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Obstetrics I - OSCE > Complications of 3rd Stage > Flashcards

Complications of 3rd Stage Flashcards

1
Q
A
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2
Q

Def of Retained Placenta

A

Failure of delivery of placenta èin 30 minutes after delivery of fetus.

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3
Q

Types of Retained Placenta

A
  • Retained separated placenta
  • Retained non separated placenta
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4
Q

Etiology of Retained Separated Placenta

A

1) Uterine atony.
2) Constriction ring.
3) Rupture uterus.

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5
Q

Etiology of Retained non-separated Placenta

A

1) Uterine atony.
2) Abnormally adherent placenta
3) Abnormal shape of placenta: Placenta membranacea & succenturiate placent

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6
Q

Etiuology & RF for Abnormally adherent placenta

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7
Q

Types of Abnormally adherent placenta

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8
Q

Complications of Retained Placenta

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9
Q

TTT of Uterine atony

A

Give ergometrine & do gentile uterine massage (to stimulate uterine contraction) then try to deliver placenta by 1 of the following:

a. Brandt-Andrew’s maneuver

b. Crede’s method:

c. Manual removal

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10
Q

TTT of Uterine atony

  • Crede’s Method (Complications)
A
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11
Q

TTT of Uterine atony

  • Manual removal of placenta (Technique)
A
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12
Q

TTT of Uterine atony

  • Manual removal of placenta (Complications)
A
  1. Perforation of uterus.
  2. Retained parts of placenta or membranes.
  3. Infection.
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13
Q

Dx of adherent placenta

A
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14
Q

TTT of Adherent placenta

A
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15
Q

TTT of Adherent placenta

  • Ordinary (simple) adherence & partial placenta accreta
A
  • Remove as much as possible from placenta & insert uterine pack
  • if bleeding continues → bilateral uterine artery ligation, bilateral internal iliac artery ligation or hysterectomy.
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16
Q

TTT of Adherent placenta

  • Complete placenta accreta, placenta increta or placenta percreta
A
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17
Q

Etiology of Puerperal Inversion of Uterus

A
  • Spontaneous inversion
  • Induced (iatrogenic) inversion
18
Q

Etiology of Puerperal Inversion of Uterus

  • Spontaneous
19
Q

Etiology of Puerperal Inversion of Uterus

  • Induced (iatrogenic) inversion
20
Q

TTT of Puerperal Inversion of Uterus

21
Q

TTT of Puerperal Inversion of Uterus

  • 1st Aid
22
Q

TTT of Puerperal Inversion of Uterus

  • O’Sullivan’s hydrostatic pressure method
23
Q

TTT of Puerperal Inversion of Uterus

  • Ogueh & Ayida
24
Q

TTT of Puerperal Inversion of Uterus

  • Manual reposition of uterus
25
Q

Def of PPH

A

Abnormal or excessive bleeding from genital tract after delivery of fetus till end of puerperium (6 weeks after delivery).

26
Q

Def of 1ry PPH

A
  • Excessive bleeding from genital tract during 3rd stage of labor or èin first 24 hours after delivery.
  • > 500 ml after vaginal delivery or > 1000 ml after CS or blood loss that affects general condition of patient.
  • Average normal blood loss = 300 ml.
27
Q

Etiology of 1ry PPH

  • Atonic
A
  1. Multiparity.
  2. Over distention of uterus
  3. PH.
  4. Uterine fibroids.
  5. Uterine relaxants (tocolytics).
  6. Halogenated anesthesia.
  7. Chorioamnionitis.
  8. Severe anemia.
  9. Full bladder or rectum.
  10. Prolonged labor or precipitate labor.
  11. Retained placenta, placental fragments, pieces of membranes or blood clots.
  12. Idiopathic.
28
Q

Arrest of Bleeding in 1ry Atonic PPH

  • Bleeding after delivery of placenta (true 1ry PPH)
29
Q

Arrest of Bleeding in 1ry True PPH

  • Ecbolics
A

a- Oxytocin drip: 20 units in 500 ml normal saline.
b- Ergometrine (Methergin): 0.25-0.50 mg IV or IM.
c- PGs: rectal or IM or intra-myometrial in CS.

30
Q

Arrest of Bleeding in 1ry True PPH

  • Inspection of placenta & membranes
A

Any missed part → removed manually under anesthesia.

31
Q

Arrest of Bleeding in 1ry True PPH

  • uterine Massage
32
Q

Arrest of Bleeding in 1ry True PPH

  • Exploration of uterine cavity & birth canal under anesthesia.
33
Q

Arrest of Bleeding in 1ry True PPH

  • Bimanual compression of uterus
A

▪ Under general anesthesia → uterus is firmly compressed for 5-30 minutes () closed fist of Rt hand
in anterior vaginal fornix & Lt hand abdominally behind body of uterus.

▪ Compression is maintained till uterus is firmly contracted (during this period, Ecbolics & blood
transfusion are given).

34
Q

Arrest of Bleeding in 1ry True PPH

  • Balloon tamponade (tamponade test):
A

Hydrostatic balloon catheter is inserted in uterus& filled è 200-500 ml warm saline to control Hge

35
Q

Types of Uterine compression sutures

A
  1. B-Lynch suture.
  2. Modified B-Lynch suture.
  3. Vertical compression sutures.
  4. Square compression sutures.
36
Q

Arrest of Bleeding in 1ry True PPH

  • Surgical treatment
A

a- Bilateral uterine artery ligation
b- Bilateral internal iliac artery ligation.
c- Bilateral ovarian artery ligation.
d- Uterine compression sutures
e- Supra-vaginal hysterectomy: if other measures failed.

37
Q

Managment of 1ry PPH

  • After care of PPH
38
Q

Arrest of Bleeding in 1ry True PPH

  • Other less commonly used methods to arrest bleeding
39
Q

Def of 2ry PPH

A

Abnormal or excessive bleeding from genital tract () 24 hours & 6 weeks after delivery.

40
Q

Etiology of 2ry PPH

41
Q

TTT of 2ry PPH

42
Q

Complications of 3rd stage of labor

Obstetrics I - OSCE (32 decks)

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