hypertension
• Dystocia (CPD, Shoulder)
• Gestational Diabetes
• Malpresentation
• Umbilical Cord Prolapse
• Placental Abruption
• Premature Labor, Premature ROM
• Chorioamnionitis, PP Infection, GBS

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Ectopic Pregnancy

• Gestation outside of normal uterine implantation
  (tubal, ovarian, abdominal)
• One of the leading causes of maternal death world
  wide
• Requires high index of suspicion
• Outcomes improved with early diagnosis

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Ectopic Pregnancy

• History Classic symptoms include
• Abdominal pain
• Amenorrhea
• Vaginal bleeding

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Ectopic Pregnancy

• Diagnosis
• Early vs Late
• Early Dx requires high suspicion index, hCG and
  ultrasound capability
• Difficult to differentiate from an early failed
  gestation or spontaneous abortion
• Late presentations much more common in developing
  countries.

6
Ectopic Pregnancy

• Differential Dx
• Low Abd pain UTI, Renal stones, appendicitis,
  PID, and pregnancy related problems
• Pregnancy test is critical in differential
• TVS one or more hCG determinations

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Ectopic Pregnancy

• Trans Vaginal Ultrasound
• Intrauterine Pregnancy gestational sac visible
  at 4 ½ wks, cardiac activity at 5 ½ to 6 weeks
• Complex adnexal mass may also be seen
• Bagel sign
• Free fluid in the peritoneal cavity/cul-de-sac

8
Treatment

• Almost always surgical in developing countries
• Transfusion may be life saving
• Medical Treatment in early Ectopic
• Methotrexate single or weekly dosing
• Requires B hcg to be followed and close followup

9
Ectopic Pregnancy in 3rd World Context

• Often present late
• Likely will not have quantitative HCG available
• Complicated by lack of followup and compliance
• Ultrasound can be life saving
• Case Presentation in Thailand

10
Global Warming
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Post Partum Bleeding

• Common cause of Maternal mortality in developing
  nations
• Preventable and treatable
• Need for a PLAN

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Definition and Mechanisms

• gt 500 cc blood in vaginal birth
• gt 1000 cc blood in C-Section
• Mechanisms
• 70 related to uterine atony
• Retained POC and clots
• Trauma
• Coagulopathy
• Placenta accreta

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Treatment of Uterine Atony

• Know the risk
• Active management of 3rd stage labor
• Fundal Massage
• Pitocin, Pitocin, Pitocin
• Cytotec
• Methergin
• Hemabate

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