• A 37-yr old lady is brought to casualty after

she collapsed…..
• She is dyspnoeic, centrally cyanosed
• Bleeding from venepuncture sites
AMNIOTIC FLUID
EMBOLISM
• Onset in late labor or within 30 min postpartum
• Acute onset of shortness of breath or gasping for air
• Sudden hypotension
• Hypoxia and or oxygen desaturation
• Diffuse coagulopathy
• Ominous fetal heart rate pattern
• Cardiopulmonary arrest
• Death
 Risk factors
• Advanced maternal age • Trauma
• Multiparity • Prolonged labor
• Caesarean section • Induction of labor
• Uterine • Operative vaginal
hyperstimulation delivery
• High cervical tear • Hydramnios
• Abruption • Uterine rupture
• Multifetal gestation • Allergy history
• Eclampsia
 Management
• Airway
• Oxygen
• Mechanical ventilation
• Fluids
• Vasopressors
• Digitalisation
• Uterotonics
• Blood product transfusion
• A 37-yr old lady is brought to casualty after
she collapsed…..
• P/A: uterus not felt
• P/V: no evidence of excessive bleeding
Uterine inversion
 Risk factors
• Mismanagement of third stage of labor
• Short cord
• Manual removal of the placenta
• Atonic uterus
• Placenta accreta
• Multiparity
• Fundal implantation of the placenta
 Classification
• Incomplete -1st degree
• Complete -2nd,3rd degree
• Prolapsed

• Acute -<24 hrs

• Subacute-24hrs-4 weeks
• Chronic->4 weeks
 Management
• Management of shock
• Manual replacement of the uterus
• O sullivan’s method
• Huntigtons method
• Haultains method
• Spinelli’s method
• Kustner method
• A 37-yr old lady is brought to casualty after
she collapsed, had complained of severe
pain before she collapsed…..
• Patient is pale
• P/A: uterus felt contacted well
• P/V: no evidence of excessive bleeding
Pelvic hematoma
 Risk factors
• Episiotomy
• Nulliparity
• Operative vaginal delivery
• Breech delivery
• Prolonged second stage
• Macrosomia
• Heriditary clotting disorders
• Vulval varicosities
 Classification
• Vulvar
• Vaginal
• Paravaginal
• Retroperitoneal

• Supralevator
• Infralevator –anterior triangle
- posterior triangle
Infralevator hematoma
Supralevator hematoma
Broad ligament hematoma
 Management
• Expectant management with/without blood
transfusion
• Compression/Ice packs
• Incision and evacuation
– Severe pain, rapidly enlarging, >10cm
• Ligation of bleeding points and obliteration of
potential space
– Don’t pack the potential space
– Don’t close if infected
 Management………….
• Packing the vagina ~12-24 hours
• Laparotomy for retroperitoneal
• Embolization
• Antibiotics
 References
• Williams obstetrics 23 edition 2010
• Am J Obstet Gynecol 2009;201:445.e1-13
• Hematological complications in obstetrics and
gynecology 2006
• Clinical obstetrics and gynecology 2010;53:2,
322–328
• RCOG Green-top Guideline No. 52 May 2009