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PUERPERAL COMPLICATIONS Part 01

PUERPERAL COMPLICATIONS Part 01
  1. RETAINED PLACENTA
  2. UTERINE INVERSION
  3. POSTPARTUM PYREXIA
  4. POSTPARTUM HEMORRHAGE (PPH)
  5. POSTPARTUM MOOD ALTERATIONS
RETAINED PLACENTA

  1. placenta undelivered after 30 minutes (3rd stage)
  2. risk factors:
    • placenta previa,
    • prior C/S,
    • post-pregnancy curettage,
    • prior manual placental removal,
    • uterine infection
  3. placenta separated but not delivered, or abnormal placental implantation
    • placenta accreta: placenta adherent to myometrium
    • placenta increta: invasion of myometrium
    • placenta percreta: invasion of myometrium beyond serosa
  4. increased risk of infection or bleeding
  5. management

    1. 2 large bore IVs, type and screen
    2. perform Brant maneuver (firm traction on umbilical cord with  one hand applying pressure suprapubically to hold uterus in place)
    3. oxytocin 10 IU in 20 mL NS into umbilical vein
    4. manual removal if above fails
    5. D&C if required



UTERINE INVERSION


  1. uterus prolapses through the cervix and passes out of the vaginal introitus
  2. often iatrogenic (excess cord traction)
  3. more common in grand multiparous (lax uterine ligaments)
  4. urgent management essential (may require general anesthetic if unsuccessful)

    • replace uterus without removing placenta
    • remove placenta manually and withdraw slowly
    • IV oxytocin infusion
    • re-explore uterus
PUERPERAL COMPLICATIONS Part 01 PUERPERAL COMPLICATIONS Part 01 Reviewed by Radiology Madeeasy on September 08, 2010 Rating: 5
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