Varney Study Guide Chapter 15

Front 1

Retained Placenta

Back 1

Placenta that has not separated and creates no visible hemorrhage
Interventions: baby to breast, nipple stimulation, squatting position, couple noncoital lovemaking, assure empty bladder, intraumbilical oxytocin 10IU in 200CC nl saline into umbilical vein.
Monitor woman for vitals, shock, bleeding, increased fundal height, empty bladder.
Perform manual removal with physician consult in hospital.

Front 2

third stage postpartum hemorrhage

Back 2

due to partial separation of the placenta
most common reason= mismanagement of third stage (do not massage uterus)
dx: steady flow of blood placenta still attached
management: call back up and ambulance, thouroughly massage uterus and controlled cord traction, place IV, type and cross match, watch for s/s of shock, manually remove placenta with empty bladder, if all else fails add pit to IV
this complication is extremely rare if uterus is left alone during the third stage.

Front 3

Placenta Accreta

Back 3

abnormal partial or total adherence of the placenta to the uterine wall (myometrium)
predisposing factors: placenta previa, previous c-sect, unexplained elevated MSAFP
dx: acute 3rd stage hemorrhage due to partially separated placenta, accreta discovered during attempted manual removal. Complete acreta has no s/s, no hemorrhage
management: stat call backup, transfer to hospital, prep for immediate surgery (emergency hysterectomy) do not further attempt to remove placenta, will cause hemorrhage/rupture/inversion.

Front 4

definition uterine inversion

Back 4

the abnormal turning of the uterus inside out with the internal surface of the corpus lying in or outside of the vagina. rare emergency 1:2000- 1:12,000
most often occurs in primips.

Front 5

etiology of inversion

Back 5

uterine abnormality
dysfunctional uterus
fetal abnormality
iatrogenic
spontaneous

Front 6

classifications of inversion

Back 6

incomplete
complete
prolapsed
acute
subacute
chronic