team ob presentation

7/31/2019 TEAM Ob Presentation

1/41


2/41

Center of Gravity Change30% Increased in Total Blood

Volume

Symbiont Relationship


3/41

Complications and

Treatment Options

in the RemoteSetting.


4/41


5/41


6/41

Definition- Developing Fetus implants inthe falopian tube instead of in the Uterus

Treatment- Confirm diagnosis by ultrasound and lab testing

If diagnosis is ruptured, orsuspected rupturedectopic pregnancy, be prepared to treat

HYPOVOLEMIC SHOCK.

Rapid transport to nearest O.R.


7/41

Hypertensive Disorders

Bleeding Problems

Malpresentations

Dystocias

Amniotic Fluid Embolism


8/41

Gestational Hypertension

Preeclampsia mild

severe

Eclampsia

HELLP Syndrome


9/41


10/41

Control BP Hydralazine

Labetolol

Prevent Eclampsia Magnesium Sulfate

The Cure For Preeclampsia is

Deliver The Baby


11/41


12/41

The only difference between Preeclampsiaand Eclampsia

SEIZUREThe Cure for Eclampsia is

Immediately

DELIVER THE BABYBUT, in the meantime


13/41


14/41


15/41

H- hemolysis

E- elevated

L- liver enzymes

L- low

P- platelets2% of patients with PEC will develop H.E.L.L.P.

A few patients will develop H.E.L.L.P. without havingsigns or symptoms of PEC


16/41

Support Vital Signs

Treat HTN

Seizure prophylaxis

The only CURE for HELLP is

DELIVER THE BABY


17/41

Please check your company protocols for proper

medication administration


18/41

Placenta Previa

Placenta AbruptionVasa Previa

Uterine Rupture

Normal?


19/41

Partial Mild

Moderate

Full Completely covers cervical OS


20/41

Placenta is completely covering cervicalOS

May have antepartum bleeding and/oracute hemorrhage

Cannot deliver vaginally

O.R. Emergency Mom and baby can exsanguinize rapidly

Treat for

HYPOVOLEMIC SHOCK


21/41

Different from Previa

Pain

Mild May happen at any time during pregnancy

Mild spotting

May be undiagnosed


22/41

Very Painful

Hemorrhage externally

Hemorrhage internally Exsanguination of mother and baby

May not be compatible with life if OR not

readily available Treat for SHOCK


23/41


24/41

O.R. EMERGENCY Pt needs emergent surgery

Support VS and treat for Shock

May not be compatible with

life in prolonged transportsetting


25/41

Complete

Footling

Frank


26/41

Feet Tucked down by buttocks

May deliver vaginallyHigh risk for cord prolapse

Tocolytics and transport

Cephalic Dystocia


27/41

Most Common in Preterm

OR Urgently

Tocolytics and Transport


28/41

May Deliver Vaginally

High Risk Cord Prolapse

Tocolytics and Transport Cephalic Dystocia


29/41

Head has delivered but the baby is stuck McRoberts Maneuver: Sharp flexion of the

maternal hips

Suprapubic pressure: attempt to dislodge the

shoulder from behind the pubic bone Rubin Maneuver: Place pressure on the

presenting shoulder to push it inward anddecrease the diamter of the presentation

Woods Corkscrew maneuver: Apply pressurebehind the posterior shoulder to rotate the babyand dislodge the anterior shoulder

Fracturing the fetal clavical


30/41

Manifested by Late Signs and

Symptoms of fetal and maternal

shockMost patients do not live past CPR

Treat For ShockTreat Respiratory Distress

Treat Cardiac arrest


31/41

Toco- picks up ctxs, place on the apexof the fundus An external Toco can only measure

frequency and duration NOT strength An IUCP is required to measure strength, we

dont have the adapter for this

US- place wherever you can pick up thebabys heart rate the best.

A reassuring 20 minute strip will include twoaccelerations and normal variability


32/41

Accelerations- twopink boxes or morefor at least two

boxes in length as aguideline

Accelerations =happy baby

i.e. baby is taking alittle jog around theblock and heartrate increases

Decels

Early- starts beforethe peak of the ctx

Late- starts after thepeak of the ctx

Variable is acombination of

both


33/41

Early decels usuallyrequire notreatment. They can

be caused by headcompression at theend stages of labor.If they are deep or

prolonged, considerrepositioning andoxygen

Late decels indicatefetal hypoxia. As thetracing loses its

variability, the fetus isbecome morehypoxic andacidotic. Late

decels alwaysrequire intervention.Oxygen, reposition,fluid bolus?


34/41


35/41

120-160


36/41

How bumpy is the tracing?

Moderate variability is normal

Is is marked? Decreased?

Beat to beat variability only accessible

through FSE


37/41

Tachycardia

Maternal fever

CNS immaturity

Maternalmedications, druguse

Bradycardia

Fetal hypoxia

Maternal drug use


38/41


39/41

What we do to

momwe also do tobaby

Move mommovebaby


40/41

Jake Feb 1,2011 6lbs 12oz 19.5 inches


41/41

Blueprints Fifth edition Ostetrics & Gynecology.Tamara L. Callahan/ Aaron B Caughey: WoltersKluwer/ Lippincott Willaims & Wilkins 2009

Williams Manual of Obstetrics PregnancyComplications twenty-second edition KennethJleveno, F. Gary Cunninggham, James M.alexander, Steven L. Bloom, Brian M. Casey, Jodi S.

Dashe, Jeanne S. Sheffield, Scott W. Robers:McGraw Hill Medical 2007

American Congress of Obstetricians andGynecologists: http://www.acog.org

team ob presentation

Documents