Week 9 Flashcards

Question

What is the pre-hospital management for phsyiological management of third stage of pregnancy?

Answer 1

```  May take 5 –60mins  Clamp cord after pulsation ceases  Placenta expelled by Maternal effort –> Maternal positioning -? Utilize gravity • e.g squatting or sitting –> Initiation of breastfeeding •release oxytocins  Support Placenta as it delivers –may require a see-saw type manouevre to deliver (do not pull)  Ensure uterus well contracted –> Gentle palpation of fundus (avoid excessive touching) –> Monitor PV bleeding –if increased •Consider active management ```

Answer 2

Immediately after delivery of the placenta - massage the fundus of the uterus through the woman’s abdomen until contracted •Palpate for a contracted uterus every 15/60 & -> repeat uterine massage for first 2 hours • Ensure that the uterus does not relax after uterine massage

Answer 3

 Assess uterus contracted but don’t over handle –> Beware of “fundal fiddling”  Gentle visual inspection of genital tract – –> Apply direct pressure to any tears  Encourage passing urine before transport  Encourage breastfeeding  Transport all blood stained material & products in biohazard bag –> Inspect placenta & membranes if desired

Answer 4

– 75 % of abnormal implantation into muscle | – Placenta attached onto the myometrium but does not penetrate the muscle itself.

Answer 5

– 17% of abnormal implantation into muscle | – Extends into the muscle itself

Answer 6

– 5% of abnormal implantation into muscle | – Penetrates the entire muscle wall & other organs

Answer 7

where a small portion or lobe of placenta separated from the main body

Answer 8

 The chorion is not attached to the edge of the placenta but to the fetal surface at some distance from the edge.  Associated with prematurity, prenatal bleeding, abruption, multiparity & early fluid loss

Answer 9

divided into lobes

Answer 10

 Risk of foetal entanglement & cord knots. |  risk of prolapse of the cord

Answer 11

 prolonged second stage, cord rupture, uterine inversion & a difficult delivery.  Can be associated Down syndrome, fetal malformation and malpresentation

Answer 12

 Blood loss of > 500mls from the birth canal from the end of second stage (neonatal delivery) to 24 hours post birth

Answer 13

``` Large Baby Polyhydramnious Multiparity Multiple gestation Retained 3rdstage Precipitate labour Difficult labour Prolonged labour Full bladder Infection –PROM APH Preeclampisa; HELLP Drugs e.g. –>MgSO4; nifidipine; Operative delivery –> Forceps; Vacum ```

Answer 14

``` Thrombin Tissue Tone Trauma Other ```

Answer 15

Often asymptomatic initially but:  Enlarged uterus that feels “boggy” +/-Visible bleeding –>?uterus or ? tears or ? both Restlessness; Pallor Tachycardia or increase in HR by 20bpm Hypotension or drop in systolic by 20mmHg Vital signs not reflective of blood loss Maternal collapse -late sign (compensate well)

Answer 16

 Position –Autoinfuse if uterus is contracted but –> Blood may pool in uterus -excerbating condition • Elevate feet on pillows but keep pelvis flat  Monitor 5/60 –> Fundus; vital signs; conscious state & blood loss  X 2 14G -16G cannula –> IV therapy –Crystalloids initially –> N/Saline/ Hartmanns -infuse rapidly Notify & transport to nearest obstetric facility;

Answer 17

``` PIPER/MICA/Consult Reducing anxiety –> Rest & Reassure woman & partner Restoring fluid volume & Oxygen capacity of blood –> IV therapy & Oxygen Find & treat cause(s) –> 4 “T’s” –> Other ```

Answer 18

 Check uterus contracted if not –> Apply gentle fundal massage •Use cupped hand •Apply circular motion  Encourage mother to empty bladder –Up to toilet  Encourage baby to suckle breast –> Releases Oxytocin Beware massaging a contracted uterus –Can cause atony ```  Give uterotonic drugs – Misoprostol 800mg Oral – Syntonion10iu IM – *Varies by service – Repeat after 5 minutes if bleeding continues ``` Check for second twin –Before administration –Confirm antenatal care & one baby on U/sound •If not consult

Answer 19

External aortic compression

Answer 20

```  Deliver placenta if still insitu– –Active management • Signsof separation & descent • Using controlled cord traction • Service dependent ```  If placenta delivered – Check placenta & membranes complete – Retained placenta/tissue?  ? Genital tract tears –Direct pressure

Answer 21

* PIPER * Rest and Reassurance * Explain to mum what’s happening * Visual inspection of vagina and perineum for tears/trauma * Normal trauma management to stem bleeding-pressure-dressings * Pain relief * IV –fluids (service dependent)

Answer 22

 <1% of all PPH  Load and go  Caused by clotting disorders – Disseminated Intravascular dissemination •Prolonged prothrombin time; activated partial thromboplastin & thrombin time – Thrombocytopenia •Platelets are consumed

Answer 23

Aortic Occlusion –Last Resort  If all else fails:  Rarely used in hospital but may be in pre-hospital  Reduces blood flow to uterus

Answer 24

 Abnormal stimulation of the clotting mechanism – Causes excessive clotting -leadsto Ischemia – At the same time there’s excessive bleeding (a paradoxical reaction)  Complication of pre-exisitingproblem: –missed abortion, abruptio placentae; amniotic fluid embolus; severe pre-eclampsia, haemorrhage & foetal death in utero

Answer 25

 Abnormal bleeding from 24 hours to 6 weeks post delivery (>500ml)  Most common 7-14 days post partum

Answer 26

 Infection |  Retained products of conception (placenta)

Answer 27

- endometriosis - retained products of conception - Lower genital tract trauma - placental abnormalities - uterine abnormalities - choriocarcinoma - C-section wound injury - Bleeding disorders

Answer 28

Small amounts of loss (not excessive –no specific amount) Lochia Rubra •1-3 days •red blood loss Lochia Serosa •4-10 days •Lighter red to brown loss Lochia Alba •11-21 days •Light brown to clear

Answer 29

 History –Days postpartum; placenta complete; ?offensive lochia; Rest & Reassure Pain relief –where required Oxygen -where required Vital signs –Especially HR; BP and temp –may be retained placenta leading to infection Monitor ABC’s & blood loss IV therapy –Normal Saline –Administer fluids (service dependent) ``` Stop bleeding if able –If fundus palpable –fundal massage –If fundus not palpable –misoprostol (service dependent); stimulate nipple; syntocin(service dependent) –? Laceration site breakdown •Direct pressure ``` Analgesia if required Nil orally until hospital to find cause Transport & Notify hospital

Week 9 Flashcards

(53 cards)