Obstetric

Intrapartum
Emergency
dr. Jerisatrio, Sp.OG
 Introduction

• Perinatal nurses/midwives face a variety of

challenges during an intrapartum emergency.
Emergent situations may be related to one or more
maternal, fetal, uterine, cord, or placental factors.
Physiology of Parturition
 EMERGENCY CASE

Mother Fetus Cord

• Uterine Ruptur • Shoulder Dystocya • Cord Prolapse

• Eclampsia
• Amniotic
Embolism
 Intrapartum Obstetric Emergency : Mother

Uterine Rupture

• Definition : Disruption full thickness or Partially of the Uterine Muscle

• Incidence : Varies from 1 in 80–500 deliveries in low-resource settings to 1

in 3000–5000 deliveries in well-resourced settings. The incidence is rising in
well-resourced setting as a result of rising CS rates.

• Initial Assesment & Treatment :

• Assess vital signs.
• Initial supportive treatment.
• Management of haemorrhagic shock and
• resuscitation of a collapsed woman.
 Uterine Rupture
IMPACT

Mother :
 Haemoragic -> Hypovolemic
Shock
 Future Fertility Compromisie
 Adverse Psychological Effect
Fetal:
 Hypoxia or anoxia and high
risk of death in utero
 High risk of admission to
neonatal ICU
 Intrapartum Obstetric Emergency : Mother

ECLAMPSIA

• Definition : Occurrence of convulsion superimposed on pre-eclampsia.

• Incidence : 1 : 2000 pregnancy, 1% of preeclampsia case

• Initial Assesment & Treatment :

• Assess vital signs.
• Initial supportive treatment. ABC
• resuscitation of a collapsed woman.
• Admisnister MGSO4
• Administer Antihipertension drugs
• Deliver fetus
 ECLAMPSIA
IMPACT

Mother :
Fetal:
• Death 1%  Hypoxia or anoxia and high
• Acute Renal Failure 4% risk of death in utero
• HELLP 3%
• DIC 3%
• Aspiration 3%
 Intrapartum Obstetric Emergency : Mother

Amniotic Fluid Embolism

• Definition : Emboly caused by Amnion Fluid content.

• Incidence : Rare. 1 : 80.000

• Initial Assesment & Treatment :

• this patient typically present with sudden catasthropic hypotension,
hypoxia and respiratory distress after amnion membrane rupture
• Supportif care
• Immediate resuscitation with oxygen and fluid
• Deliver fetus by quickest mode
 Intrapartum Obstetric Emergency : Fetus

Shoulder Dystocia
• Definition : prolong head-to body delivery time > 60 s ( usually its 25 s in
uncomplicated delivery.

• Incidence : 0.15 – 2% but may be under-reporting

• Initial Assesment & Treatment :

• Ask For HELP
• Aim to deliver within 5 min
• Using manuver effectively
 Soulder Dystocia
IMPACT

Mother :
• Postpartum hemorrhage
• Perineal tears
• Psychological injury
Fetal:
 Cerebral hypoxia
 Cerebral palsy
 Brachial plexus injury
 Erb’s paralysis
 Klumpke’s paralysis
 Intrapartum Obstetric Emergency : Cord
Cord Prolapse
• Definition :
• Cord Presentation : the presence of loop of umbilical cord between the
fetal presenting part and the cervical os
• Cord prolapse : the descent of umbilica cord through the cervix alongside
or past the presenting part in the context of ruptured membranes.

• Incidence : range from 0.1% to 0.5 % of births

• Initial Assesment & Treatment :

• Ask For HELP
• Knee- chest, face –down position
• Manual elevation – reposition
• Tocolysis
• Fill the bladder to elevate presenting part ( 500-700 ml)
 !.
• Emergencies during labor and birth may or may not
be foreseeable or preventable.
• Proactive, anticipatory nursing is the best defense
in decreasing maternal, fetal, or neonatal morbidity
and mortality.