Management of Postpartum Collapse

COLLAPSE

Before delivery	After delivery	After 3rd stage
Rupture uterus	PPH – During 3rd stage	Ruptured uterus
Amniotic fluid embolism		Uterine inversion

 

RUPTURED UTERUS

History

• Past caesarean section
• Grand multigravida
• Multigravida given oxytocin during labour
• Almost never in primigravida - except following manipulations or previous uterine scar e.g. myomectomy

Management of Postpartum Collapse - AMNIOTIC FLUID EMBOLISM



Presentation

• Extremely sudden severe shock with severe dyspnoea, cyanosis Pulmonary oedema
• Blood stained frothy sputum
• Convulsions may occur  

Onset

• Usually immediately after membranes rupture however it can occur even with intact membranes occurs during strong uterine contractions
• Usually fatal 

Management of Postpartum Collapse - CONVULSIONS

Convulsions may be due to eclampsia, epilepsy, malaria, head injury, cerebral abscess, meningitis, encephalitis, etc.

Whatever the cause, initial steps are the same.

• Stop the fits
• Maintain airway
• Prevent aspiration
• Prevent injuries

Immediate care :

• Position the patient - head low, turn to a side
• airway - plastic or metal
• Suck the mouth and pharynx
• Place cushions around the patient or tie the limbs loosely with soft cloth  

Scan technique ii

Indications for 2nd & 3rd trimester scanning

• Assigning dates
• Assessing foetal growth, amniotic fluid volume, foetal heart motion & foetal presentation.
• Assessing placental position & texture.
• For review of foetal anatomy
• To detect the presence of adenexal masses or cysts or uterine myomas

Scan technique

• Bi parietal diameter measurement of the foetal head –BPD
• BPD measurement is more accurate in the first trimester.
• BPD is the distance between the anterior & posterior tables of the skull.
• It is measured perpendicular to the mid line echo (falx)

 

Scan technique i

First trimester

Indications

• Bleeding after a POA
• Pain during pregnancy
• Pregnancy complicated by fibroid or ovarian cyst

 

Preparation
Scans are performed though the full bladder using a 5 MHtz curvilinear probe.

Indications for first trimester sonography 

• Localization of the GS –Intra uterine or Ectopic pregnancy
• Identification of foetal viability
• Anovular gestation
• Estimation of POG
• Assessment of multiple pregnancy, number of embryos chorionicity & amniocity