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21 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Active mx of third stage of labour |
1. Oxytocics 2. Controlled cord traction 3. Uterine massage |
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Dose of oxytocin |
10 U IM + 5 U IV Bolus |
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4 Ts in pph pathology |
Tissue Thrombin Tone Trauma |
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Third stage complications |
1. Pph 2. Retained p 3. Morbidly adherant p 4. Inversion of uterus 5. Amniotic fluid embolism |
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1°pph |
500 ml+ in 24 h 1000ml+ in cs |
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2°pph |
After 24h upto 12 weeks |
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Causes of pph |
(6) Atonic Traumatic Coagulopathy Retained p Morbidly adherant p Uterine inversion |
(6) |
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Factors predisposing to pph |
GOLMAL PPH COMA |
(13) |
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O/E of atonic |
Flabby uterus Shock symptoms |
(2) |
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O/E of Traumatic |
Contracted uterus Trickling blood Uterine massage doesn't stop bleeding |
(3) |
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Coagulopathy causes |
Sepsis Sev. Preeclampsia with HELLP Abruption AF embolism IU Death |
It causes DIC and hypofibrogenemia (5) |
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Mx of PPH |
General Medical Mechanical Surgical |
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General |
Resuscitation Ix Monitor Confirm D× |
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Resuscitation |
Call for help 2 large bore IV lines 16 gauge, IVF NS O2 10-15L/min BT, prc, ffp, cryo, plt conc. Hand on uterus to dx and allow contraction |
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Medical with dose |
Uterotonics: Oxytocin 10-20 U in 500ml NS Methergin 0.2mg IV 15minly PGF2< 250microg im and intramurally, 15minly upto 3 times. |
(3) |
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Mechanical |
1. Hand on uterus 2. Bimanual compression 3. Uterine packing 4. Balloon tamponade 5. Condom tamponade |
(5) |
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Surgical |
1. Undersewing 2. Cho's block sutures 3. B-Lynch suture 4. modif B-Lynch suture 5. Systematic pelvic devascularisation 6. Angiographic embolisation 7. Hysterectomy |
(7) |
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Traumatic |
Look for tears Repair (sutures) Antibiotics Can coexist with atonic |
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2°pph cause |
Fragments of placenta retained Poor healing of cs uterine incision Sepsis Trophoblastic tumor |
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2°pph dx and rx |
1. Broad spectrum Antibiotics 2. USG to confirm dx 3. Evacuation of tissue, sent for assessment 4. If still pph, then pelv. Devasc., hysterectomy. |
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Sheehan synd signs |
Rare complication Lactation failure 1st sign Adrenocortical insufficiency Hypothyroidism Amenorrhoea Empty sella tursica of radiology |
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