EMRG 251 Obstetrics - Part 2 Complications

School of Health and Public Safety - Obstetrics Complications

Overview

• Focus on various complications that can arise during pregnancy, such as substance abuse, premature labor, abortion, and trauma management.

Substance Abuse

Tobacco Use

• Associated risks:

  • Decreased fetal growth

  • Increased rates of spontaneous abortions

  • Increased risk of Sudden Infant Death Syndrome (SID's)

  • Increased premature rupture of membranes

  • Increased risk of premature labor

• Secondhand smoke poses similar risks to mothers.

• Vaping: No conclusive data available yet.

Medication Use

• Category C medications are not recommended due to potential adverse effects on the fetus.

• Example: A drug lasting 4-5 hours in the mother could remain in the fetus for 7 days.

• Consideration of benefit versus risk is crucial, as most pregnant women prefer to avoid medication due to these concerns.

Premature Labour

• Defined as labor before 37 weeks of gestation.

• Possible causes:

  • Abnormalities in placenta/cord/membrane

  • Substance use (smoking/vaping)

  • Maternal health issues (cardiac, renal, infection, diabetes)

  • Trauma

• Higher incidence of breech deliveries.

• Risk of recurrence in subsequent pregnancies.

• Diagnosis made in a hospital via cervical changes.

Factors in Preterm Labour

• Placental Factors

  • Placenta previa

  • Abruptio placenta

• Fetal Factors

  • Multiple gestations

  • Excessive amniotic fluid

  • Fetal infections

Spontaneous Abortion - Miscarriage

• Defined as termination of pregnancy before the 20th week.

• Symptoms:

  • Cramping, abdominal pain, backache, vaginal bleeding

  • Typically resembles an intensified menstrual complaint.

• Management involves tracking blood loss, providing emotional support, and assessing stability.

Stages of Abortion

1. Threatened Abortion

   • Vaginal bleeding during the first half of pregnancy; can either progress or cease.

2. Inevitable Abortion

   • Severe abdominal pain with uterine contractions; includes cervical dilation.

3. Incomplete Abortion

   • Some products of conception retained; require alertness for shock signs.

4. Missed Abortion

   • Fetus dies during the first 20 weeks but remains in utero; transport required with emotional support.

Placenta Previa

• Abnormal implantation of the placenta at the lower uterine segment/cervix.

• Symptoms:

  • Painless vaginal bleeding in the third trimester

  • Soft uterus, fetal movement usually detectable

• Management typically requires delivery by C-section.

Abruptio Placenta

• Definition: Premature separation of a normally implanted placenta after the 20th week of gestation.

• Types: Partial or complete; may present with apparent or concealed bleeding.

• Risks include:

  • Hypovolemic shock

  • Renal failure

  • Fetal complications such as hypoxia or even death.

Signs and Symptoms

• Sudden severe abdominal/back pain, potential for vaginal bleeding, uterine tenderness.

• Labor may spontaneously occur; fetal monitoring essential.

Uterine Rupture

• Occurs during labor or after surgeries; greatest risk in women with prior Cesarean scars.

• Suspected in cases of severe tearing abdominal pain, lack of uterine contour, shock, and possible vaginal bleeding.

• Overall mortality rates: 10% for mothers, nearly 100% for fetuses.

Hypertension Related Complications

Chronic Hypertension

• Blood pressure of 140/90 mm Hg or higher prior to 20 weeks of pregnancy; greater risk for maternal complications if blood pressures exceed 160/110 mm Hg.

Gestational Hypertension

• Increased blood pressure diagnosed after the 20th week without systemic issues.

Pre-Eclampsia/Eclampsia

• Unexplained pathology, possibly due to abnormal placenta perfusion and endothelial dysfunction.

• Symptoms include elevated blood pressure, proteinuria, and peripheral edema.

• Requires monitoring for signs of progression to eclampsia, including severe headaches and visual disturbances.

HELLPS Syndrome

• A severe variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelet count.

• Symptoms and treatment focus on managing organ failure risks, including possible transfusions.

Diabetes in Pregnancy

General Effects

• Pregnancy hormones drastically affect insulin regulation, leading to fluctuating glucose levels.

Gestational Diabetes

• Can develop around the second trimester; linked to later diabetes risk.

• Management includes monitoring for hypoglycemia and implementing dietary changes or medications as necessary.

Pulmonary Embolism

• Major cause of maternal death; can result from pelvic circulation clots.

• Symptoms include sudden dyspnea, tachycardia, or hypotension in postpartum women.

Trauma Management

• Trauma is the leading cause of maternal mortality, with motor vehicle accidents (MVAs) presenting significant risks.

• Physical responses to trauma:

  • Changes in digestion, blood volume, and cardiac output can complicate assessments and responses to injury.

  • Document the position of any seatbelts during MVA for trauma evaluation.

• Fetal vulnerability to maternal trauma is significant; fetal heart rate is a critical monitoring measure post-trauma.

Treatment of the Pregnant Trauma Patient

• General approach involves prioritizing the needs of the mother, which typically benefits the fetus as well.

• Basic life support (ABCs) remains the highest priority, following standard emergency medical protocols.