PPH

Question 1

Avg time taken for 3rd stage of labour

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

Answer 1

15-20min (20min)

Prolonged 3rd stage

Question 2

After delivery of baby where does fundus lies

To what period of gestation does it correspond to

Answer 2

Just below umbilicus

20 weeks

Question 3

Sequence of 3rd stage of labour

Answer 3

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

Question 4

Name the methods by which placenta separates

Answer 4

1. Schultz method

2. Duncans method

Question 5

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

Answer 5

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

Question 6

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

1. Schultz method
2. Duncans methods

Answer 6

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

Question 7

Explain the Duncans method of placental separation

Answer 7

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

Question 8

Most imp part for placental separation is

Answer 8

Uterine

Question 9

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

Answer 9

Give oxytocin

Question 10

Separation of placenta is along with which part

Answer 10

Spongiosa

Question 11

Normal blood loss after normal vaginal delivery

Answer 11

500ml

Question 12

Normal blood loss after C.S

Answer 12

1000ml

Question 13

Normal blood loss after normal twin vaginal delivery

Answer 13

1000ml

Question 14

Blood loss in Cesarian hysterectomy

Answer 14

1.5 L/1500ml

Question 15

Criteria for PPH

Answer 15

PPH blood loss more than normal

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

Question 16

Mcc of primary PPH

Answer 16

Uterine atony

Question 17

Mcc of secondary PPH

Answer 17

Retained placental tissue

Question 18

Which placental abnormality is risk factor for PPH

Answer 18

Succenturiata and bilobata

Question 19

What is the difference between bilobata and succenturiata

Answer 19

Bilobata have equal lobes

Succenturiata have unequal lobes

Question 20

Battle door placenta

Can it cause PPH

Answer 20

Umbilical cord attached to the periphery

Yes when we pull it ,it can cause PPH

Question 21

MCC of PPH

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

Answer 21

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

Question 22

Causes of PPH

Answer 22

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

Question 23

Prophylaxis for all labouring patients

Prophylaxis against what

Answer 23

AMTSL

PPH

Question 24

Components of AMTSL

Answer 24

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

Question 25

Uterotonic agents given immediately after delivery

Answer 25

``` Oxytocin (mainly,best) Methergin Syntometrine Carbetocin Misoprostol Tranexaemic acid ```

Question 26

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

Answer 26

It should be given with in 1 min of delivery | Dose 10 I.U. - i/m bolus or i/v infusion

Question 27

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

Answer 27

``` 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)

Question 28

Oxytocin is a octapeptide or nonapeptide

Answer 28

Oxytocin is both octapeptide and nonapeptide Naturally occurring - nonapeptide Synthetic formulation - octapeptide

Question 29

Where is the octapeptide form of oxytocin synthesised

Answer 29

Hypothalamus in the PARAVENTRICULAR NUCLEUS

Question 30

How do you store oxytocin | For how long it can stay normal if kept at room temp

Answer 30

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

Question 31

Milk synthesising hormone

Answer 31

Prolactin

Question 32

Milk ejection hormone

Answer 32

Oxytocin

Question 33

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

Answer 33

``` It causes severe side effects Hypotension Reflex bradycardia Arrhythmia Cardiac arrest Myocardial infarction ALSO water intoxication ``` Pneumonic - MARCH