Urgente Obstetricale

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URGENTE OBSTETRICALE

Prolaps cordon ombilical Hemoragii masive antepartum  placenta previa  abruptio placenta  ruptura uterina Hipertensiunea indusa de sarcina Embolismul cu lichid amniotic Hemoragia pospartum

Prolaps cordon ombilical(PCO) Prolaps compresie cordon ombilical asfixie fetala Factori predispozanti :-cordon ombilical lung -malprezentare -multiparitate -ruptura artificiala a membranelor

Bradicardie fetala brusca ridica suspiciunea de PCO

Diagnostic confirmat prin

examen clinic

Tratament: pozitie Tredelenburg

impingerea manuala a fatului inapoi in uter cezariana sub AG

Placenta previa Apare la paciente care au efectuat varstnice multipare cu placenta larga

cezariana miomectomie

Placenta previa Confirmare diagnostic >>>echo abdominal »Sarcina <37s Sangerare moderata »Sarcina >37s »Instabilitate HD hemoragie activa

repaus la pat monitorizare cezariana cu A.regionala resuscitare lichidiana cezariana cu AG histerectomie daca hemoragia nu

se opreste(placenta poate fi f aderenta de pereti uterini

Abruptio placentae = separare prematura a unei placente normale, cauzata de o sangerare in stratul bazal al placentei Factori de risc: HTA, trauma cordon ombilical prea scurt multiparitate abuz alcool

Abruptio placentae Tratament

Abruptie moderata Sarcina> 37s

nastere normala

Semne de suferinta fetala

cezariana

Abruptio severa(fatala)

cezariana de urgenta sub AG transfuzie masiva aport de Tr, FC

Ruptura uterina Apare in timpul travaliului datorita: -dehiscentei uterului cicatriceal -miomectomie -reconstructie uterina -manipulare intrauterina -travaliu prelungit -disproportie feto-pelvina

Ruptura uterina

Clinic se poate manifesta ca: hemoragie hTA cu sangerare oculta intraabdominala Tratament: resuscitare volemica laparotomie de urgenta sub AG ligaturarea a.hipogastrice+ histerectomie-daca hemoragia nu poate fi controlata

Hipertensiunea indusa de sarcina (preeclampsia) Apare dupa saptamana 20 Se remite la 48h dupa expulzie

Eclampsia

Embolia cu lichid amniotic

Embolia cu lichid amniotic Colaps c-vasc –I semn de ELA hTA, convulsii, dispnee, coagulpatie Prezenta de resturi fetale in circulatia materna-certifica ELA HTP, hipoxie, Ivs, coagulopatie-primele evenimente in ELA Management: tratament simptomatic mentinere oxigenare suport circulator corectare coagulopatie

Hemoragia postpartum Poate fi asociata cu : travaliu prelungit preeclampsia sarcini multiple epsiotomie mediolaterala Cauze: atonie uterina laceratii obstetrice inversie uterina tocolitice inainte de expulzie

Hemoragia postpartum Laceratii obstetrice > bloc rusinos infiltratii locale Masaj uterin bimanual Extractie manuala a placentei > Reversia uterului inversat

AG

Atonie uterina > Oxytocin=20-30U/L fluid iv F rar > histerectomie laparotomie de urgenta liagaturarea A. iliace interne

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