Tag: dic

ECLAMPSIA

Posted on by The Rebel Surgeon in ECLAMPSIA
Eclampsia

Treatment:

  • Controle convulsions with Magnesium Sulfate and/or Valium
  • Treat hypertension  
  • Deliver as rapidly and least traumatically as possible
    • FETUS ALIVE
      • Gestational age > 36 weeks
        • Urgent C/S
      • Gestational age < 36 weeks
        • Vaginal delivery
        • Induction and/or augmentation
          • Oxytocin
    • FETUS DEAD
      • Vaginal delivery
      • Induction and/or augmentation
        • Misiprostol (Cytotec)
      • Destructive delivery if needed
  • Monitor vital signs closely
  • Continue antihypertensive treatment
  • Give regular doses of Magnesium Sulfate and/or Valium to prevent convulsions
  • Keep a syringe with 5-10 mg valium at bedside for immediate i.v. administration to control breakthrough convulsions
  • Watch out for signs of DIC (HELLP)
  • Valium ready
  • Close monitoring

PLACENTAL ABRUPTION

Posted on by The Rebel Surgeon in PLACENTAL ABRUPTION

Symptoms and signs:

  • Sudden onset of painfull uterine contractions
  • Vaginal bleeding
  • Shock
  • Uterus tender on palpation

FETUS ALIVE

  • Gestational age > 36 weeks   
    • Deliver by C/S
  • Gestational age < 36 weeks    
    • Vaginal delivery
  • Gestational age unknown
    • Use best guess

FETUS DEAD

  • Vaginal delivery 
  • Destructive delivery if needed    

The uterus appears battered:

POST PARTUM HEMORRHAGE (PPH)

Posted on by The Rebel Surgeon in POST PARTUM HEMORRHAGE (PPH)

Causes:

  • Atony of the uterus
  • Retained placental parts
  • Uterine rupture
  • Cervical and/or vaginal tears
  • DIC (HELLP)

Treatment:

  • Resuscitate with fluids
  • Massage the uterus manually
  • Apply firm and continuous pressure suprapubically with a closed fist for a full 10 minutes
    • Eyes on the watch!
  • Oxytocin infusion i.v. (preferred)
    • 30 units in 500 cc in Normal Saline
    • Infused over 2 to 4 hours
  • Misostoprol (Cytotec) tablets (if oxytocin is not available)
    • 2 – 4 tablets
      • Oral or rectal adminstration

Bleeding does not subside:

  • Bring patient to operating theater
  • Place legs in stirrups
  • Examine by intracavitary palpation
    • Placental parts present:
      • Remove
    • Uterine rupture present:
      • Laparotomy and repair
    • Neither retained placenta nor rupture of the uterus is present:
      • Pack firmly with gauze
      • Remove gauze pack in the operating theater after 24 hours
  • Transfuse one or two units of fresh blood

  • Perform hysterectomy as a last resort

Speculum Examination:

  • It is usually difficult and messy to identify bleeding site(s) from cervical tears
  • Attempts to suture the friable tissue results in further tearing and bleeding
  • Proceed directly with gauze packing in the absence of retained placental parts or ruptured uterus.