2P - CS, Postpartum Hysterectomy, VBACS Flashcards
When does do we do hysterectomy?
At the time or within 24 hrsd after delivery
What type of patients require a readily available hysterectomy?
Multiple risk factors and prior post partum hemorrhage
What is the most common planned hysterectomy cause?
placenta accreta, increta and percreta
Also those with cervical carcinoma and myoma
What is the most common cause for emergent hysterectomy?
Uncontrolled Uterine hemorrhage
What organs are removed by total hysterectomy?
uterus, cervix and corpus
What are removed in subtotal or supracervical hysterectomy?
Uterus and corpus leaving the cervix
What direction of incision is preferred in operative delivery?
Vertical incision
A G1P1 patient develops placenta previa, hysterectomy should be high or low?
High
High hysterectomy also preferred in large bladder varicosities and significant anterior adhesions
Stain test that can help check if there is a bladder injury or leak post surgery?
Methylene blue test
Stain test that can help check if there is a ureter injury or leak post surgery?
indigo carmine test
What procedure post surgery after checking the bladder and the ureters help lessen risk of infection?
Copious irrigation
Process that controls low pressure pelvic bleeding?
Pelvic packing
A more readily available hemostatic agent that fibrin sealant?
absorbable gelatin
What drugs can be given to prevent venous thrombosis post op?
LMW heparin or enoxaparin
If a patient is stable, how many hours post op can a urinary catheter be removed?
24 hrs
How many cm of surgical repair requires a cystourethrogram prior to removing the catheter?
2 cm
hemorrhage and hysterectomy are contraindications for breastfeeding? T or F?
False
Both the success rate and risk of failure for VBAC is high? T or F?
True
What type of incision has higher chance of uterine rupture? Transverse or vertical?
Vertical
Risk of uterine rupture is higher in VBAC than the
RCD (repeat cesarean delivery)? T or F?
True
likelihood of fetal death is higher with VBAC than ERCD? T or F?
True
A failed TOLAC is usually associated with what complication?
Uterine rupture
What is the fetal weight for macrosomia among patients with GDM?
4000g
> 4500g with no GDM
What kind of CS incision will TOLAC be considered not to be offered?
Classical CS
happens when there is a transverse lie or myoma
How many years from previous delivery can TOLAC be considered to have less risk for uterine rupture?
2 years
What is the best prognostic factor to having a successful TOLAC?
Previous vaginal delivery
What is increased in risk if a woman if TOLAC is attempted by induction in labor?
Uterine rupture
Highest in TOLAC with prostaglandin induced labor
Women attempting TOLAC seem to have labor patterns
similar to those who?
not had a prior cesarean
delivery
Excessive vaginal bleeding or signs of hypovolemia
may indicate?
Uterine Rupture
