Transcript Pathology postpartum. Secondary postpartum hemorrhage

Emergency
conditions and
problems of the
newborn.
Neonatal
resuscitation.
Intrauterine
infection of the
fetus.
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Perinatology - the science of the fetus and its
development, the impact of external and
internal environment, diseases of the
newborn, resulting from violations of its womb.
Due to the close functional relationship and
interdependence of the utero-placental
blood flow and fetal became widespread,
the term "fetoplacental system", although to
speak of the mother-placenta-fetus.
Perinatal period - the time interval of 22 weeks
of fetal development on the 7th day of life of
the newborn.
Divided into:
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Ante 2. Intra 3. Postnatal
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the antenatal period to reflect the state
of development of the fetus pregnancy
and abnormal pregnancy.
 In the intrapartum period, the fetus is
influenced by deviations from the normal
course of childbirth, as well as their
combination with previous pathology of
pregnancy.
Pathology leading to stillbirths
and perinatal deaths occur:
 1.
in the antenatal period - 63%
 2. in intrapartum - 21.2%
 3. postnatal - 5.7%
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Especially vital in the fetus during pregnancy, the
fetus in the womb is as if in a sterile incubator,
where it provides oxygen, glucose, amino acids
and electrolytes. Practical benefits without
wasting energy on heat buildup, muscle work,
digestion and elimination processes. Most of the
energy of the fruit consumed by synthetic
processes, ie on growth and development. Fetus
responds to external stimuli mediated by the
mother's body. Direct stimuli of the fetus, in the
end, the following: Changes in quantitative and
qualitative terms, the receipt of necessary
materials for his life.
pressure changes placental
blood flow oxygen supply of
the fetus depends on the
following factors:
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Motherboard
 2. Placental
 3. Fetus during its internal development
fetus provides the vital needs of the
placenta.
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Respiratory surface villous placenta late in pregnancy is 6-10 m2 (body of an
adult subject - 1,4-1,82). Through a complex mechanism naps provide the
fetus with oxygen saturation of the blood and removal of CO2. However,
during pregnancy, placental development can not keep up the
development of the fetus: the third month of pregnancy, the placenta is
increased by 15 times, the fruit - 800 times. Therefore, fetuses develop
compensatory mechanisms to ensure its survival in low supply of oxygen hypoxia. These include: Big V circulation (fetal heart rate of 120-140 per 1
min.) The increased number of red blood cells - 6. 1012 to 1 liter. Hb
concentration - 210-230 g / l Hb increased affinity for oxygen active fetal
movement (speed reducing muscle blood flow) Less need for oxygen
Features fetal circulation (oxygenated blood is distributed mainly in the liver
and upper torso. Possibility of the metabolic processes in the the absence of
oxygen (anaerobic glycolysis). Nevertheless, even in normal pregnancy the
fetus in her late severe shortages of oxygen. Timely delivery and resulting in
the emergence of infant pulmonary respiration save him from intrauterine
death. cause fetal hypoxia is fetoplacental insufficiency, which develops
when: Pregnancy Pathology Pathology birth mother extragenital diseases
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Diseases of the fetus (fetal napr.GB) placental insufficiency
is divided into: Chronic: Mts. anemia, heart, lungs, etc.
Placenta praevia, perenashivanie, hypertension,
pregnancy, Rh and ABO-conflict and other Acute : PONRP,
hemorrhagic shock, rupture of the vessel at plevistom
placentation, rod.sil abnormalities, uterine rupture, impaired
circulation in the vessels of the umbilical cord, knot, loop
loss, compression loops, the absolute and the relative
shortness of umbilical cord and other direct methods for the
detection of fetal threat status Register Ultrasonic
registration of motor activity of the respiratory movements
(in Tech. 20 min) fetal ultrasound scan ultrasound biometry
placenta amnioscopy, oretoskopiya ECG and PCG fetal
monitor Continuous monitoring for 30-60 minutes to study
the heart rate (cardiotocography).
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Therapy failure FPS based on the method and
products that will improve uterine blood flow and
increasing the utero-placental blood flow.
Principles of therapy: Vasodilation m n complex
relaxation of muscles of the uterus (tocolysis)
Improve metabolism of the myometrium and
placenta is achieved: bed rest (on the side, the
elimination of physical stress, emo-tional stress) .
Estrogenic hormones - improve the transport
function of the fetus (positive integer folliculin,
estradiol-dipropionate (20 thousand units / m c / o
12 hours), 2% -0.5 hexestrol / m, sigetin 1% - 2 ml /
m β-mimetics (tocolytics)
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Antispasmodic and vasodilator - aminophylline, baralgin, maksigan,
complamin (theophylline + nikotin.k-ta) Courant
(koronarorasshiryayuschego vessels of the placenta and fetus.) ATP
- improves metabolism of the placenta. Heparin five thousand units
in / m Breathing oxygen Antigipoksanty Solvte vitamins and amino
acids. Intrauterine infection of the fetus. problem intrauterine
infection - one of the leaders in obstetric practice. It is due to high
rates of infection during pregnancy, childbirth and postpartum
women, risk of impaired fetal growth and birth of an affected child.
Among the causes of perinatal smetrtnosti share intrauterine
infection is more than 30%. presence of foci of infection in a
pregnant woman feel important risk factor for infection of the fetus
and newborn. should distinguish between such concepts as
vnuriutrobnoe infection and intrauterine infection. Under
intrauterine fetal infection involve the penetration of
microorganisms into the fetus and its contamination.
Risk factors for emergency
conditions in the newborn:
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Prenatal factors:
- Age> 35 years;
- Diabetes mother;
- Hypertension;
- Anemia;
- Bleeding (I or II trimester);
- Maternal infection;
- Premature rupture of membranes;
- Prolonged pregnancy;
- Disparity in labor;
- Medication (lithium carbonate, magnesium,
adrenergic blockers);
- Abuse of harmful substances;
- Malformation of the fetus;
- Reducing the mobility of the fetus;
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Intrapartum factors:
- Emergency cesarean section;
- Abnormal presentation;
- Premature birth;
- Fragile heart in the fetus;
- Tetany of the uterus;
- The introduction of drugs for the mother and less than four or
more than 24 hours before delivery;
- Accelerated labor;
- Prolonged labor (over 24 hours);
- A prolonged second stage of labor (more than 2 hours);
- Traces of meconium in the amniotic fluid;
- The loss of the umbilical cord;
- Detachment of the placenta;
- Placenta previa
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Is it possible to predict the need for neonatal resuscitationtion?
Higher risk needs resuscitation in the following cases:
- Preterm infants with a gestational age less than 35 weeks
- Children born in breech presentation, twins, triplets
- Infants with intrauterine growth
- Tachycardia or bradycardia in the fetus
- Repetitive variable decelerations, late decelerations
- Low fetal biophysical profile
- Meconium in the amniotic fluid
- Mother received painkillers or she performed anesthesia
 The
reasons for the oppression of the vital
functions in the newborn
 Asphyxia - a progressive hypoxia, the
accumulation of CO2 and acidosis. This
process, if it goes far enough, can lead to
irreversible brain damage and even
death. It can also affect the function of
other vital organs.
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Physiology of asphyxia
Apnea
Primary apnea - not applicable to the receipt of O2 in the
child begins a long period of non-rapid breathing. If
asphyxia continues, breathing movements stop, heart rate
falls and the neuro-muscular tone is gradually reduced,
and the newborn begins a period of primary apnea.
Secondary apnea - for continuing asphyxiated baby
developing asthma, heart rate continues to fall, starts to
decrease blood pressure, and the child disappears almost
completely tone. Breathing becomes weaker, until the
child is doing the last heavy breath, followed by a period.
Distinguish between primary and secondary apnea is
difficult. For this reason, sleep apnea should be considered
as secondary, and without delay to the intensive care unit.
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Removal of fetal lung liquid:
-Her light displacement and expansion may require
pressure, co-Thoroe two to three times greater than
the pressure required for normal breathing;
-Chest and can not be considered as the only
indicator of effective breathing.
Reduction of pulmonary blood flow in asfiktichnogo
baby usually is called pulmonary vasoconstriction.
The most important indicators of the newborn:
- Respiratory motion;
- Heart Rate;
- Colouring of skin.
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The cycle of "action-evaluation solution"
action action assessment decision
the child must be under the
ventilation
not breathing excessive
ventilation
tactile pressure light
stimulation
child to assess the heart rate
breathing following
normal assessment
Thank
you for
attention