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Complex Care 1 > Complications of the third stage and perineal trauma > Flashcards

Complications of the third stage and perineal trauma Flashcards

1
Q

PPH

A

blood loss of 500mL or more during or after childbirth
severe over 1000mLs; or amount that causes haemodynamic compromise
primary 24 hrs
secondary btwn 24 hrs and 6 weeks

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2
Q

4 T’s

A

tone
trauma
tissue
thrombin

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3
Q

tone

A
  • 70%
  • Atonic uterus
  • Precipitate labour
  • Prolonged labour
  • Polyhydramnios
  • Multiple pregnancy
  • Full bladder
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4
Q

trauma

A
  • Lacerations
  • Episi
  • Uterine rupture
  • Uterine inversion
  • Extensions/lacerations at c-section
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5
Q

tissue

A
  • 10-20%
  • Retained products
  • Retained placenta or succenturiate lobe
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6
Q

thrombin

A
  • Coagulation disorders acquired in pregnancy
  • Idiopathic thrombocytopenic purpura
  • Von willebrands disease
  • Thrombocytopenia with pre-eclampsia
  • Disseminated intravascular coagulation
  • Pre-eclampsia
  • Dead fetus in utero
  • Severe infection
  • Abruption
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7
Q

acute management PPH

A
  • Rub up a contraction
  • Give an oxytocic
  • Empty bladder
  • Syntocinon infusion
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8
Q

prophylaxis

A
  • Avoid anaemia, dehydrations, prolonged labour
  • Empty bladder 2nd hourly
  • Oxytocic for 3rd stage
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9
Q

syntoconin

A

IM 10 units

40 units IV in 1 litre of hartmanns at 250mls/hr
use electrolyte solution

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10
Q

syntoconin side effects

A

painful contractions
nausea, vomiting (water intoxication)
transient vasodilatation & hypotension if undiluted IV doses high doses or prolonged administration in electrolyte-free fluids can cause water intoxication

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11
Q

syntometrine

A

IM Syntometrine 1 mL following expulsion of placenta, or when bleeding occurs:
Repeat dose of 1 mL after no less than two hours if necessary, The total dose given in 24 hours should not exceed 3 mL
don’t use if blood pressure issues

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12
Q

syntometrine side effects

A

Nausea, vomiting uterine hypertonicity & abdominal pain headache, dizziness skin rashes hypertension bradycardia cardiac arrhythmia chest pain anaphylactoid reactions

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13
Q

ergometrine

A

Ergometrine 250 micrograms IM
OR Ergometrine 250 micrograms IV. (This should be injected slowly over one minute or diluted to a volume of 5 mL with sodium chloride 0.9% before administration to prevent serious side effects.)
Do not add ergometrine to IV flasks containing other drugs

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14
Q

ergo side effects

A

nausea, vomiting abdominal pain headache dizziness rash peripheral vasoconstriction hypertension cardiac arrhythmias chest pain anaphylactoid reactions

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15
Q

prostin (dinoprost trometamol)

A

Mix 5mg prostaglandin F2 alpha (1mL of a 5mg/mL solution) with 9mL normal saline.
The Medical Officer injects 1 mL (0.5 mg) transabdominally into the myometrium on each side of the fundus i.e. 1mg (2mL of prepared solution) into the uterine fundus. This may be repeated at the doctor’s discretion if atonia persists, to a maximum dose of 3mg (6mL of prepared solution).
Alternatively, a transcervical injection at 9 and 3 o’clock can be given

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16
Q

prostin (dinoprost trometamol) side effects

A

nausea, vomiting, diarrhoea, headache, flushing, pyrexia, cardiac arrest relative risks include pelvic

17
Q

intractable PPH

A

fluid and blood components
- Bilateral ligation of the uterine arteries
- Bilateral ligation of the internal iliac arteries
- Selective arterial embolization (requires radiological support)
- Hysterectomy

18
Q

degree of shock

A

compensation
mild shock
moderate shock
severe shock

19
Q

compensation

A

blood loss 900mLs 15%
BP (systolic) no change
minimal signs and symptoms

20
Q

mild shock

A

blood loss 1200-1500mls
20-25%
bp (systolic) minor 80-100mmHg
signs - weakness, anxiety, tachy, slow capillary refill

21
Q

moderate shock

A

blood loss 1800-2000mls 30-35%
bp (systolic) marked fall 70-80mmHg
signs - tachy, restlessness, cold/clammy, pallor

22
Q

severe shock

A

blood loss 2400mls 40%
bp (systolic) profund fall 50-70mmHg
signs - collapse, depressed, air hunger, anuria

23
Q

resus PPH

A

wide bore cannula x2
collect bloods for FBC, cross match and HB
crystalloids - n/s, hartmanns in a volume at least 3 times the measured volume lost
blood
colloids

24
Q

uterine inversion

A

incorrect management
short cord
precipitate labour and/or birth
manual removal
pathologically adherent placenta
spont. with no obvious cause

25
Q

classification of uterine inversion

A

1st degree - fundus reaches the internal os
2nd degree - the body of the uterus is inverted to the internal os
3rd degree - the uterus, cervix and vagina are inverted and are visible

26
Q

spontaneous perineal trauma

A

Perineal trauma involves any type of damage to the female genitalia during labour, which can occur spontaneously - Anterior perineal trauma can affect the anterior vaginal wall, urethra, clitoris and labia.

27
Q

1st degree tear

A

injury to skin

28
Q

2nd degree tear

A

injury to the perineum involving perineal muscles but not involving the anal sphincter

29
Q

3rd degree tear

A

injury to the perineum involving the anal sphincter complex, 3a, 3b, 3c

30
Q

4th degree tear

A

injury to the perineum involving the external anal sphincter and internal anal sphincter and anal epithelium

31
Q

episiotomy

A
  • Surgical incision made into the end perineum, which is required should be performed only immediately prior to birth to enlarge the vaginal outlet and to assist the birth of the baby
  • Problems include unsatisfactory anatomical results, increased blood loss, perineal pain
  • Indications – fetal distress, short or rigid perineum, shoulder dystocia, fetal malposition, instrumental
32
Q

types of episi

A
  • Midline – cut vertically from the fourtchette down towards the anus
  • Mediolateral – starts in the midline position at the fourchete but is then directed diagonally outwards to avoid the anal sphincter
33
Q

complications of the puerperium

A
  • PPH
  • Thrombophlebitis
  • Deep vein thrombosis
  • Pulmonary embolus
  • Puerperal infection
  • Puerperal haematoma
  • Breast problems
34
Q

puerperal infection

A
  • Temp of 38 occuring on a single occasion or of 37.5 occuring on three or more successive occasions within 28 days of childbirth
  • Deaths from puerperal sepisis in Australia are 0.1 per 1000 births
35
Q

factors of puerperal infection

A
  • Preconception
  • H/O venous thrombosis, UTI, mastitis, pneumonia
  • Diabetes
  • Anemia, malnutrition
  • Alcohol/drug abuse
36
Q

intrapartum factors of infection

A
  • PROM
  • Chorioamnionitis
  • Prolonged labour
  • Bladder catheterisation
  • FSE
  • Retained placental fragments
37
Q

general plan for infection

A
  • Antibiotics
  • Obs 4th hrly
  • Fluids
  • Comfort measures
  • Assistance with mothercrafting
  • Education
  • Documentation

Complex Care 1 (9 decks)

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