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48 Cards in this Set
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management of severe APH and PPH |
Call for help Oxygen by mask initially 2 14-gauge intravenous lines Full blood count and clotting studies Test for renal function and liver function tests Cross-match at least 6 units of blood Fluid resusication intravenously Notify blood bank and consult haematologist Foley catheter into the bladder and fl uid balancechart Transfuse blood as soon as possible – uncrossmatchedsame group as mother or, in extremecases, O negative Central venous pressure and arterial lines May need fresh frozen plasma, platelets andcryoprecipitate (consult haematologist) Eliminate the cause – deliver the baby andplacenta, manage postpartum haemorrhage |
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complications of abruption |
MATERNAL SHOCK FETAL HYPOXIA RENAL SHUTDOWN DIC |
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CAUSES OF ABRUPTION |
MULTIGRAVIDA SMOKING COCAINE MULTIPLE GESTATIONS POLUHYDRO TRAUMA HYPERTENSION |
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HISTORY IN A WOMAN WITH PLACENTAL ABRUPTION |
PAINFUL BLEEDING |
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SIGNS IN PLACENTAL APRUPTION |
HARD TENDER UTERUS BLEEDING LOW BP RAISED PULSE OLIGOURIA REDUCED FETAL MOVEMENTS |
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PREVIA PRESENTATION SIGNS INVESTIGATIONS |
PAINLESS RECURRENT CAUSELESS THIRD TRIMESTER BLEEDING SOFT NON TENDER UTERUS U/S, CBC, CLOTTING PROFILE, BLOOD GROUPING AND CROSS MATCHING |
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VASA PRAEVIA |
LOSS OF FETAL BLOOD LEADING TO FETAL DEATH AFTER RUPTURE OF MEMBRANE |
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RISK FACTORS FOR PLACENTA PRAEVIA |
PREVIOUS C SECTION UTERINE STRUCTURAL ANOMALY (SUBMUCOUS FIBROIDS) MULTIPLE GESTATIONS ASSISTED CONCEPTION |
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CAUSES FOR PTL |
APH INFECTION UTERINE ABNORMAILTY CERVICAL WEAKNESS DUE TO CONE BIOPSY SURGICAL PROCEDURE IDIOPATHIC CONCURRENT ILLNESS |
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DIAGNOSIS OF PTL |
The gestational period is less than 36 completedweeks. • Uterine contractions, preferably recorded ona tocograph, occur every 5–10 minutes, last for atleast 30 seconds and persist for at least 60 minutes. • The cervix is more than 2.5 cm dilated and more than75% effaced. |
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TEST FOR PTL DIANOSTIC |
FIBRONECTIN |
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MANGEMET OF PPROM |
ADMIT IN FACILITY WITH NICU STERILE SPECULUM EXAM , POOLING TEST HVS FOR BACTERIOLOGY MONITOR MOTHER BP, TEMP, PULSE SERIAL CTG PROPHYLACTIC CORTICOSTEROIDS ERYTHROMYCIN( GROUP b STREPTOCOCUS, POLYBACTERIAL) |
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FIRST STAGE MANAGEMENT |
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SECOND STAGE MANAGEMENT |
LIE IN ANY POSITION EXCEPT SUPINE POSITION LITHOTOMY POSITOIN WHEN URGE TO PUSH AT 1 OR STATION TELL HER TO PUSH GIVE MORE ANALGESICS DUE TO MORE PAIN USE WET TOWELS SOME WOMEN GET INTO DIFFERENT POSITIONS UNTIL THE HEAD IS VISIBLE SECOND STAGE TAKES 2 HOURS OR 3 WITH EPIDURAL |
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MECHANISM OF LABOR |
SERIES OF CHANGES IN THE ATTITUTDE AND POSITION OF THE FETUS DURING ITS PASSAGE THROUGHT THE BIRTH CANAL ENGAGEMENT DECENT AND FLEXION OCCUR SIMULTANEOUSLY |
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ENGAGEMENT |
WHEN THE EIDEST PRESENTING PART OF THE FETUS HAS PASSED SUCCESSFULLY THROUGH THE PELVIC INLET. |
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INTERNAL ROTATION |
DONE BY THE LEVATOR ANNI MUSCLES WHEN THE HEAD TOUCHES IT. |
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RESTITUTION |
1/8TH TURN OF THE CHILD HEAD AFTER EXTENSION |
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EXTERNAL ROTATION |
1/8TH ROTATION AFTER RESTITUTION THAT BRINGS THE SHOULDERS IN LIN E WITH THE AP DIAMETER |
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what are the fates of an OP |
delivered as an OA if persists as op it might deliver normally but with more damage , instruments can be used vaccum or Kjelands forcep if deep transverse arrest then manual rotation or vaccum to rotate if caput and molding are mild, if not then C |
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vitamin k given |
at birth , 3-4 days , 6 weeks |
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expectant management |
.gush of blood • The fundus rises in the abdomen and becomesspherical • That part of the umbilical cord which can be seenat the vulva, lengthens • If the fundus is lifted upwards the umbilical corddoes not shorten. |
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active management |
oxytocin followed by manual traction after 2 minutes , i failed try again after 10 minutes if failed then removal of RPOC under general anesthesia. |
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abnormal presentations |
breech presentations, face presentations, transverse presentations and browpresentations. |
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breech presentation |
episotomy is done when anus is seen over fourchette shoulders are delivered by rocking boat or the same thing has to be done manually called lovesets Mauricceau smelly veit maneuvere is done to remove the head and if it doesnt work then instruments are used |
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puerperium |
2 day, hpl drops 7day, E n P drops 10 day , HCG drops 2 weeks, cvs comes back to normal |
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uterus isnt palpable abd |
on 12th day |
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lochia |
blood and remnants of the placental tissue which presents as dischage after birth |
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PPH |
Primary postpartum haemorrhage is a blood loss pervaginam of more than 500 mL in the first 24 hours afterbirth. Secondary postpartum haemorrhage is defined asabnormal bleeding from 24 hours after birth until 6 weekspostpartum. |
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etiology of PPH |
remnants atony coagulopathy laceration in the genital tract |
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hartmanns solution |
crystalloid |
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PPH third stage |
• A contraction is rubbed up and fundal pressurecombined with controlled cord traction is generatedwith the aim of delivering the placenta. If bleedingcontinues in spite of a contracted uterus, the lowervaginal tract should be inspected to see if there is anydamage.• If the placenta cannot be delivered or if, when it isdelivered, inspection shows that it is incomplete,the uterine cavity must be explored. Unless thepatient already has an epidural anaesthetic, ageneralanaestheticis given and manual removalof the placentais effected by inserting a glovedhand into the uterine cavity and controlling itsactions with the other hand placed on the fundus(Fig. 23.2). The umbilical cord is followed to itsinsertionand the lower placental edge is identified.With the palm of the intra-uterine hand facingthe uterinecavity,the obstetrician separates theplacentafrom its attachmentswith a sawing motion.When the placentahas been completely detached,the remainderof the uterine cavity is explored |
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PPH true |
check the placenta is totally out massage the uterus the give synto,ergosyntometrine,miso, carboprost if hypotonic if more than 1000ml loss then transfuse check and treat coagulopathy if U is contracted then check genital tract manual compression baloon cathtrization internal artery ligation, b lynch suture, hysterectomy uterine artery embolisation in placcenta percreta |
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complications of pph |
orthostatic hypotension PP ANEMIA AND DEPRESSION SHEEHANS SYNDROME OCCULT MI, DILATATIONAL MYOPATHY |
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episiotomy complications |
take consent must be done in te second phase of labor, use local anesthetic and do it mediolaterally as there are less chances of extension hemorrhage,infection, dysperunia, extension to anus. |
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instrumental delivery prerequisites |
uterus should be contracting, if not then augment the uterus bladder should be empty head should be fully engaged cervix should be fully dilated membranes should be ruptured adequate analgesia position of the presenting part should be known eg Occipito posterior experienced obstetrician and consent of the patient episiotomy if nulliparous and forceps delivery to avoid lacerations |
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vaccum delivery |
identify the flexion point and then apply suction cup there, the pressure should be between 0.8kg/cm2, but first make sure there are no maternal tissues in between, hold the cup nwith your index finger and thumb and then apply suction perpendicularly, procedure should be done in less than 15 minutes, and should be tried only twice. pudendal nerve block is also done. |
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c sectin major indications |
previous c malpresentation dystocia fetal distress |
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cord prolapse management |
when the cord is present below the presenting part with the membranes ruptured prepare for a c section and meanwhile put patient on all fours, push the cord in and inflate the bladder with 500ml normal saline, try not to touch is much because it causes vasospasm, |
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diagnosis of shoulder dystocia |
turtles sign |
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management of shoulder dystocia |
call for help episiotomy macroberts position suprapubic pressure reuben 2 wood screw reverse wood screw symphysiotomy zavanellis fracture of clavicle |
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complications of dystocia |
clavivle, humerus hand fracture CP child brachial plexus compression 3rd to 4 drgree perineal tears |
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most common infection during pregnancy |
UTI |
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when to give anti d to Rh D negative women |
it should be given when theres threatened or spontaneous miscarriage, abruption, chorionic villus sampling, termination of pregnancy, curettage it should be given antenatally at weeks 28 and 34 routinely at delivery if the infant is Rh D positive the does should be enough to clear up the featal blood cells and to calculate that we do a kliehauer betke test. |
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benefits of a dating scan |
accurate dating reduced incidence of induction for prolonged pregnancy (cause we will know its not prolonged) fetal abnormalities can be detected multiple pregnancies failed pregnancy |
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antenatal care |
physical exam in which we have to calculate the BMI, as those with low bmi are predisposed to IUGR and with higher are to GD, pre eclampsia check for bP as well urinalysis: to check for asymptomatic bacteriuria, and to check for protein for pre eclampsia CBC: less than 11 is anemia, it is repeated at 28 weeks of gestation. screenig for fetal abnormalities: nuchal translucency at 11-14 weeks neural tube defects: 15-20 weeks |
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when s gestational diabetes be tested what are the risks |
risk factors are if the BMI is more than 30kg/m2 previous large baby or GD, or first degree relative 2hr 75gm OGTT is done at 24-28 weeks in women with these risks those with history of gd are tested at 16-18 and then at 24-28 |
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anemia |
10-11 mild 7-10 moderate 4-7 severe less than 4 is very severe most common cause is iron deficiency and acute blood loss closely spaced, multiple, low socio economic status, vegan. serum ferritn level is the diagnostic test. it is not affected by recently injested iron, and shows the true level, less than 15 means iron depletion, less than 13 means iron deficiency, oral supplemtation should be taken on empty stomach and ideally with vitamin C, blood transfusion is done when the symptoms are severe or the patient is severly anemic or when the GA is more than 34 weeks. oral iron takes 3-4 weeks to raise the hb, parentral is given if the aptient is not compliant or she has a malapsorption syndrome, or she has intolerance. |
