postnatal case what. is this ? pt died within hr after expeltion of placenta .
Looks like a a case of complete inversion of the uterus with placenta still attached to the inverted fundus. Cause of death could be neurogenic shock.Morbidly adherent placenta has to be ruled out as a cause of inversion.
i had similar case. that was a second gravida. i did repositioning. but she had severe atonic pph, couldn't be corrected with medical measure. she went in to shock. anaesthetist told us to go for hysterectomy, not to conservative measures and she's already in established shick. v discussed with the bystanders , arranged and transfused blood and blood products, did hysterectomy. now that pt is safe
Uterine inversion with placenta in situ. Patient died of neurogenic shock . We had two patients with complete uterine inversion minutes after deliveries. We reposed the uterus immediately with placenta in situ. Placenta removed later and in both the cases there were uneventful recoveries .
Uterine inversion with adherent placenta. Death Due to neurogenic shock. Mismanaged third stage of labour - most likely the cause. If this case was due to adherent placenta, traction should not be given to pull the placenta. she should have been shifted to OT for manual removal of placenta under GA. If still not possible, options of leaving the placenta in situ and inj. Methotrexate Or hysterectomy
if its not an adherent placenta, remove it and try repositioning. if it's not possible go 4 emergency lapRotomy, and go 4 sugical conservative measures. if that to failed then go for hysterectomy. these things should be done without wasting time. mean while v need to arrange blood and blood products and do massive transfusion
Invension of uterus
complete uterine inversion. pt died of neurogenic shock.
It is acute inversion of uterus . I have had a similar case we separated the placenta pushed the uterus back packed it all under anesthesia with blood transfusion .my patient is alive..so it is worth trying unless it is adherent
inversion. deathay be due to shock... neurogenic/hypovolumic .
A case of morbidly adherant placenta with ut inversion. Had a similar case a year back . Prompt treatmen with blood 7 units with em hysterectomy. Pt survived.
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SUDDEN MATERNAL COLLAPSE. OBSTETRIC CAUSES CAUSES. Massive obstetric hemorrhage. *Placenta previa. *Abruptio placenta. *PPH. *Uterine rupture. *Supra levator hematoma following genital tract trauma. *Severe pre eclampsia with intra cranial hemorrhage. *Eclampsia. *Amniotic fluid embolism. *Neurogenic shock due to uterine inversion. *Surgical complications. Bleeding after caesarean section. Pelvic /broad ligament hematoma. *Severe sepsis -chorio amnionitis. *Cardiac failure. -peri party cardiomyopathy. MEDICAL //SURGICAL CAUSES Massive pulmonary embolism. Cardiac failure.-pre existing cardiac disease. - Myocardial infarction. Shock -Anaphylactic. -Septic. Intra abdominal bleeding.-hepatic. -spleenic. -aortic rupture Intra cerebral hemorrhage. Metabolic //endocrine -diabetic coma. Over dosage //substance abuse. Cerebral infections. -encephalitis -cerebral malaria. GENERAL INVESTIGATIONS. History. B.P,PR,RR,SP O2,Temperature,urine output. CBP,coagulation profile. Urea and electrolytes. S.uric acid. RBS. Blood group,Rh type and cross match. SPECIFIC INVESTIGATIONS. If a cardiorespiratory cause is suspected ECG. CXR. ABG. If pulmonary embolism 6 suspected Doppler ultrasound of calf veins. Ventilation /perfusion scan V/Q scan. If intracranial pathology is suspected -CT / MRI TREATMENT. Specific treatment depends on the cause. Multidisciplinary approach to optimize outcome. IMMEDIATE MATERNAL RESUSCITATION IS VITAL. "A" AIRWAY. open airway with head tilt and chin lift. "B" BREATHING.Assess for chest movements and breath sounds feel for breathing..If no breathing,put on cardiac arrest call and give rescue breaths. "C" CIRCULATION.Check carotid pulse.optimise circulation by aggressive IV fluids and blood transfusion if needed. CARDIOPULMONARY RESUSCITATION SHOULD BE INITIATED AS NECESSARY. "D" DRUGS To maintain circulation. To combat infections. Anti coagulants in embolism. Anti dotes in drug overdose. "E" ENVIRONMENT. Avoid injury in eclampsia. Ensure safety of the patient and staff. "F" FETUS. If CPR is required , unless there is immediate reversal,immediate caesarean section must be performed If CPR is not required,assess fetal well being and plan delivery as appropriate once maternal condition is stable.
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