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Gyne > Third Stage > Flashcards

Third Stage Flashcards

1
Q

What is the third stage of labor?

A

From delivery of fetus > expulsion of placenta

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2
Q

What is the normal duration for third stage of labor?

A

5-10 min but can be up to 30 minutes

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3
Q

When is third stage of labor considered prolonged

A

> 30 minutes

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4
Q

What is the main event in third stage of labor

A

Palcenta seperation and expulsion

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5
Q

What are the signs for placenta seperation?

A

1- gush of blood from vagina
2- umbilical cord lengthening
3- fundus of the uterus raises and firms (starting to contract)

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6
Q

What are the two types of managemend for 3rd stage of labor?

A

1- physiological: waiting

2- active: cord traction + uterogenic agent

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7
Q

Why is active management of third stage of labor is indicated?

A

To reduce the risk of PPH

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8
Q

What is the expectant method to treat third stage of labor

A

Observe, massage uterus, and examine placenta, membrane and cord

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9
Q

What is the active management of third stage of labor?

A
  • Oxytocin after delivery of posterior shsoulder of the feuts
  • brandt-andrews maneuver to tract the umbilical cord
  • uterine massage
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10
Q

How to do controlled cord traction?

A

Pulling the cord gently with pressing on the uterus to prevent uterine inversion

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11
Q

What are the major complications of third stage of labor

A

1- hemorrhage
2- lacerations
3- retained placenta
4- uterine inversion

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12
Q

Define PPH:

A

1- excessive genital bleeding (>500ml in vaginal - >1000 in CS)
2– signs of hypovoulmeic stature

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13
Q

What is early PPH and what is late PPH

A
  • early: within 24 hours

- late: 24hours > 6 weeks

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14
Q

What are the causes for early PPH (Four Ts)

A

1- Tone (atony)
2- trauma (episiotomy & laceration),
3- tissue (retain placenta\membrane),
4- thromboplastin (IUFD, PET, Sepsis, abruptio)

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15
Q

What is the most common cause for eaerly PPH?

A

Uterine atony

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16
Q

what is the pathogenesis of atony? How does it cause bleeding

A

The muscle fibers surround blood vessels, if they contract they stop bleeding.
Atony, loss of contraction

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17
Q

What are the predisposing factors for uterine atony?

A
  • general anesthesia
  • uterine overdistension (polyhydraminous or multipara)
  • prolonged labor
  • uterine leiomyoma
  • operative delivery
  • oxytocin
  • infections
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18
Q

What is the general approach for managing PPH?

A
  • adquate circulation (IVF + blood)
  • adquate oxygenation
  • reverse or prevent coagulopathy
  • elimentation of obstetric causes (laceration or RPOC)
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19
Q

Why is insuring tissue oxygenation in the management of PPH is important?

A

To prevent end organ damage which is the most important complication of PPH

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20
Q

How to manage PPH?

A
  • immediate: [2] large bors (IVs) & infuse isotonic crystalloid + compress & massage uterus
  • inspect vagina\cervix for trauma or suture
  • explore uterus to remove RPOC
  • examine for coagulation
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21
Q

How to treat atony

A

Uterine massage, tonic drugs, blood or blood products, surgicall if needed

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22
Q

What are the uterine tonic drugs?

A

Oxytocin, ergomertine, misoprostol

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23
Q

What are the surgical treatment options for atony?

A

1- Balloon temponade
2-Uterine artery embolization
3- hysterectomy

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24
Q

When to opt for hysterctomy in aton

A

If all other options have failed

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25
Q

What is the most common cause for late PPH?

A

Subinvolution of the uterus

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26
Q

What are the signs of lat PPH

A

1- fever
2- foul smelling vaginal bleeding
3- anemia
4- uterus is soft and larger than expected

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27
Q

What are other causes of late PPH?

A
  • Retained placenta\blood clots

- Infection (endometritis)

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28
Q

What is the microbial cause for endometritis?

A

Polymicrobial (give broad spectrum AB)

29
Q

How to treat PPH secondary to endometritis?

A

1- admit
2- adminster broad spec AB
3- + or - evacuation (RPOC)

30
Q

What is puerperium?

A

From delivery of baby > 6-8 weeks postpartum

31
Q

What happens during the puerperium period

A

Reproductive organs return to the pre-pregnancy state

32
Q

How long does uterus return to its pre-pregnancy state?

A

6 weeks

33
Q

When will the uterus be impalpable post delivery?

“Returns to the pelvic organ”

A

2 weeks post delivery

34
Q

What will happen to the uterus immidiatly after birth?

A

Reach the umbilical level (20wks)

35
Q

What is the weight of the uterus immediately post partum and after the periperurum period?

A
  • postpartum: 1kg

- periperum: <100g

36
Q

What is the involution of uterus

A

process by which the post partum uterus weighing 1KG

returns to its pre pregnancy state of less than 100 g.

37
Q

What physiological action acceleraets the involution of uterus

A

Oxytocin release by breastfeeding

38
Q

What happens to the cervix post delivery?

A

Lose its elasticity & closed by 2nd weeks.

39
Q

Does the vagina return to the nulliparous dimensions

A

No

40
Q

What happens to the decidua 2-3days postpartum?

A

Differentiated into two layers

  • superifical> necrotic forming lochia
  • basal > the new endometrium
41
Q

What is lochia

A

Blood stained uterine discharge that consist of blood and necrotic decidua

42
Q

What are the types of lochia

A

1- rubra: red (1-3d)
2- serosa: pink & pale (4-10)
3- alba: yellow (>11)

43
Q

How does the abdominal wall change in pureperium state

A

Returns to prepregnancy appearance but the silver stria presist

44
Q

Describe leukocytosis:

  • during birth:
  • after birth:
  • after 1 week postpartum:
A
  • during & after: leukocytosis (30,000)

- 1 week: return to pre-pregnancy state

45
Q

What happens to the CVS after delivery

A
  • Increase peripheral vascular resistance

- increase in CO

46
Q

When is the most critical period for pregnant women with cardiac disease

A

48 hours following delivery due to increase cardiac output

47
Q

What happens to the urinary tract post-delivery

A

Increase capacity and insensitive to overdistension > incomplete emptying & excessive residual urine

48
Q

How long does it take to return to normal body weight after delivery

A

6 months *may retain 1.4kg of excess weight

49
Q

How many kg is lost following delivery?

A

Almost 5-6kg due to uterine evacuation and normal blood loss

50
Q

How long does it take to return of menesturation after delivery

A
  • breast feeding: lactational amenorrhea

- not breast feeding: 6-8 weeks

51
Q

What does colustrum contain?

A

Protein, fat, mineral and IgA

52
Q

How does breastfeeding occurs

A

1- drop in estrogen
2- suckling stimulate prolactin + oxytocin
3- production of colostrum (3-6d) & mature milk

53
Q

What is puerperal pyrexia

A

Fever >39 on [2] occasions at least [4] hrs apart for up to 10days postpartum

“Excluding the first 24 hours post partum”

54
Q

Why do we exclude the first 24 hours post partum from puerperal pyerxia?

A

Increase inflammatory mediators causing fever

55
Q

What are the 7Ws of maternal fever

A

0: wind
1: water
2-3: womb
4-5: wound
5-6: walk
7-21: wean
Anytime: wonder drug

56
Q

What is the most important risk factor for postpartum endometritis?

A

C\S

57
Q

Name predisposing factors for postpartum endometritis (5)

A 
1- anemia 
2- prolonged labor 
3- PROM 
4- C\S 
5- DM & SLE
58
Q

What type of infection is endometritis considered?

A

Ascending infection

59
Q

What is the clinical presentation for endometritis

A

Fever - pelvic pain - bleeding\discharge - abnormal smell and delay in uterine involution

60
Q

How to manage endometritis

A
  • admit
  • IV or oral fluids
  • antipyretics
  • IV antibiotics (Clinda + genta)
61
Q

Which tissue in the breast is responsible for producing the milk
(Glandular vs lactiferous)

A

Glandular tissue (alveolar cells)

62
Q

What are the changes that happen during pregnancy for the breast

A

1st trimester: ductal proliferation

2nd trimester: lobular formation

63
Q

What are the mechanisms of lactation?

A

1- mammogenesis
2- lactogensis
3- galactopoeisis

64
Q

What is the mammogenesis?

A

Development of breast tissue during pregnancy

65
Q

What are the stages of lactogenesis?

A

Stage1: 2nd half of pregnancy
Stage 2: immediately after delivery

(Stage 1: progestrone inhibits milk - stage 2: progestrone is gone)

66
Q

What maintains the galactopoesis

A

Suckling which increases production of oxytocin & prolactin

67
Q

What is the role of
Oxytocin, prolactin, progestrone
In breastfeeding

A
  • oxytocin: letdown (contract muscle surrounding the alveoli to eject milk)
  • prolactin: production of milk
  • progestrone: inhinit milk production
68
Q

What is sheehan syndrom and what does it most commonly affects?

A

ant Pituitary ischemia

Gyne (18 decks)

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