Intrapartum Flashcards
Series of events by which uterine contractions and abdominal pressure expels the fetus and other by products of pregnancy via the birth canal
Labor
Descent and settling of the fetal head into the pevis
Engagement
Spaces b/n bones of the fetal head
Fontanels
Division b/n bones f the fetal head
Sutures
What are the 5 theories in labor
- Uterine stretch theory
- Oxytocin theory
- Progesterone deprivation theory
- Prostaglandin cascade theory
- Theory of aging placenta
The idea of this theory is based on the concept that any hollow body organ, when stretched to its capacity will inevitably contract to expel its contents
Uterine stretch theory
According to this theory, the uterus, a hollow organ, bcms stretched due to the growing fetal structures, in return, the pressure increases causing physiologic changes (uterine contractions) that initiate labor.
Uterine stretch theory
According to this theory, pressure on the cervix stimulates the hypophysis to release oxytocin from the maternal posterior pituitary gland.
Oxytocin theory
What is released due to the pressure on the cervix which would then stimulate the hypophysis to release it
Oxytocin
The presence of this hormone causes the initiation of contraction of the smooth muscles of the body
Oxytocin
According to this theory, progesterone has the ability to inhibit motility, thus, if its amount decreases, labor pains occur
Progesterone deprivation theory
This hormone is designed to promote pregnancy and is believed to inhibit uterine motility
Progesterone
What theory indicates that increase in prostaglandin causes uterine contraction thus, labor is initiated
Prostaglandin Cascade theory
What hormone does fetal membrane and uterine increase?
Prostaglandin
A decrease in progesterone amounts also elevates what hormone?
Prostaglandin
According to this theory, Uterine contractions is caused by the decrease in blood supply to the uterus due to advance placental age
Theory of aging placenta
What are the 6 steps in initiation of labor
- Baby moves deeper into mother’s birth canal
- Pressoreceptors in cervix of uterus excited
- Afferent impulses to hypothalamus
- Hypothalamus sends efferent impulses to posterior pituitary, where oxytocin is stored
- Posterior pituitary releases oxytocin to blood; oxytocin targets mother’s uterine muscle
- Uterus responds by contracting more vigorously
What are the 7 preliminary signs of labor
- lightening
- activity level
- braxton hick’s contraction
- overt loss of weight
- ripening of cervix
- Buttersoft ruptured BOW
- Show
Does activity during labor increase or decrease?
Increase
Does false labor would later on turn into true labor?
Yes
False labor or True labor:
Contractions remain irregular
False labor
False labor or True labor:
Contractions may be slightly irregular at first but become regular and predictable in a matter of hours
True labor
False labor or True labor:
The pain is generally confined to the abdomen
False labor
False labor or True labor:
The pain is first felt in the lower back and sweep around to the abdomen in a girdle like fashion
True labor
False labor or True labor:
There is no increase in contractions in terms of duration, frequency, and intensity. Interval remain long
False labor
False labor or True labor:
There is an increase in contractions in terms of duration, frequency, and intensity. Intervals remain short
True labor
False labor or True labor:
Contractions often disappear if the mother ambulates, relieved when walking
False labor
False labor or True labor:
Contractions continue no matter what the woman’s level of activity and is not relieved by walking
True labor
False labor or True labor:
Absent cervical changes
False labor
False labor or True labor:
Accompanied by cervical effacement and dilation
True labor
False labor or True labor:
Absent or brownish discharge
False labor
False labor or True labor:
Show:present:pink tinged
True labor
What is considered as the Passenger
Fetus
It is the largest part of the fetal body, most frequent presenting part, and least compressible of all parts
Fetal head
Alteration of the shape of fore-coming head while passing through the resistant birth passage during labor
Moulding
What are the 4 sutures of the fetal head
- Sagittal or longitudinal
- Coronal
- Frontal
- Lambdoid
Suture b/n the two parietal bones
sagittal or longitudinal suture
Suture b/n parietal and frontal bones on either side
Coronal suture
Suture b/n two frontal bones
Frontal suture
Suture that separates occipital bone and the two parietal bones
Lambdoid sutures
Wide gap in the suture line
Fontanel
What are the two fontanels
Anterior and Posterior fontanels
This fontanel has a diameter of 3 cm
Anterior
When is the ossification of the anterior fontanel
18 months after birth
This fontanel is found on the junction of sagittal suture anteriorly and lambdoid suture on either side
Posterior fontanel
The measurement of this fontanel is 1.2 x 1.2 cm
Posterior fontanel
When does the posterior fontanel close
3-4 months after birth
In the transverse diameter of the fetal head, what is the measurement of:
Biparietal:__________
Bitemporal:_________
Bimastoid:___________
Biparietal: 9.25cm
Bitemporal:8 cm
Bimastoid: 7 cm
In the anterior-posterior diameter of the fetal head, what is the measurement of:
Suboccipitobregmatic:
Occipitofrontal:
Occipitomental:
Subementobregmatic:
Suboccipitobregmatic: 9.25 cm
Occipitofrontal: 12 cm
Occipitomental: 13.5 cm
Subementobregmatic: 9.5 cm
What is the smallest AP diameter
Suboccipitobregmatic
This is when the mother is having difficulty in labor; the fetal head goes in and out repeatedly resulting in an elongated fetal head
Caput succedaneum
Formation of diffuse, boggy swelling due to stagnation of sero-sanguineous fluid in the layers of the scalp beneath girdle of contract crossing midline suture
Caput succedaneum
the formation of diffuse, boggy swelling in caput succedaneum is due to the stagnation of?
sero-sanguineous fluid
Refer to the fetal part that is above the pelvic inlet
Fetal presentation
What are the three types of fetal presentation
- Cephalic
- Breech
- Shoulder
It is also called as the mucus plug
Operculum
What are the 4 types of cephalic presentation
- Vertex
- Brow
- Face
- Mentum (sinciput or military presentation)
What are the 3 types of breech presentation
1.Complete
2. frank
3. footling
This presentation is where the head is showing first
Cephalic presentation
This presentation is where the head is showing first
Cephalic presentation
This presentation is where the butt or foot of the fetus is showing
Breech presentation
This presentation is where the butt or foot of the fetus is showing
Breech presentation
This presentation is where the fetus is lying transveraslly
Shoulder presentation
What are the two types of shoulder presentation
1.acromium
2. Hand or elbow
Relationship of the long axis (spine) of the fetus to the long axis of the mother
Fetal lie
Three types of fetal lie
Longitudinal
Transverse
Oblique
The relationship of the fetal parts to one another
Attitude or Habitus or Posture
True or false:
The fetus forms an ovoid mass that corresponds to the shape of the uterine cavity
True
What are the 4 fetal attitudes
Complete flexion
Moderate flexion
Poor flexion
Full flexion
Relationship of he fetal reference point to specific quadrant of the mother’s pelvis
Fetal Position
Identify what each letter means according to fetal position:
L-
R-
Fetal presentation:
O-
M-
Sa-
A-
Fetal landmark:
A-
P-
T-
L- Left
R- Right
Fetal presentation:
O- Occiput
M- Mentum
Sa- Sacrum
A- Acromium
Fetal landmark:
A- Anterior
P- Posterior
T- Transverse
In Fetal position, what are the first letters
L or R
In Fetal position, what are the second letters
O, M, Sa or A
In Fetal position, what are the third letters
A, P or T
4 parts of fetus as landmarks:
VERTEX – (2)
BREECH – (1)
SHOULDER – (2)
VERTEX – OCCIPUT, MENTUM
BREECH – SACRUM
SHOULDER – SCAPULA, ACROMIUM PROCESS
Measure of descent of
the presenting part
Station
What part is considered as station 0
Pelvic inlet / Ischial spine
If the fetus is on stations -3, -2, -1, the fetus is what?
Floating
If the fetus is on stations +3, +2, +1, the fetus is what?
At outlet / nearing in delivery
What stations are considered as the inlet
-3 and -2
What stations are considered as the midpelvis
-1, 0, +1
What stations are considered as the outlet
+2 and +3
when the widest part of the baby’s presenting part (usually the head) enters the pelvic brim or inlet
Fetal Engagement
Invisible line that is b/n the true and false pelvis
Linea Terminalis
What is the direction of the upper part and lower part of the passageway
Upper: Downward backward
Lower: Downwards forward
Superior half of the pelvis
FALSE PELVIS
Supports the uterus during late months pregnancy
FALSE PELVIS
Aids in directing the fetus into the true pelvis
FALSE PELVIS
Inferior half of the pelvis
TRUE PELVIS
Imaginary line from sacral prominence at the back of the pelvis to the superior aspect of the symphysis pubis at the from
LINEA TERMINALIS
Also called as Pelvic Brim (Pelvic Inlet)
LINEA TERMINALIS
3 major parts of the pelvic passageway
- PELVIC INLET
- PELVIC OUTLET
- PELVIC CAVITY
Part of the pelvic passageway:
Entrance to the true pelvis
PELVIC INLET
Part of the pelvic passageway:
At the level of Line terminalis
PELVIC INLET
Part of the pelvic passageway:
Appears heart shaped
PELVIC INLET
Part of the pelvic passageway:
Wider transversely than anterio-posterior diameter
PELVIC INLET
Part of the pelvic passageway:
Inferior Portion
PELVIC OUTLET
Part of the pelvic passageway:
At the level of Linea terminalis
PELVIC OUTLET
Part of the pelvic passageway:
Greatest Diameter is the anterio-posterior diameter
PELVIC OUTLET
Part of the pelvic passageway:
Mid pelvis
PELVIC CAVITY
Part of the pelvic passageway:
Curved Passage to slow down and control speed of birth
PELVIC CAVITY
the only way to assess the dimensions of the pelvis in labor.
CLINICAL PELVIMETRY
What are the 3 AP diameters of the pelvic inlet
- Diagonal Conjugate
- Obstetric Conjugate
- Conjugate Vera
AP diameter between anterior sacral prominence and posterior Symphysis Pubis
Diagonal Conjugate
What is the measurement of the Diagonal Conjugate
Measurement: 12.5cm to 13cm
Smallest AP Diameter
Obstetric Conjugate
AP diameter that is a Sacral promontory to the inner surface of the symphysis pubis
Obstetric Conjugate
How is the Obstetric Conjugate solved?
OC= DC – (1.5 to 2cm)
What is the measurement of the Obstetric Conjugate?
Measurement: 10.5cm – 11cm
AP diameter that is Between the posterior aspect of the symphysis pubis and the promontory of the sacrum
Conjugate Vera
How is the Conjugate Vera solved?
CV= DC– (1 to 1.5cm)
What is the measurement of the Conjugate Vera?
Measurement: 10.5 – 11 cm
The pelvic inlet diameter that is the greatest Distance between the linea terminalis on either side
Transverse Diameter
The pelvic inlet diameter that is the Segment posterior to the intersection
Transverse Diameter
The pelvic inlet diameter that Facilitates the descent of fetal head
Transverse Diameter
What is the measurement of Transverse Diameter of the Pelvic Inlet
Measurement: 13.5 cm
The pelvic inlet diameter that Extends from sacroiliac joint on one side to ilio eminence on other side
Oblique Diameter
What are the two sides of the Oblique Diameter of the Pelvic Inlet
Left OD
Right OD
What are the two points of the pelvic inlet that indicates the oblique diameter
sacroiliac joint on one side to ilio eminence on other side
What is the measurement of Oblique Diameter of the Pelvic Inlet
Measurement: 13 cm
The pelvic Cavity diameter is Mid-symphysis to fused S2, S3
AP Diameter
What is the measurement of the AP diameter of the pelvic cavity
Measures: 11.5 to 12 cm
The Transverse or Interspinous Diameter is found b/n the base of what?
Between the base of ischial spines
The pelvic Cavity diameter that is the Smallest Diameter of pelvis
Transverse or Interspinous Diameter
What is the measurement of the Transverse or Interspinous Diameter of the pelvic cavity
Measures: 10cm
The pelvic Cavity diameter is the Midpoint between ischial spines and sacrum
Posterior Sagittal Diameter
What is the measurement of the Posterior Sagittal Diameter of the pelvic cavity
Measures: 4.5 to 5 cm
The AP Diameter of the pelvic outlet is on the Inferior border of ________ to posterior aspect of ___________
pubic symphysis
sacrum tip
What is the measurement of the AP Diameter of the Pelvic Outlet
Measures: 9.5 to 11.5 cm
The Transverse or Interspinous Diameter is found b/n the base of inner edges of what?
ischial tuberosities
What is the measurement of the Transverse or Interspinous Diameter of the Pelvic Outlet
Measures: 9 to 11cm
The Posterior Sagittal Diameter is found at midpoint b/n ___________ and ___________ of the tip of the sacrum
ischial tuberosities
external surface
What is the measurement of the Posterior Sagittal Diameter of the Pelvic Outlet
Measures: 7.5 cm
A disorder where a pelvis with a measurement of less than 1.5 to 2 cm in any of its important diameters
CONTRACTED PELVIS
Contracted Pelvis is suspected if:
✓ __________ has not yet taken place after 37 weeks in primis
✓ there is a history of ______, _______ and _______ in multi
lightening
stillbirth
difficult labor
forceps delivery
Contracted pelvis is suspected if lightening has not yet taken place after how many weeks in primis?
37 weeks
True or false:
Mothers with contracted pelvis can still have a vaginal delivery?
False
Refer to the force generated by the contraction of the uterine myometrium
Power Uterine contractions
Power Uterine contractions refer to the force generated by the contraction of the __________
uterine myometrium
3 types of Power Uterine contractions
Mild
Moderate
Strong
A power where uterine muscle are somewhat tense but can be indented by a gentle pressure
Mild
A power where uterus is moderately firm and a firmer pressure is needed to indent
Moderate
A power where the uterus becomes very firm that at the height of contraction cannot be indented
Strong:
The abdomen of the mother is compared to be _____________ when she is having strong power uterine contractions
board-like
2 kinds of Power
- PRIMARY POWER
- SECONDARY POWER
Primary or Secondary power:
* Physiologic
* Involuntary urge
* Uterine muscular contractions
* Measurable
PRIMARY POWER
Primary or Secondary power:
* Psychologic
* Voluntary urge
* Use of abdominal muscles to push
SECONDARY POWER
PHASES OF CONTRACTION
o Increment
o Acme
o Decrement
A phase of contraction when the intensity of the contraction increases
Increment
A phase of contraction when the contraction is at its strongest
Acme
A phase of contraction when the intensity decreases
Decrement
Between contractions, the
uterus ________
Relaxes
What labor is where the cervix is at 0 - 3 cm
LATENT-EARLY LABOR
What labor is where the cervix is at 4 -7 cm.
ACTIVE LABOR
What labor is where the cervix is at 8 -10 cm
TRANSITION LABOR
LATENT-EARLY LABOR
Duration: ____________secs
Frequency: ________ mins
Duration: 20-40 secs
Frequency: 5-10 mins
ACTIVE LABOR
Duration: ____ secs
Frequency: _____ mins
___ hr ____hr
Duration: 40-60 secs
Frequency: 3-5 mins
3 hr 2 hr
TRANSITION LABOR
Duration: ____ secs
Frequency: _____ mins
Duration: 60-90 secs
Frequency: 2-3 mins
What power uterine contraction is experienced in latent-early labor
Mild
What power uterine contraction is experienced in active labor
Moderate
What power uterine contraction is experienced in Transition labor
Strong
What Power and Labor is this:
Excited, euphoric with some apprehension but still with ability to communicate
MILD
LATENT-EARLY LABOR
What Power and Labor is this: Takes up 6 - 12-hour 1ST stage
MILD
LATENT-EARLY LABOR
What Power and Labor is this:
Mother fears losing control of herself
MODERATE
ACTIVE LABOR
What Power and Labor is this:
Feeling of losing control, anxiety, panic, irritability
STRONG
TRANSITION LABOR
What Power and Labor is this:
Perspiration, neck vein distention
STRONG
TRANSITION LABOR
What Power and Labor is this:
N and v due to decreased gastric motility, urge to push
STRONG
TRANSITION LABOR
In the contour changes of the uterine, it is separated by what?
physiologic retraction ring
What portion of the uterine becomes thicker and active during labor
Upper portion
What portion of the uterine becomes thin-walled,
supple, and passive during labor
Lower portion
Uterine Changes
o Contour changes
- Round, ovoid uterus to _________
elongate
What are the two Cervical Changes
Effacement
Dilatation
A cervical change that is the Shortening and thinning of the cervical canal
Effacement
Why must effacement occur at the peak of dilation
cervical tearing may happen
When does effacement happen in primipara
occur before cervical dilation
A cervical change where there is Enlargement or widening of the cervix canal
Dilatation
What are the 2 main methods of cervical ripening
Non-Pharmacologic methods
Pharmacologic methods
What are the 3 Non-Pharmacologic methods
Membrane stripping
Foley bulb
Amniotomy
A Non-Pharmacologic method where it needs favorable cervix, if cervix is favorable it can get labor started
Amniotomy
Is the artificial rupturing of membranes
Amniotomy
This scoring system is used to identify if the cervix is favorable by measuring its parameters
Bishop’s score
What pharmacologic agents aid in cervical ripening
Dinoprostone (Prepadil and Cervadil) PGE₂
oxytocin
Misoprostol (Cytotec) PGE₁
What PGE is important for cervical maturation
PGE₂
What PGE causes myometrial contractions
PGF ₂ alpha
Ultrasound grading system of the placenta based on its maturity
PLACENTAL GRADING
Placental grading is related to what?
gestational age.
At what weeks (AOG) is where blood flow is easily demonstrable
12–13 weeks
At what weeks (AOG) is where Placenta is well established
14–15 weeks
What are the 4 placental grades
Grade 0, 1, 2, 3
What placental grade is this:
Homogenous placenta, uniform echogenicity—first and early second trimester
Grade 0
What is uniform in grade 0 of placental grading
echogenicity
What placental grade is this:
Occasional hypo-/hyperechoic areas—late second trimester
Grade 1
What placental grade is this:
Larger calcifications along the basal plate—early third trimester
Grade 2
What placental grade is this:
Larger and denser calcifications along with compartmentalization of placenta—late third trimester
Grade 3
It is based on the Readiness of the mother
PSYCHE
what trimester is where the mother Accept the pregnancy; Fetus as part of self
1st Tri
what trimester is where there is Quickening, mother accepts
2nd Tri
what trimester is where the mother prepares for child birth; baby layette
3rd tri
12 positions in labor
(Wa, Si, Ta, Se, Ha, Sta, Squa, Kne, Li, La, Up, Si)
- Walking
- Sitting/leaning
- Tailor sitting
- Semi-recumbent
- Hands and knees
- Standing
- Squatting
- Kneeling and leaning forward with support
- Lithotomy
- Lateral recumbent
- Upright
- Side lying
7 Mechanisms of Labor (Cardinal Movements)
- ENGAGEMENT
- DESCENT
- FLEXION
- INTERNAL ROTATION
- EXTENSION
- EXTERNAL ROTATION
- EXPULSION
A mechanism of labor where there is Settling of the presenting part of the fetus far enough
into the pelvis to be at the level of the ischial spine
ENGAGEMENT
A mechanism of labor where there is Downward movement of the biparietal diameter of the fetal head to within the pelvic inlet
DESCENT
A mechanism of labor where it Allows the longest fetal head diameter (anteroposterior) to conform to the longest diameter of the maternal pelvis
INTERNAL ROTATION
A mechanism of labor where the head meets resistance from the soft tissues of the pelvis
FLEXION
A mechanism of labor where the Head bends forward to present the smallest antero-posterior diameter (suboccipito-bregmatic diameter) to the birth canal
FLEXION
A mechanism of labor that Occurs as a result of negotiation of the fetal head to the curve of the pelvis
EXTENSION
A mechanism of labor where there is Rotation of the head, immediately after it was born, back to the diagonal or transverse position
EXTERNAL ROTATION
A mechanism of labor where the rotation Brings the shoulder into an anteroposterior position
EXTERNAL ROTATION
External rotation of the head accompanies ___________ of the shoulders
internal rotation
A mechanism of labor where the baby is delivered
EXPULSION
What are the stages of labor
Stage 1, 2, 3, 4
LENGTH OF LABOR in PRIMI
First Stage
Second Stage
Third Stage
Fourth Stage
First Stage: 12-14 hours
Second Stage: 80 minutes
Third Stage: 10 mins
Fourth Stage: 2-4 hours
Total of hours of labor in primis
14-16 HOURS
LENGTH OF LABOR in MULTI
First Stage
Second Stage
Third Stage
First Stage: 7 hours
Second Stage: 20-30 minutes
Third Stage: 10 mins
Total of hours of labor in multi
8 hours
What stage of labor is where there is Onset of labor to full dilatation
STAGE 1
Duration of stage 1 in nullipara (average and range)
8-10 hours average; 6-18 hours range
Duration of stage 1 in multipara (average and range)
6-7 hours average; 2-10 hours range
Cervical dilation per hour of stage 1 in nullipara
1.2 cm/hr
Cervical dilation per hour of stage 1 in Multipara
1.5 cm/hr
labor curve; used to identify & monitor progression of cervical dilation
Friedman’s curve
3 phases of stage 1 of labor
LATENT
ACTIVE
TRANSITION
What phase of stage 1 is:
Onset of labor until cervix starts to make change
LATENT
What phase of stage 1 is:
Greater rate of cervical change
ACTIVE
What phase of stage 1 is:
8-10 cm dilation
TRANSITION
What are the care given in first stage:
Latent:
E-
B-
A-
Latent:
E- elimination, voiding
B- breathing - chest breathing
A- ambulation
What are the care given in first stage:
Active:
A-
D-
A-
N-
Active:
A- assessment inc: v/s, cervix, FHT
D- Dry lips (oral care)
A- Abdominal breathing
N- By mouth
What are the care given in first stage:
Transient:
T-
I-
R-
E-
D-
Transient:
T- Tired
I- Inform of progress
R- Rest and breathing technique
E- Encourage and praise
D- Discomforts
DURATION CONTRACTION (LATENT)
Strength/ Intensity
Rhythm
Frequency
Duration
Show/Mucus Plug Color
S: Mild to moderate
R: Irregular
F: 5-30 min apart
D: 30-45 sec
Show: Brownish discharge, or pale pink mucus
DURATION CONTRACTION (ACTIVE)
Strength/ Intensity
Rhythm
Frequency
Duration
Show/Mucus Plug Color
S: Moderate to strong
R: more regular
F: 3-5 min apart
D: 40-70 sec
Show: Pink to bloody mucus
DURATION CONTRACTION (TRANSITION)
Strength/ Intensity
Rhythm
Frequency
Duration
Show/Mucus Plug Color
S:Strong to very strong
R:Regular
F:2-3 min apart
D:45-90 sec
Show: Bloody Mucus
What stage of labor is where there is Full dilation to delivery
STAGE 2
This stage of labor Begins from full cervical dilation to fetal expulsion
STAGE 2
Duration in nullipara and multipara of stage 2 of labor
Nullipara—30-min to 3 hours
multipara—5-30 minutes
Contractions change from the characteristic ___________
crescendo-decrescendo
This stage of labor is where Perspiration and the blood vessels in the neck may become distended
STAGE 2
Signs of imminent delivery (5)
- Mother feels as if to move her bowel
- “The baby is coming!”—classic sign
- Intense and unstoppable need to push
- Bulging perineum to crowning
- Increased bloody show
Extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery.
Modified Ritgen’s Maneuver
a cut (incision) through the area between your vaginal opening and your anus
Episiotomy
This stage of labor is where there is:
Modified Ritgen’s Maneuver
Episiotomy
Perineal Bulging
Care of the newborn
STAGE 2
This stage of labor is when the placenta is delivered
STAGE 3
Delivery of placenta-can take up to ____
30 minutes
This stage of labor Begins from expulsion of the baby to placental expulsion
STAGE 3
Duration of stage 3 of labor
5-10 minutes
What is the normal blood loss of stage 3 of labor
300-500 mL
What are the two phases of stage 3 of labor
Signs of Placental separation
Placental expulsion
What are the 4 signs of Placental separation
✓Rising of the fundus
✓Lengthening of the umbilical cord
✓Sudden gush of vaginal blood
✓Globular shape of the uterus (Calkin’s sign)
Globular shape of the uterus
Calkin’s sign
What placental presentation appears shiny and glistening from the fetal membranes
Schultze presentation
What placental presentation appears raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces showing
Duncan presentation
This stage of labor Begins from the delivery of placenta to the first 1-2 hours after birth
STAGE 4
This stage of labor is where the Contracted uterus is below the level of umbilicus
STAGE 4
vaginal discharges after birth
Lochia
What should you WOF in stage 4 of labor
bleeding
What kind of lochia is seen at the first 3 days after birth, consists
almost entirely of blood, with only small particles of decidua
and mucus
lochia rubra
What kind of lochia is seen at the 4th day where involved in the cast-off tissue decreases and leukocytes begin to invade the area, the
flow becomes pink or brownish
lochia serosa
What kind of lochia is seen at the 10th the amount of the flow decreases and becomes colorless
or white
lochia alba
Pharmacologic Management of Discomforts (6)
- Local anesthesia
- Intravenous – narcotic analgesic
- Paracervical block
- Pudendal block
- Epidural block
- General anesthesia
Median or Mediolateral:
Easy to repair
Median
Median or Mediolateral:
More difficult to repair
Mediolateral
Median or Mediolateral:
Faulty healing rare
Median
Median or Mediolateral:
Less painful in puerperium
Median
Median or Mediolateral:
Faulty healing more common
Mediolateral
Median or Mediolateral:
Pain in 1/3 cases for few days
Mediolateral
Median or Mediolateral:
Dyspareunia rarely follows
Median
Median or Mediolateral:
Dyspareunia occasionally follows
Mediolateral
Median or Mediolateral:
Anatomic end results almost always excellent
Median
Median or Mediolateral:
Anatomic end results more or less faulty in some 10% of cases
Mediolateral
