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Obs Gynae > PPH > Flashcards

PPH Flashcards

1
Q

Avg time taken for 3rd stage of labour

What is the condition called If more then the avg time taken

A

15-20min (20min)

Prolonged 3rd stage

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2
Q

After delivery of baby where does fundus lies

To what period of gestation does it correspond to

A

Just below umbilicus

20 weeks

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3
Q

Sequence of 3rd stage of labour

A
  1. Gush of blood :placenta separate :venous sinuses bleed
  2. Suprapubic bulge
  3. Lengthening of U.Cord (apparent)
  4. Height of the fundus increases :placenta comes down and pushes fundus up
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4
Q

Name the methods by which placenta separates

A
  1. Schultz method

2. Duncans method

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5
Q

Which of the following is true for Schultz method

  1. Bleeding is apparent only after complete separation of the placenta
  2. Total loss of blood is more here
  3. Retroplacental clot or Hematoma is formed here
  4. It is mc separation that occurs
A

1,3,4 are true

  1. Bleeding is apparent only after complete separation of the placenta because here placental separation begins from centre so blood collects behind the placenta
  2. Total blood loss is less here because blood collects in the centre and forms a retroplacental clot or hematoma b/w the placenta and decidua basalis stopping the bleeding
  3. 80% of the separation that occurs are by schultz type
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6
Q

Fetal or maternal which side presents at the vulva in 3rd stage of labour in the following methods

  1. Schultz method
  2. Duncans methods
A
  1. Schultz method - fetal side presents at the vulva (SHINY SIDE )
  2. Duncans method - maternal side presents at the vulva (DIRTY SIDE )
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7
Q

Explain the Duncans method of placental separation

A

It begins from periphery
External bleeding begins with separation
Hence Total blood loss is more here because there while be continues bleeding now no retroplacental clot formation occurs
Occurs in 20% only

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8
Q

Most imp part for placental separation is

A

Uterine

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9
Q

If after placental separation their is retained placenta then what should u do

A

Give oxytocin

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10
Q

Separation of placenta is along with which part

A

Spongiosa

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11
Q

Normal blood loss after normal vaginal delivery

A

500ml

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12
Q

Normal blood loss after C.S

A

1000ml

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13
Q

Normal blood loss after normal twin vaginal delivery

A

1000ml

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14
Q

Blood loss in Cesarian hysterectomy

A

1.5 L/1500ml

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15
Q

Criteria for PPH

A

PPH blood loss more than normal

  1. BL >500ml in normal vaginal
  2. BL>1000ml in C.S
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16
Q

Mcc of primary PPH

A

Uterine atony

17
Q

Mcc of secondary PPH

A

Retained placental tissue

18
Q

Which placental abnormality is risk factor for PPH

A

Succenturiata and bilobata

19
Q

What is the difference between bilobata and succenturiata

A

Bilobata have equal lobes

Succenturiata have unequal lobes

20
Q

Battle door placenta

Can it cause PPH

A

Umbilical cord attached to the periphery

Yes when we pull it ,it can cause PPH

21
Q

MCC of PPH

  1. Atony
  2. Rupture uterus
  3. Amniotic fluid embolism (AFE)
  4. Inversion
  5. Retained tissue
  6. Genital tract trauma
A

ATONY >Genital tract trauma > Retained tissue > inversion > rupture uterus >AFE

22
Q

Causes of PPH

A

GENERAL
Tone , trauma ,tissue ,thrombosis
SPECIFIC
Atony > genital tract traum >retained tissue> inversion > rupture uterus > AFE

23
Q

Prophylaxis for all labouring patients

Prophylaxis against what

A

AMTSL

PPH

24
Q

Components of AMTSL

A
  1. Uterotonic agents given immediately after delivery
  2. Removal of placental cord by controlled cord traction
  3. Cord clamping
  4. Intermittent uterine tone assessment
25
Q

Uterotonic agents given immediately after delivery

A 
Oxytocin (mainly,best)
Methergin
Syntometrine
Carbetocin 
Misoprostol
Tranexaemic acid
26
Q

Uterotonic agents given after delivery is oxytocin…….with in time limit it should be given

A

It should be given with in 1 min of delivery

Dose 10 I.U. - i/m bolus or i/v infusion

27
Q

What is the time of onset of action of oxytocin when given i/m bolus and i/v infusion and what will be its duration of action

A 
1. Oxytocin i/m bolus 
Time of onset - with in 3 min 
Duration of action - 3 hours
2. Oxytocin i/v infusion 
Time of onset - immediate 
Duration of action - 1 hour

*t1/2 oxytocin -3 min (3-5 min)

28
Q

Oxytocin is a octapeptide or nonapeptide

A

Oxytocin is both octapeptide and nonapeptide

Naturally occurring - nonapeptide
Synthetic formulation - octapeptide

29
Q

Where is the octapeptide form of oxytocin synthesised

A

Hypothalamus in the PARAVENTRICULAR NUCLEUS

30
Q

How do you store oxytocin

For how long it can stay normal if kept at room temp

A

Refrigerator
2 to 8° C ideally
It shelf life than last only for 3 months

31
Q

Milk synthesising hormone

A

Prolactin

32
Q

Milk ejection hormone

A

Oxytocin

33
Q

Why oxytocin is not given i/v bolus when used as uterotonic agent

A 
It causes severe side effects 
Hypotension 
Reflex bradycardia 
Arrhythmia
Cardiac arrest 
Myocardial infarction 
ALSO water intoxication

Pneumonic - MARCH

Obs Gynae (7 decks)

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