Complications of 3rd Stage

Question 2

Def of Retained Placenta

Answer 2

Failure of delivery of placenta èin 30 minutes after delivery of fetus.

Question 3

Types of Retained Placenta

Answer 3

• Retained separated placenta
• Retained non separated placenta

Question 4

Etiology of Retained Separated Placenta

Answer 4

1) Uterine atony.
2) Constriction ring.
3) Rupture uterus.

Question 5

Etiology of Retained non-separated Placenta

Answer 5

1) Uterine atony.
2) Abnormally adherent placenta
3) Abnormal shape of placenta: Placenta membranacea & succenturiate placent

Question 6

Etiuology & RF for Abnormally adherent placenta

Answer 6

Question 7

Types of Abnormally adherent placenta

Answer 7

Question 8

Complications of Retained Placenta

Answer 8

Question 9

TTT of Uterine atony

Answer 9

Give ergometrine & do gentile uterine massage (to stimulate uterine contraction) then try to deliver placenta by 1 of the following:

a. Brandt-Andrew’s maneuver

b. Crede’s method:

c. Manual removal

Question 10

TTT of Uterine atony

• Crede’s Method (Complications)

Answer 10

Question 11

TTT of Uterine atony

• Manual removal of placenta (Technique)

Answer 11

Question 12

TTT of Uterine atony

• Manual removal of placenta (Complications)

Answer 12

1. Perforation of uterus.
2. Retained parts of placenta or membranes.
3. Infection.

Question 13

Dx of adherent placenta

Answer 13

Question 14

TTT of Adherent placenta

Answer 14

Question 15

TTT of Adherent placenta

• Ordinary (simple) adherence & partial placenta accreta

Answer 15

• Remove as much as possible from placenta & insert uterine pack
• if bleeding continues → bilateral uterine artery ligation, bilateral internal iliac artery ligation or hysterectomy.

Question 16

TTT of Adherent placenta

• Complete placenta accreta, placenta increta or placenta percreta

Answer 16

Question 17

Etiology of Puerperal Inversion of Uterus

Answer 17

• Spontaneous inversion
• Induced (iatrogenic) inversion

Question 18

Etiology of Puerperal Inversion of Uterus

• Spontaneous

Answer 18

Question 19

Etiology of Puerperal Inversion of Uterus

• Induced (iatrogenic) inversion

Answer 19

Question 20

TTT of Puerperal Inversion of Uterus

Answer 20

Question 21

TTT of Puerperal Inversion of Uterus

• 1st Aid

Answer 21

Question 22

TTT of Puerperal Inversion of Uterus

• O’Sullivan’s hydrostatic pressure method

Answer 22

Question 23

TTT of Puerperal Inversion of Uterus

• Ogueh & Ayida

Answer 23

Question 24

TTT of Puerperal Inversion of Uterus

• Manual reposition of uterus

Answer 24

Question 25

Def of **PPH**

Answer 25

Abnormal or excessive bleeding from genital tract after delivery of fetus till end of puerperium (6 weeks after delivery).

Question 26

Def of **1ry PPH**

Answer 26

- Excessive bleeding from genital tract during 3rd stage of labor or èin first 24 hours after delivery. - > 500 ml after vaginal delivery or > 1000 ml after CS or blood loss that affects general condition of patient. - Average normal blood loss = 300 ml.

Question 27

Etiology of **1ry PPH** - Atonic

Answer 27

1. Multiparity. 2. Over distention of uterus 3. PH. 4. Uterine fibroids. 5. Uterine relaxants (tocolytics). 6. Halogenated anesthesia. 7. Chorioamnionitis. 8. Severe anemia. 9. Full bladder or rectum. 10. Prolonged labor or precipitate labor. 11. Retained placenta, placental fragments, pieces of membranes or blood clots. 12. Idiopathic.

Question 28

Arrest of Bleeding in **1ry Atonic PPH** - Bleeding after delivery of placenta (true 1ry PPH)

Answer 28

Question 29

Arrest of Bleeding in **1ry True PPH** - Ecbolics

Answer 29

a- Oxytocin drip: 20 units in 500 ml normal saline. b- Ergometrine (Methergin): 0.25-0.50 mg IV or IM. c- PGs: rectal or IM or intra-myometrial in CS.

Question 30

Arrest of Bleeding in **1ry True PPH** - Inspection of placenta & membranes

Answer 30

Any missed part → removed manually under anesthesia.

Question 31

Arrest of Bleeding in **1ry True PPH** - uterine Massage

Answer 31

....

Question 32

Arrest of Bleeding in **1ry True PPH** - Exploration of uterine cavity & birth canal under anesthesia.

Answer 32

...

Question 33

Arrest of Bleeding in **1ry True PPH** - Bimanual compression of uterus

Answer 33

▪ Under general anesthesia → uterus is firmly compressed for 5-30 minutes () closed fist of Rt hand in anterior vaginal fornix & Lt hand abdominally behind body of uterus. ▪ Compression is maintained till uterus is firmly contracted (during this period, Ecbolics & blood transfusion are given).

Question 34

Arrest of Bleeding in **1ry True PPH** - Balloon tamponade (tamponade test):

Answer 34

Hydrostatic balloon catheter is inserted in uterus& filled è 200-500 ml warm saline to control Hge

Question 35

Types of Uterine compression sutures

Answer 35

1. B-Lynch suture. 2. Modified B-Lynch suture. 3. Vertical compression sutures. 4. Square compression sutures.

Question 36

Arrest of Bleeding in **1ry True PPH** - Surgical treatment

Answer 36

a- Bilateral uterine artery ligation b- Bilateral internal iliac artery ligation. c- Bilateral ovarian artery ligation. d- Uterine compression sutures e- Supra-vaginal hysterectomy: if other measures failed.

Question 37

Managment of **1ry PPH** - After care of PPH

Answer 37

Question 38

Arrest of Bleeding in **1ry True PPH** - Other less commonly used methods to arrest bleeding

Answer 38

Question 39

Def of **2ry PPH**

Answer 39

Abnormal or excessive bleeding from genital tract () 24 hours & 6 weeks after delivery.

Question 40

Etiology of **2ry PPH**

Answer 40

Question 41

TTT of **2ry PPH**

Answer 41

Question 42

Complications of 3rd stage of labor

Answer 42