Birth in prolonged pregnancy timeline
And fetal mortality risks are even higher as more prolonged gestational age, maternal age younger age, higher parity, fetal birth weight less, the association with abnormal presentations or other maternal morbid states. Pregnant metabolic rebalancing requires repeated administration of oxygen required and careful monitoring of uterine dynamics.
At birth, this syndrome needs to be indicated Ballantyne Runge - CLIFORD characterized by: - General signs: fetal length 53-54 cm, big hair, hands washerwoman; - Biological signs: hypoglycemia, hyponatremia, hypocalcemia, acidosis, increased hematocrit; - Signs skin: scaly skin, hands and pursed plants, the elderly; - Signs of nerves: the fetus shows hypothermia, hypertonic, is excited about life, and may cyanotic seizures.
After making a positive diagnosis of conduct in chronologically prolonged pregnancy can be of two types: conservative, when they expect active and spontaneous onset (classic approach), in which attempts to trigger labor. This can be done through several methods: 1. administration of castor oleum 2. administration of calcitonin 3. by administration of 8-12 estrogenizarea sintofolin ampoules / day 4. ocitocice be administered in tablet form or as slow infusion 5. administration of prostaglandin is the most indicated.
Labor should be closely monitored to track the dynamics of the fetal heart beat and uterine caesarean section is indicated whenever there is another indication if pregnant or dead fetuses also presented chronologically by prolonged pregnancy.
Showing posts with label issues of pregnancy. Show all posts
Showing posts with label issues of pregnancy. Show all posts
Tuesday, March 1, 2011
Prolonged Pregnancy timeline Diagnosis
Prolonged Pregnancy timeline
Diagnosis
1. Medical history - the history is retained after the last menstrual period, when it moved for the first time the fetus, if pregnant this regular or irregular menstrual cycles, if you had a single sexual intercourse, age data which is calculated after pregnancy. Also have to mention taking out third trimester of pregnancy.
2. Clinical examination of the mother - pregnant with extended chronologically real task shows a false labor on time, and dyspnea disappeared upper abdominal discomfort intensifying pelvic discomfort, is well-formed lower segment, the cervix is ripe, the baby is shaken to palpation and symphysis exceeds fetal skull. Active fetal movements become painful.
3. Clinical signs of fetal - to confirm the diagnosis of pregnancy suprapurtata clinical examination of the fetus after birth is very important. Thus, 60% of eutrophic fetuses are very sensitive but with a length of 53 cm. Adipose tissue is poorly represented until his disappearance complete new look is born alive and open (the sign of vigilance WOLF KIEL). Cliford describes the infant from a pregnancy suprapurtata as a small old man (LITTLE OLD MAN), with "hands and feet pursed, the washerwoman would like to borrow clothes."
There are three degrees of postmaturitate (Ballantyne Runge fetal syndrome): - Grade I, in which the burden exceeds 300 days. The child is long, thin, without vernix, amniotic fluid volume is low but clear, opalescent; - Grade II, in which the duration of pregnancy exceeds 305 days. The baby is long, thin, wrinkled, impregnated with meconium, respiratory distress and sometimes shows hypoglycemia. Amniotic fluid is the least viscous, stained with meconium; - Grade III, the load exceeds 310 days. The fetus is greenish yellow skin, macerated, lung atelectasis shows respiratory distress. In some cases fetal distress can lead to fetal death.
Paraclinical diagnosis
1. Diagnosis is made by placental insufficiency: amnioscopie determination placental flow (flow is very low if the cord which can cause fetal death intrauerina). 2. Diagnosis of placental function is pharmaco-dynamic tests: test atropine (not so wrinkled tachycardia due to placenta) maternal exercise testing induces fetal tachycardia, the oxytocin test. 3. Echography 4. Fetal radiography 5. Citohormonal hormonal examination and are indicative 6. Amniocentesis 7. Enzymatic investigations - as a result of cytolysis increases of serum transaminases hundreds maternal values (TGO - 220UI, SGPT - 93 IU).
Changes in fetal
Placental flow reduction leads to fetal hypoxia and acidosis result in fetal. Fetal response to acidosis is the increase of fetal hemoglobin and hematocrit. Show fetal distress can lead to fetal death.
Diagnosis
1. Medical history - the history is retained after the last menstrual period, when it moved for the first time the fetus, if pregnant this regular or irregular menstrual cycles, if you had a single sexual intercourse, age data which is calculated after pregnancy. Also have to mention taking out third trimester of pregnancy.
2. Clinical examination of the mother - pregnant with extended chronologically real task shows a false labor on time, and dyspnea disappeared upper abdominal discomfort intensifying pelvic discomfort, is well-formed lower segment, the cervix is ripe, the baby is shaken to palpation and symphysis exceeds fetal skull. Active fetal movements become painful.
3. Clinical signs of fetal - to confirm the diagnosis of pregnancy suprapurtata clinical examination of the fetus after birth is very important. Thus, 60% of eutrophic fetuses are very sensitive but with a length of 53 cm. Adipose tissue is poorly represented until his disappearance complete new look is born alive and open (the sign of vigilance WOLF KIEL). Cliford describes the infant from a pregnancy suprapurtata as a small old man (LITTLE OLD MAN), with "hands and feet pursed, the washerwoman would like to borrow clothes."
There are three degrees of postmaturitate (Ballantyne Runge fetal syndrome): - Grade I, in which the burden exceeds 300 days. The child is long, thin, without vernix, amniotic fluid volume is low but clear, opalescent; - Grade II, in which the duration of pregnancy exceeds 305 days. The baby is long, thin, wrinkled, impregnated with meconium, respiratory distress and sometimes shows hypoglycemia. Amniotic fluid is the least viscous, stained with meconium; - Grade III, the load exceeds 310 days. The fetus is greenish yellow skin, macerated, lung atelectasis shows respiratory distress. In some cases fetal distress can lead to fetal death.
Paraclinical diagnosis
1. Diagnosis is made by placental insufficiency: amnioscopie determination placental flow (flow is very low if the cord which can cause fetal death intrauerina). 2. Diagnosis of placental function is pharmaco-dynamic tests: test atropine (not so wrinkled tachycardia due to placenta) maternal exercise testing induces fetal tachycardia, the oxytocin test. 3. Echography 4. Fetal radiography 5. Citohormonal hormonal examination and are indicative 6. Amniocentesis 7. Enzymatic investigations - as a result of cytolysis increases of serum transaminases hundreds maternal values (TGO - 220UI, SGPT - 93 IU).
Changes in fetal
Placental flow reduction leads to fetal hypoxia and acidosis result in fetal. Fetal response to acidosis is the increase of fetal hemoglobin and hematocrit. Show fetal distress can lead to fetal death.
Umbilical cord prolapsing
Umbilical cord prolapsing
Is this belt loops at the lower end of the uterus, together with the anchor.
Classification It is based on location and situation membranes prolapsing loop in the following forms: - Laterocidenta or occult cord prolapsing result from lowering the belt loop next presentation, but not exceeding the internal orifice of cervix; - Prolapsing actual rupture of membranes occurs at the location of the belt loop in front of the presenter and can be of three grades: Grade I, in which the cord is in place, Grade II in the cord reaches the vulva and grade III in cord exceeds the vulvar opening, exteriorizandu away; - Procubitus, the membranes were intact, before the presentation was prolapsing loop and can be easily palpable through membranes, if there is a degree of dilatation of the cervix; - Prolapsing complicated the cord prolapsing prolapsing is associated with a member of the fetus.
Frequent Cord prolapsing occurs in 2-5 cases per 1000 births.
Etiology. Items in obstetrical pathology that prevents proper application of the presentation at the lower end of the uterus and employment are factors favoring the superior strait of the cord prolapsing. They are:
1. ovulari factors - Multiple pregnancy - Prematurity; - Pathological presentations (breech, frontal, facial, transverse) - Placenta praevia; - Polihidramniosul; - Spontaneous premature rupture of membranes, before engaging presentations; - Long or velamentous insertion cord.
2. maternal factors - Multiparity; - Pelvic tumors praevia; - Rough channel dystocia.
3. iatrogenic factors - unexpected amniotomy (when not engaged or presentational during obstetric maneuvers).
Pathophysiology This loops the cord at the same level presentational cause intermittent compression, rhythmic contractions, the umbilical and superior strait, cervix, vagina. In the intervals of cord compression, fetal circulation is compromised in terms of duration and intensity, is installed with fetal hypoxia and brain damage exitus.
In addition, actual prolapsing, cord contact with the external environment (air) produces irritation to cooling and drying, causing spasm of umbilical vessels and emphasizing the damage the fetus.
Diagnosis
In prolapsing itself, depending on the degree and major complications, and examined by simple inspection reveals valves Prolab chance that outwardly through the cervix. Digital vaginal examination confirmed this loop cord.
Procubitusului diagnosis is possible by observing that the vaginal examination with valves cord through transparent membranes and digital vaginal examination, which identifies this structure as an elastic cord, soft, running and feel the pulses of which the umbilical vessels.
Laterocidenta is a possibility that can rarely be diagnosed by digital vaginal examination. This diagnosis should be suspected when monitoring indicates fetal bradycardia promptly and variables that appear concurrently with uterine contractions, without pre-existing motivation and disappear after cessation cintractiilor. BCF These changes indicate the presence of fetal distress, which in the case of total compression and prolonged hypoxia and acidosis cause and fetal exitusului final.
Fetal prognosis is reserved, and perinatal mortality varies between 20% and 60%. Factors that influence prognosis are: 1. prompt extraction of the fetus, looking directly related to the degree and duration of cord compression, if the interval between the appearance of prolapsing and extracting the fetus, followed by resuscitation to no more than five minutes, the prognosis is good, otherwise serious damage or fetal death are inevitable; 2. how to resolve delivery, caesarean section is the optimal solution; 3. type presentations, presentational skull, although it is associated with a lower incidence of prolapsing is the most unfavorable; 4. associated pathology: prematurity, fetal distress preexisting.
Breast prognosis is burdened by risks associated pathology, especially traumatic obstetric maneuvers.
Prophylactic Conduct addresses all pregnancies there prolapsing conditions favored production of cord and consists of the following: - Artificial rupture of membranes, is well practiced only when applied to cervical preyentatia (employed or at least fixed); - Spontaneous rupture of membranes will be followed promptly by a careful vaginal examination to eliminate the possibility of a prolapsing of the weld; - Pregnant women or those with pathological presentations insufficiently cranial presentation will benefit from an ultrasound exam to determine the exact position of the fetus and umbilical cord; - Because most procidentelor occur during labor, as cervical dilatation progresses, pregnant women will be constantly monitored to detect early occurrence rate alterations BCF.
Therapeutic attitude will be adopted according to: - Clinical form; - The degree of dilatation of the cervix; - Fetal status (viability, maturity, presentation).
In prolapsing itself, immediately after diagnosis, genital exam is done to specify the dilation of cervix, presentation and delivery mechanism, whether umbilical pulsation vessels, possible prolapsing a member (prolapsing complicated), to listen to BCF.
If the fetus is alive, and performing cesarean birth conditions are met, the intervention is compulsory and is an obstetrical emergency. After extraction, the fetus will be immediately taken to intensive care in neonatology for the application required.
If the fetus is compromised, assist in presentations longitudinal natural birth, in presentational Transverse Cesarean afectueaza embriotomie or interest in breast and uterine retraction if there was no imminent uterine rupture.
If the fetus is viable, cervical dilation is complete and presenter, skull or pelvis, is engaged, proceed to the rapid completion of vaginal birth by forceps application or big draw.
Current concepts on the treatment methods do not allow the cord prolapsing attempts to reduce prolapsing loop digital.
Laterocidenta (prolapsing occult cord), suggested the appearance cardiotocografic variables characterized by bradycardia during labor, genital exam requires immediate action to remove the possibility of a prolapsing itself. Pregnant is then placed in lateral decubitus (Sims position) or Trendelenburg position to relieve cord compression and fetal oxygen saturation monitors.
If the activity is restored and normal fetal pilfer the conditions for the birth the natural way obstetrics, it will be allowed to proceed normally under supervision.
If signs persist or recur compresiuneasupra cord, threatening the life of the fetus, caesarean section is performed.
In procubitus, in women with pregnancy at term, indicating the birth by caesarean section before rupture of membranes practiced. If your baby is premature, pregnant women will benefit from hospitalization and bed rest, prolonged, with the intention of getting back into normal position cord. During this period, repeated ultrasound examinations to be charged, to establish the cordon location, presenter and gestational age.
In conclusion, cord prolapsing is an obstetrical emergency, that is preferable, most often by cesarean birth, natural birth is reserved especially for fetuses and premature deaths.
Is this belt loops at the lower end of the uterus, together with the anchor.
Classification It is based on location and situation membranes prolapsing loop in the following forms: - Laterocidenta or occult cord prolapsing result from lowering the belt loop next presentation, but not exceeding the internal orifice of cervix; - Prolapsing actual rupture of membranes occurs at the location of the belt loop in front of the presenter and can be of three grades: Grade I, in which the cord is in place, Grade II in the cord reaches the vulva and grade III in cord exceeds the vulvar opening, exteriorizandu away; - Procubitus, the membranes were intact, before the presentation was prolapsing loop and can be easily palpable through membranes, if there is a degree of dilatation of the cervix; - Prolapsing complicated the cord prolapsing prolapsing is associated with a member of the fetus.
Frequent Cord prolapsing occurs in 2-5 cases per 1000 births.
Etiology. Items in obstetrical pathology that prevents proper application of the presentation at the lower end of the uterus and employment are factors favoring the superior strait of the cord prolapsing. They are:
1. ovulari factors - Multiple pregnancy - Prematurity; - Pathological presentations (breech, frontal, facial, transverse) - Placenta praevia; - Polihidramniosul; - Spontaneous premature rupture of membranes, before engaging presentations; - Long or velamentous insertion cord.
2. maternal factors - Multiparity; - Pelvic tumors praevia; - Rough channel dystocia.
3. iatrogenic factors - unexpected amniotomy (when not engaged or presentational during obstetric maneuvers).
Pathophysiology This loops the cord at the same level presentational cause intermittent compression, rhythmic contractions, the umbilical and superior strait, cervix, vagina. In the intervals of cord compression, fetal circulation is compromised in terms of duration and intensity, is installed with fetal hypoxia and brain damage exitus.
In addition, actual prolapsing, cord contact with the external environment (air) produces irritation to cooling and drying, causing spasm of umbilical vessels and emphasizing the damage the fetus.
Diagnosis
In prolapsing itself, depending on the degree and major complications, and examined by simple inspection reveals valves Prolab chance that outwardly through the cervix. Digital vaginal examination confirmed this loop cord.
Procubitusului diagnosis is possible by observing that the vaginal examination with valves cord through transparent membranes and digital vaginal examination, which identifies this structure as an elastic cord, soft, running and feel the pulses of which the umbilical vessels.
Laterocidenta is a possibility that can rarely be diagnosed by digital vaginal examination. This diagnosis should be suspected when monitoring indicates fetal bradycardia promptly and variables that appear concurrently with uterine contractions, without pre-existing motivation and disappear after cessation cintractiilor. BCF These changes indicate the presence of fetal distress, which in the case of total compression and prolonged hypoxia and acidosis cause and fetal exitusului final.
Fetal prognosis is reserved, and perinatal mortality varies between 20% and 60%. Factors that influence prognosis are: 1. prompt extraction of the fetus, looking directly related to the degree and duration of cord compression, if the interval between the appearance of prolapsing and extracting the fetus, followed by resuscitation to no more than five minutes, the prognosis is good, otherwise serious damage or fetal death are inevitable; 2. how to resolve delivery, caesarean section is the optimal solution; 3. type presentations, presentational skull, although it is associated with a lower incidence of prolapsing is the most unfavorable; 4. associated pathology: prematurity, fetal distress preexisting.
Breast prognosis is burdened by risks associated pathology, especially traumatic obstetric maneuvers.
Prophylactic Conduct addresses all pregnancies there prolapsing conditions favored production of cord and consists of the following: - Artificial rupture of membranes, is well practiced only when applied to cervical preyentatia (employed or at least fixed); - Spontaneous rupture of membranes will be followed promptly by a careful vaginal examination to eliminate the possibility of a prolapsing of the weld; - Pregnant women or those with pathological presentations insufficiently cranial presentation will benefit from an ultrasound exam to determine the exact position of the fetus and umbilical cord; - Because most procidentelor occur during labor, as cervical dilatation progresses, pregnant women will be constantly monitored to detect early occurrence rate alterations BCF.
Therapeutic attitude will be adopted according to: - Clinical form; - The degree of dilatation of the cervix; - Fetal status (viability, maturity, presentation).
In prolapsing itself, immediately after diagnosis, genital exam is done to specify the dilation of cervix, presentation and delivery mechanism, whether umbilical pulsation vessels, possible prolapsing a member (prolapsing complicated), to listen to BCF.
If the fetus is alive, and performing cesarean birth conditions are met, the intervention is compulsory and is an obstetrical emergency. After extraction, the fetus will be immediately taken to intensive care in neonatology for the application required.
If the fetus is compromised, assist in presentations longitudinal natural birth, in presentational Transverse Cesarean afectueaza embriotomie or interest in breast and uterine retraction if there was no imminent uterine rupture.
If the fetus is viable, cervical dilation is complete and presenter, skull or pelvis, is engaged, proceed to the rapid completion of vaginal birth by forceps application or big draw.
Current concepts on the treatment methods do not allow the cord prolapsing attempts to reduce prolapsing loop digital.
Laterocidenta (prolapsing occult cord), suggested the appearance cardiotocografic variables characterized by bradycardia during labor, genital exam requires immediate action to remove the possibility of a prolapsing itself. Pregnant is then placed in lateral decubitus (Sims position) or Trendelenburg position to relieve cord compression and fetal oxygen saturation monitors.
If the activity is restored and normal fetal pilfer the conditions for the birth the natural way obstetrics, it will be allowed to proceed normally under supervision.
If signs persist or recur compresiuneasupra cord, threatening the life of the fetus, caesarean section is performed.
In procubitus, in women with pregnancy at term, indicating the birth by caesarean section before rupture of membranes practiced. If your baby is premature, pregnant women will benefit from hospitalization and bed rest, prolonged, with the intention of getting back into normal position cord. During this period, repeated ultrasound examinations to be charged, to establish the cordon location, presenter and gestational age.
In conclusion, cord prolapsing is an obstetrical emergency, that is preferable, most often by cesarean birth, natural birth is reserved especially for fetuses and premature deaths.
Umbilical cord pathology Pathology accidental
Umbilical cord pathology
Pathology accidental
Includes eventualitatiile that cause compression of the umbilical vessels and fetal distress in succession through a complex mechanism (hypoxia, hypovolemia, vagal reflex).
a. umbilical cord blood
Windings are single or multiple segments of the cord around the fetus (neck, trunk, limbs), most frequently around the neck. Coil around torso are called scarf or camisole.
b. umbilical Nodes
Nodes may be false or true cord, single or multiple.
c. umbilical cord prolapsing
Is this belt loops at the lower end of the uterus, together with the anchor.
d. thrombosis They are favored by velamentous insertion of the cord inflammation or circular. Although a rare event, umbilical vessel thrombosis of acute fetal distress may lead to intrauterine death.
e. Leakage cord They are exceptionally rare contingencies that may arise in cases of short cord, subjected to traction during a twist or precipitate obstetric maneuvers.
f. cord torsion Normally, fetal active movements cause the cord twist, which may occur at any point along the length of cord. Sometimes twisting is so important compromise fetal circulation and cause fetal death. Clinically, the torsion is discovered during the expulsion of dead fetuses in utero. Since, by an unknown mechanism after exitusul fetus in utero can occur very interesting twist, it is considered that it is practically impossible to determine which is the initial twisting or fetal death. Twisting the reality of existence, the strangulation cord, leading to intermittent occlusion of the vessels if the funicular, which can cause cerebral hypoperfusion and consecutive fetal hypoxia.
g. cord stenosis In terms of etiologic correlates with torsion and is associated with severe focal deficiency of gelatine Wharton. The consequence is the high rate of stenosis mortinatalitatii cord.
h. cord edema It is a rarity, most commonly being associated with fetal edema.
Pathology accidental
Includes eventualitatiile that cause compression of the umbilical vessels and fetal distress in succession through a complex mechanism (hypoxia, hypovolemia, vagal reflex).
a. umbilical cord blood
Windings are single or multiple segments of the cord around the fetus (neck, trunk, limbs), most frequently around the neck. Coil around torso are called scarf or camisole.
b. umbilical Nodes
Nodes may be false or true cord, single or multiple.
c. umbilical cord prolapsing
Is this belt loops at the lower end of the uterus, together with the anchor.
d. thrombosis They are favored by velamentous insertion of the cord inflammation or circular. Although a rare event, umbilical vessel thrombosis of acute fetal distress may lead to intrauterine death.
e. Leakage cord They are exceptionally rare contingencies that may arise in cases of short cord, subjected to traction during a twist or precipitate obstetric maneuvers.
f. cord torsion Normally, fetal active movements cause the cord twist, which may occur at any point along the length of cord. Sometimes twisting is so important compromise fetal circulation and cause fetal death. Clinically, the torsion is discovered during the expulsion of dead fetuses in utero. Since, by an unknown mechanism after exitusul fetus in utero can occur very interesting twist, it is considered that it is practically impossible to determine which is the initial twisting or fetal death. Twisting the reality of existence, the strangulation cord, leading to intermittent occlusion of the vessels if the funicular, which can cause cerebral hypoperfusion and consecutive fetal hypoxia.
g. cord stenosis In terms of etiologic correlates with torsion and is associated with severe focal deficiency of gelatine Wharton. The consequence is the high rate of stenosis mortinatalitatii cord.
h. cord edema It is a rarity, most commonly being associated with fetal edema.
Umbilical cord pathology Tumors of the umbilical cord
Umbilical cord pathology
Tumors of the umbilical cord
Contingencies are extremely rare. May be cystic or solid. The most common are angiomixoamele considered an extension of placental corioangioamelor. Tumors have been described as a rare teratoma and hemangioma.
Cystic formations observed in the cord can be classified into true and false. The true are small and derived from the remains of omfolo-mesenteric duct and false alantoidei.Cele can reach considerable size and results of liquefying gelatine Wharton.
Hematoma, although they are not true tumors, represents a serious complication of a ruptured varicose dilations with suffusions in cord. Hematoma associated with postmaturitatea, adipose degeneration of vessels, infection and calcification of vascular walls.
During pregnancy, the diagnosis can be established by ultrasound.
Tumors of the umbilical cord
Contingencies are extremely rare. May be cystic or solid. The most common are angiomixoamele considered an extension of placental corioangioamelor. Tumors have been described as a rare teratoma and hemangioma.
Cystic formations observed in the cord can be classified into true and false. The true are small and derived from the remains of omfolo-mesenteric duct and false alantoidei.Cele can reach considerable size and results of liquefying gelatine Wharton.
Hematoma, although they are not true tumors, represents a serious complication of a ruptured varicose dilations with suffusions in cord. Hematoma associated with postmaturitatea, adipose degeneration of vessels, infection and calcification of vascular walls.
During pregnancy, the diagnosis can be established by ultrasound.
Umbilical cord pathology Abnormalities of the umbilical cord length
Umbilical cord pathology
Abnormalities of the umbilical cord length
Normally, the cord length of time, on average about 55 cm, but there are a great individual variety.
Order experimental and clinical arguments suggest that cord length is influenced by the quality of amniotic fluid and fetal mobility.
For example, in cases with oligoemnios sarcinp, is noticeably shorter cord. In pelvic presentations, the average length of cord is approximately 5 cm lower.
1. Absence of cord (agreement).
It is an extremely rare event in which the fetus is in direct contact with the placenta.
2. Short cord. This is rebound clinical enitate when, due to primitive or windings. Cord length is less than 35 cm. This length is necessary to avoid embarrassment delivery mechanism (32-35 cm distance from the placenta normal background inserted to vulva).
This short cord can cause: - Abnormal presentations; - Dezinsertia or cord rupture with severe hemorrhage to the fetus; - Intrapartum fetal distress; - Off the normally inserted placenta with hematoma formation; - Birth defects of the mechanism; - Uterine inversion.
Diagnosis is supported by the following aspects: - High status that applies to the presentation, sets and engage with difficulty; - Presentation on expulsion during descent and does not remain at the level reached during the contractions, but their termination ascensioneaza again, this amendment adds rhythm BCF, which are bradycardia, sometimes arrhythmic.
Conduct rapid completion of delivery targets for signs of fetal distress, usually parts forceps application.
3. Long Cord
If the term is umbilical cord length exceeds 70 cm, reaching values of 300 cm. This entity does not have a particular clinical interest, except in the long cord is complicated by real nodes, prolapsing, circular vascular thrombosis.
Abnormalities of the umbilical cord length
Normally, the cord length of time, on average about 55 cm, but there are a great individual variety.
Order experimental and clinical arguments suggest that cord length is influenced by the quality of amniotic fluid and fetal mobility.
For example, in cases with oligoemnios sarcinp, is noticeably shorter cord. In pelvic presentations, the average length of cord is approximately 5 cm lower.
1. Absence of cord (agreement).
It is an extremely rare event in which the fetus is in direct contact with the placenta.
2. Short cord. This is rebound clinical enitate when, due to primitive or windings. Cord length is less than 35 cm. This length is necessary to avoid embarrassment delivery mechanism (32-35 cm distance from the placenta normal background inserted to vulva).
This short cord can cause: - Abnormal presentations; - Dezinsertia or cord rupture with severe hemorrhage to the fetus; - Intrapartum fetal distress; - Off the normally inserted placenta with hematoma formation; - Birth defects of the mechanism; - Uterine inversion.
Diagnosis is supported by the following aspects: - High status that applies to the presentation, sets and engage with difficulty; - Presentation on expulsion during descent and does not remain at the level reached during the contractions, but their termination ascensioneaza again, this amendment adds rhythm BCF, which are bradycardia, sometimes arrhythmic.
Conduct rapid completion of delivery targets for signs of fetal distress, usually parts forceps application.
3. Long Cord
If the term is umbilical cord length exceeds 70 cm, reaching values of 300 cm. This entity does not have a particular clinical interest, except in the long cord is complicated by real nodes, prolapsing, circular vascular thrombosis.
Umbilical cord pathology Abnormalities of the umbilical cord insertion
Umbilical cord pathology
Abnormalities of the umbilical cord insertion
Insertion cord is normally in the center or near the center of the placenta. Eccentric insertion is quite common and can not be considered abnormal only in marginal cases and velamentoase insertion.
Marginal cord insertion
Marginal cord insertion is the insertion of the edge of the placenta and is observed in 2-15% of cases.
Clinical bleeding can occur through small, which make differential diagnosis problem with placenta previa. Some authors have found that more frequent association with preterm birth abnormalities, but this view is not universally accepted. Another discussion is the pathological association with intrauterine growth retardation, explained by a decrease in uteroplacental flow.
Ultrasound diagnosis is made during the course of pregnancy and by inspection of the placenta, postpartum.
Velamentous insertion of umbilical cord
Velamentous insertion is the insertion of the umbilical cord membrane, outside board villi, placental edge distance. Funicular vessels to travel the placenta without having any support, displayed between the villi and amniotic foil.
This anomaly results from development of vasculature eccentric to the future of primary placental site, which explains the frequent association with some of placental abnormalities (placenta biloba, succenturiata, praevia).
Frequent This type of cord insertion is present in more than 1% of births to single fetus, twins more frequently (9%) and the loads are almost the rule triple.
Vasa praevia If the cord insertion velamentoase sometimes funicular vessels are located between the membranes from the lower end of the hole and the internal cervix before the presentation. This situation is called Utensils and previa is a common abnormality in twin pregnancies.
Pathophysiology In both situations, and utensils velamentous insertion praevia is fetal distress during labor induced by these mechanisms: - Compression of the vessels, the progress of the delivery mechanism, causing fetal hypoxia; - Praevia vessel rupture, with rupture of membranes, causes hemorrhage and acute fetal anemia (syndrome Benckiser).
This anomaly of the cord insertion is more frequently associated with intrauterine growth retardation, premature birth and cord prolapsing.
Diagnosis
During pregnancy, the clinical diagnosis is practically impossible.
At birth, clinically speaking, vaginal bleeding and sometimes is found when the membranes are intact umbilical vessels may feel that protrudes through the membranes located above presentations. Fetal monitoring showed concomitant alteration BCF rate when these vessels are compressed between the fingers that examines and presenter. Vessels can be viewed directly when the cervix is dilated, the amnioscopie or ultrasound.
The differential diagnosis is placenta previa, bleeding or rupture of the marginal sinus of placenta. Unlike placenta previa, rupture of membranes does not improve bleeding.
For the diagnosis of fetal origin is required to confirm bleeding, may be used for this purpose two laboratory methods: - Fit test based on fetal hemoglobin resistance in alkaline environments; - Kleihauer-Betke test, which identified by staining with fetal hemetiile Erythrosine in eluting acid.
Of these, the first is more beneficial because it can be done in minutes, in any laboratory.
Breast prognosis is good, but the fetal prognosis is reserved, due to fetal mortality and morbidity 60% fetal posthemoragica dominated by severe anemia.
Conduct Once the diagnosis is indicated by cesarean birth, the fetal interest. Rarely, when there was no travalilui during practice conditions Caesarean section, it must quickly end in vaginal delivery by forceps or small mining application.
Abnormalities of the umbilical cord insertion
Insertion cord is normally in the center or near the center of the placenta. Eccentric insertion is quite common and can not be considered abnormal only in marginal cases and velamentoase insertion.
Marginal cord insertion
Marginal cord insertion is the insertion of the edge of the placenta and is observed in 2-15% of cases.
Clinical bleeding can occur through small, which make differential diagnosis problem with placenta previa. Some authors have found that more frequent association with preterm birth abnormalities, but this view is not universally accepted. Another discussion is the pathological association with intrauterine growth retardation, explained by a decrease in uteroplacental flow.
Ultrasound diagnosis is made during the course of pregnancy and by inspection of the placenta, postpartum.
Velamentous insertion of umbilical cord
Velamentous insertion is the insertion of the umbilical cord membrane, outside board villi, placental edge distance. Funicular vessels to travel the placenta without having any support, displayed between the villi and amniotic foil.
This anomaly results from development of vasculature eccentric to the future of primary placental site, which explains the frequent association with some of placental abnormalities (placenta biloba, succenturiata, praevia).
Frequent This type of cord insertion is present in more than 1% of births to single fetus, twins more frequently (9%) and the loads are almost the rule triple.
Vasa praevia If the cord insertion velamentoase sometimes funicular vessels are located between the membranes from the lower end of the hole and the internal cervix before the presentation. This situation is called Utensils and previa is a common abnormality in twin pregnancies.
Pathophysiology In both situations, and utensils velamentous insertion praevia is fetal distress during labor induced by these mechanisms: - Compression of the vessels, the progress of the delivery mechanism, causing fetal hypoxia; - Praevia vessel rupture, with rupture of membranes, causes hemorrhage and acute fetal anemia (syndrome Benckiser).
This anomaly of the cord insertion is more frequently associated with intrauterine growth retardation, premature birth and cord prolapsing.
Diagnosis
During pregnancy, the clinical diagnosis is practically impossible.
At birth, clinically speaking, vaginal bleeding and sometimes is found when the membranes are intact umbilical vessels may feel that protrudes through the membranes located above presentations. Fetal monitoring showed concomitant alteration BCF rate when these vessels are compressed between the fingers that examines and presenter. Vessels can be viewed directly when the cervix is dilated, the amnioscopie or ultrasound.
The differential diagnosis is placenta previa, bleeding or rupture of the marginal sinus of placenta. Unlike placenta previa, rupture of membranes does not improve bleeding.
For the diagnosis of fetal origin is required to confirm bleeding, may be used for this purpose two laboratory methods: - Fit test based on fetal hemoglobin resistance in alkaline environments; - Kleihauer-Betke test, which identified by staining with fetal hemetiile Erythrosine in eluting acid.
Of these, the first is more beneficial because it can be done in minutes, in any laboratory.
Breast prognosis is good, but the fetal prognosis is reserved, due to fetal mortality and morbidity 60% fetal posthemoragica dominated by severe anemia.
Conduct Once the diagnosis is indicated by cesarean birth, the fetal interest. Rarely, when there was no travalilui during practice conditions Caesarean section, it must quickly end in vaginal delivery by forceps or small mining application.
Umbilical cord pathology
Umbilical cord pathology
* Introduction
* Abnormalities of the umbilical cord insertion
* Abnormalities of the umbilical cord length
* Tumors of the umbilical cord
* Vascular Anomalies of the umbilical cord
* Pathology accidental
The umbilical cord is an important element in the developing fetus, the blood supply that provides a permanently growing DURING pregnancy outcome.
At the time, blood flow reaches 300-350 cm3/min, which represents approximately 40% of fetal umbilical flow.
Elements of morphology of umbilical cord vessels means of protection is contained with the finality of the constant blood flow in placental circulation.
Umbilical vessels, two umbilical arteries and veins have a spiral trajectory, with a twisting clockwise or counterclockwise (50-90% of cases). It is considered that this aspect of the cylindrical helix with constant curvature and equidistant from the central axis, attenuates the effect of "blocking" of blood flow that occurs when torque.
Extracellular matrix, represented by Wharton's jelly, which is a specialized connective tissue (mucoid), and which, together with the internal connective tissue septa, includes blood vessels, protecting them.
Amniotic cord is covered by foil, which gives sliding surface.
Fluid environment that is cord (amniotic fluid) helps avoid compressions.
Generalized flexion attitude of the fetus provides a protective space for the cord.
The umbilical cord can be established for a disease which becomes manifest especially in labor, affecting fetus with a serious condition involving fetal circulation to fetal death.
Classification cord disorders:
Various aspects of cord pathology can be grouped into two categories:
1. Abnormal development a. abnormal insertion (marginal velamentoasa) b. abnormal length; c. tumors d. vascular anomalies.
2. Pathology accidental a. Circular; b. knots; c. prolapsing; d. thrombosis; e. rupture; f. twist; g. stenosis; h. edema.
* Introduction
* Abnormalities of the umbilical cord insertion
* Abnormalities of the umbilical cord length
* Tumors of the umbilical cord
* Vascular Anomalies of the umbilical cord
* Pathology accidental
The umbilical cord is an important element in the developing fetus, the blood supply that provides a permanently growing DURING pregnancy outcome.
At the time, blood flow reaches 300-350 cm3/min, which represents approximately 40% of fetal umbilical flow.
Elements of morphology of umbilical cord vessels means of protection is contained with the finality of the constant blood flow in placental circulation.
Umbilical vessels, two umbilical arteries and veins have a spiral trajectory, with a twisting clockwise or counterclockwise (50-90% of cases). It is considered that this aspect of the cylindrical helix with constant curvature and equidistant from the central axis, attenuates the effect of "blocking" of blood flow that occurs when torque.
Extracellular matrix, represented by Wharton's jelly, which is a specialized connective tissue (mucoid), and which, together with the internal connective tissue septa, includes blood vessels, protecting them.
Amniotic cord is covered by foil, which gives sliding surface.
Fluid environment that is cord (amniotic fluid) helps avoid compressions.
Generalized flexion attitude of the fetus provides a protective space for the cord.
The umbilical cord can be established for a disease which becomes manifest especially in labor, affecting fetus with a serious condition involving fetal circulation to fetal death.
Classification cord disorders:
Various aspects of cord pathology can be grouped into two categories:
1. Abnormal development a. abnormal insertion (marginal velamentoasa) b. abnormal length; c. tumors d. vascular anomalies.
2. Pathology accidental a. Circular; b. knots; c. prolapsing; d. thrombosis; e. rupture; f. twist; g. stenosis; h. edema.
Premature Birth Treatment
Premature Birth
Treatment
Treatment for women in preterm labor, the fetus still in utero or premature infant.
For mothers
Treatment depends on the stage of pregnancy and the evolution of labor graders. In some cases, bed rest and drinking enough to stop premature contractions. Beanta In cases of uterine cervix (abnormal opening of the orifice of the cervix), perform a procedure called serclaj aims to prevent preterm birth. Serclajul cervix consists of applying a circular suture to raise the cervix. Sutures are removed in the last month of pregnancy. In other cases, drugs are preferred (terbutaline, magnesium sulfate), which relaxes smooth muscles, including those of the uterus. Can be used and drugs that block production of substances that stimulates uterine contractions (prostaglandins).
To Fetus
If there is a risk of premature birth, are adopted measures to prevent predictable complications in newborns, especially respiratory problems. Thus, corticosteroids (betamethasone or dexamethasone) to accelerate fetal lung maturation in a period of 24-48 hours. After the 34th week of gestation, steroids are no longer needed because fetal lung development is within limits of normality.
For the premature infant
There are two categories of preterm. Those born between the 35th and 36th week of pregnancy are relatively less likely to develop complications. In contrast, children born before the 35th week of pregnancy, weighing less than 2 kg should receive special care, being exposed to multiple complications. Premature generally kept in an incubator for newborn isolation and maintaining a normal body temperature. New baby without swallowing reflex will be powered by nasogastric tube. When it becomes strong enough, it can be put to the breast or bottle feeding.
Treatment
Treatment for women in preterm labor, the fetus still in utero or premature infant.
For mothers
Treatment depends on the stage of pregnancy and the evolution of labor graders. In some cases, bed rest and drinking enough to stop premature contractions. Beanta In cases of uterine cervix (abnormal opening of the orifice of the cervix), perform a procedure called serclaj aims to prevent preterm birth. Serclajul cervix consists of applying a circular suture to raise the cervix. Sutures are removed in the last month of pregnancy. In other cases, drugs are preferred (terbutaline, magnesium sulfate), which relaxes smooth muscles, including those of the uterus. Can be used and drugs that block production of substances that stimulates uterine contractions (prostaglandins).
To Fetus
If there is a risk of premature birth, are adopted measures to prevent predictable complications in newborns, especially respiratory problems. Thus, corticosteroids (betamethasone or dexamethasone) to accelerate fetal lung maturation in a period of 24-48 hours. After the 34th week of gestation, steroids are no longer needed because fetal lung development is within limits of normality.
For the premature infant
There are two categories of preterm. Those born between the 35th and 36th week of pregnancy are relatively less likely to develop complications. In contrast, children born before the 35th week of pregnancy, weighing less than 2 kg should receive special care, being exposed to multiple complications. Premature generally kept in an incubator for newborn isolation and maintaining a normal body temperature. New baby without swallowing reflex will be powered by nasogastric tube. When it becomes strong enough, it can be put to the breast or bottle feeding.
Premature Birth Signs of premature birth
Premature Birth
Signs of premature birth
It is important to recognize the signs that announce the birth of premature to ask for help and it could stop in time.
● contractions every ten minutes or less.
● back pain that either appear and disappear, or are constant, but fail either by changing the position or other measures to reduce discomfort
● lower abdominal pain (with or without diarrhea)
● pelvic or vaginal pressure
● abdominal cramps similar to those during menstruation
● watery vaginal discharge
● vaginal bleeding
● flu-like symptoms: nausea, vomiting, diarrhea
● decreased fetal movements (baby do not hit walls as often uterus)
Patients who suspect a premature birth, but have not found a watery secretion, should stop all activity and rest. Contractions every 10 minutes or more often, you contact the doctor to determine the presentation to the hospital.
Signs of premature birth
It is important to recognize the signs that announce the birth of premature to ask for help and it could stop in time.
● contractions every ten minutes or less.
● back pain that either appear and disappear, or are constant, but fail either by changing the position or other measures to reduce discomfort
● lower abdominal pain (with or without diarrhea)
● pelvic or vaginal pressure
● abdominal cramps similar to those during menstruation
● watery vaginal discharge
● vaginal bleeding
● flu-like symptoms: nausea, vomiting, diarrhea
● decreased fetal movements (baby do not hit walls as often uterus)
Patients who suspect a premature birth, but have not found a watery secretion, should stop all activity and rest. Contractions every 10 minutes or more often, you contact the doctor to determine the presentation to the hospital.
Premature Birth
Premature Birth
* Introduction
* Signs of premature birth
* Treatment
Premature birth (before the deadline) is birth that occurs before the 37th week of amenorrhea (after last menstrual period).
Pregnancy lasts an average of 266 days from the date of fertilization. But, in obstetrical practice, early pregnancy is fixed on the first day of last normal menstrual flow, fertilization is considered to be held in approximately 14 days after the beginning of the last menstruation. So the average length of pregnancy is 280 days or 40 weeks of amenorrhea (absence of menstruation).
Premature baby is born between the 22nd and 37th week of amenorrhea (absence of menstruation). Instead, the child born after 41 weeks and 3 days is called postmatur. As prematurity is more important, so the baby is more fragile, and its possibilities to survive birth without medical care are low.
If a birth that occurs before the 32nd week (a critical gestational age), perinatal mortality is common, and neurological or psychomotor sequelae are possible.
For these reasons, it is very important that premature birth can be avoided by knowing the risk factors and their control as far as possible. Multiple Pregnancy, urinary or genital infections, placenta previa, diabetes, gestational hypertension (during pregnancy), age, lifestyle habits too strenuous, weight gain, or on the contrary, weak sharp ... all these factors must be considered during pregnancy .
Pre term newborn pathologies will present more or less important depending on the stage of pregnancy. For example, pulmonary immaturity may prevent the infant to breathe spontaneously and will require ventilatory assistance. If the body does not adapt to ambient temperature, the risk of hypothermia, and pre term newborn will be placed in an incubator. Will be given infusions of glucose solution because of the risk of hypoglycaemia. Immaturity of the digestive tract can cause metabolic and nutritional disorders.
Most pregnancies last about 40 weeks. By definition, a premature birth takes place more than three weeks before the due date.
A premature birth gives a baby less time to develop and mature in the womb. The result is an increased risk of various medical and developmental problems, including trouble breathing and bleeding in the brain. If you go into labor too early, your doctor may try to delay your baby's birth. Even if premature birth is inevitable, a few extra days in the womb can promote significant development.
Although the rate of premature birth seems to be on the rise, there's good news. A healthy lifestyle can go a long way toward preventing preterm labor and premature birth.
* Introduction
* Signs of premature birth
* Treatment
Premature birth (before the deadline) is birth that occurs before the 37th week of amenorrhea (after last menstrual period).
Pregnancy lasts an average of 266 days from the date of fertilization. But, in obstetrical practice, early pregnancy is fixed on the first day of last normal menstrual flow, fertilization is considered to be held in approximately 14 days after the beginning of the last menstruation. So the average length of pregnancy is 280 days or 40 weeks of amenorrhea (absence of menstruation).
Premature baby is born between the 22nd and 37th week of amenorrhea (absence of menstruation). Instead, the child born after 41 weeks and 3 days is called postmatur. As prematurity is more important, so the baby is more fragile, and its possibilities to survive birth without medical care are low.
If a birth that occurs before the 32nd week (a critical gestational age), perinatal mortality is common, and neurological or psychomotor sequelae are possible.
For these reasons, it is very important that premature birth can be avoided by knowing the risk factors and their control as far as possible. Multiple Pregnancy, urinary or genital infections, placenta previa, diabetes, gestational hypertension (during pregnancy), age, lifestyle habits too strenuous, weight gain, or on the contrary, weak sharp ... all these factors must be considered during pregnancy .
Pre term newborn pathologies will present more or less important depending on the stage of pregnancy. For example, pulmonary immaturity may prevent the infant to breathe spontaneously and will require ventilatory assistance. If the body does not adapt to ambient temperature, the risk of hypothermia, and pre term newborn will be placed in an incubator. Will be given infusions of glucose solution because of the risk of hypoglycaemia. Immaturity of the digestive tract can cause metabolic and nutritional disorders.
Most pregnancies last about 40 weeks. By definition, a premature birth takes place more than three weeks before the due date.
A premature birth gives a baby less time to develop and mature in the womb. The result is an increased risk of various medical and developmental problems, including trouble breathing and bleeding in the brain. If you go into labor too early, your doctor may try to delay your baby's birth. Even if premature birth is inevitable, a few extra days in the womb can promote significant development.
Although the rate of premature birth seems to be on the rise, there's good news. A healthy lifestyle can go a long way toward preventing preterm labor and premature birth.
Post-partum haemorrhage Treatment
Post-partum haemorrhage
Treatment
General measures should be initiated immediately to stop the bleeding. Depending on the cause of bleeding required a series of specific measures.
Among general measures include: - In the presence of external bleeding uterus appeared to be massaged if it is not firmly contracted, and if signs of placental separation are present, expression of placenta, uterine exerting pressure on the bottom should be done; - Manual extraction of placenta is performed immediately post-partum. This maneuver is performed under general anesthesia (intravenous); - Control of the vaginal walls, the cervix, to identify their business continuity and suture; - After delivery of the placenta, uterine palpation is mandatory to check if it is well contracted; - Intramuscular or intravenous administration or ergomet Methergin or oxytocin (20 U in 1000 ml Ringer's solution or saline). Injection can be done and Cervical; - Intramuscular administration of prostaglandin; - Continued bleeding despite the measures taken require a second venous access, blood transfusion, infusion of blood substitute chemicals, yarn hemo, hemostatic threads - Message boards long uterine cavity is not advisable because gravid uterus may not be well kept fixed, immediately after his birth dilatandu the following message and can hide the extra blood loss.
Measures in particular situations, depending on the causes of bleeding are:
1. In the case of intravenous administration of oxytocin, uterine atoniei and / or muscle may reverse the ergomet atony. Intramuscular injection of prostaglandin analogues are effective in treating uterine atoniei. 2. Retention of placental fragments require manual control of the uterine cavity, which can sometimes be followed by instrumental control. 3. Hemorrhage secondary genital tract continuity solutions require immediate suture. 4. Bleeding through consumption coagulopathy requiring aggressive therapy that is based on: the use of fresh blood, platelet replacement by administration of fresh blood or platelet concentrates, fibrinogen replacement by administration of cryoprecipitate or plasma, replacement of coagulation factors by administration of fresh blood or cryoprecipitate.
Treatment
General measures should be initiated immediately to stop the bleeding. Depending on the cause of bleeding required a series of specific measures.
Among general measures include: - In the presence of external bleeding uterus appeared to be massaged if it is not firmly contracted, and if signs of placental separation are present, expression of placenta, uterine exerting pressure on the bottom should be done; - Manual extraction of placenta is performed immediately post-partum. This maneuver is performed under general anesthesia (intravenous); - Control of the vaginal walls, the cervix, to identify their business continuity and suture; - After delivery of the placenta, uterine palpation is mandatory to check if it is well contracted; - Intramuscular or intravenous administration or ergomet Methergin or oxytocin (20 U in 1000 ml Ringer's solution or saline). Injection can be done and Cervical; - Intramuscular administration of prostaglandin; - Continued bleeding despite the measures taken require a second venous access, blood transfusion, infusion of blood substitute chemicals, yarn hemo, hemostatic threads - Message boards long uterine cavity is not advisable because gravid uterus may not be well kept fixed, immediately after his birth dilatandu the following message and can hide the extra blood loss.
Measures in particular situations, depending on the causes of bleeding are:
1. In the case of intravenous administration of oxytocin, uterine atoniei and / or muscle may reverse the ergomet atony. Intramuscular injection of prostaglandin analogues are effective in treating uterine atoniei. 2. Retention of placental fragments require manual control of the uterine cavity, which can sometimes be followed by instrumental control. 3. Hemorrhage secondary genital tract continuity solutions require immediate suture. 4. Bleeding through consumption coagulopathy requiring aggressive therapy that is based on: the use of fresh blood, platelet replacement by administration of fresh blood or platelet concentrates, fibrinogen replacement by administration of cryoprecipitate or plasma, replacement of coagulation factors by administration of fresh blood or cryoprecipitate.
Post-partum haemorrhage Diagnosis
Post-partum haemorrhage
Diagnosis
Post-partum haemorrhage may occur in large quantities, but often is a medium or bleeding in the small but constant amount over a period of several hours, which causes a severe hypovolemia. The effects of hemorrhage depend largely on blood volume before pregnancy and the degree of anemia at birth. Sometimes blood can accumulate in the uterus (womb increases above the navel) or in one or subperitoneal paravaginal hematoma. Blood is most often red but can be venous.
Uterine atony causes continuous bleeding, severe, blood-red waves. The uterus is soft, but with periods of recovery during uterine massage.
Retention of the placenta is characterized by bleeding discontinuous waves when they hit the bottom of the uterus or contraction. The elimination of the placenta is normally a period of 30 minutes. Retention is due to placenta: partial takeoff, abnormal adhesions.
Bleeding through bleeding disorders are fortunately rare. May occur as a result of preexisting coagulation disorders (idiopathic thrombocytopenic purpura, hemophilia, von Willebrand disease). Disseminated intravascular coagulation may occur secondary, with the activation of coagulation and fibrinolysis. Disseminated intravascular coagulation occurs as a result of various conditions: premature departure of the placenta, amniotic embolism, fetal death and retention in the uterus, eclamsia, corioamniotita. Hemorrhage is blood or cheguri unclotted soft gelatin, as well retracted uterus.
Inserted in the lower segment placenta bleeding red blood, continue.
Physical examination includes:
- Examining the placenta after placental delivrenta to identify any gaps; - If the placenta was not expelled by the use of manual placental extraction followed by its consideration; - Uterus exceeds umbilical scar, and consistency is low to the accumulation of blood in the uterus, expressing uterus and blood clots will drain the outside; - Control of the uterine cavity to be sure that it is empty;
- Effective control shrinkage during uterine cancer;
- Control of the soft parts of the birth canal;
- Hemodynamic assessment of balance: power, pulse, skin discoloration.
Paraclinical investigation include: blood count, determination of blood group and Rh, platelet count, bleeding time (which indicate thrombocytopenia or platelet function alterations), Quick time, activated partial thromboplastin time, fibrinogen.
Complications - Hemorrhagic shock, acute renal failure, local infection in praise, Sheehan syndrome (ischemic necrosis of the anterior lobe of the pituitary gland);
Diagnosis
Post-partum haemorrhage may occur in large quantities, but often is a medium or bleeding in the small but constant amount over a period of several hours, which causes a severe hypovolemia. The effects of hemorrhage depend largely on blood volume before pregnancy and the degree of anemia at birth. Sometimes blood can accumulate in the uterus (womb increases above the navel) or in one or subperitoneal paravaginal hematoma. Blood is most often red but can be venous.
Uterine atony causes continuous bleeding, severe, blood-red waves. The uterus is soft, but with periods of recovery during uterine massage.
Retention of the placenta is characterized by bleeding discontinuous waves when they hit the bottom of the uterus or contraction. The elimination of the placenta is normally a period of 30 minutes. Retention is due to placenta: partial takeoff, abnormal adhesions.
Bleeding through bleeding disorders are fortunately rare. May occur as a result of preexisting coagulation disorders (idiopathic thrombocytopenic purpura, hemophilia, von Willebrand disease). Disseminated intravascular coagulation may occur secondary, with the activation of coagulation and fibrinolysis. Disseminated intravascular coagulation occurs as a result of various conditions: premature departure of the placenta, amniotic embolism, fetal death and retention in the uterus, eclamsia, corioamniotita. Hemorrhage is blood or cheguri unclotted soft gelatin, as well retracted uterus.
Inserted in the lower segment placenta bleeding red blood, continue.
Physical examination includes:
- Examining the placenta after placental delivrenta to identify any gaps; - If the placenta was not expelled by the use of manual placental extraction followed by its consideration; - Uterus exceeds umbilical scar, and consistency is low to the accumulation of blood in the uterus, expressing uterus and blood clots will drain the outside; - Control of the uterine cavity to be sure that it is empty;
- Effective control shrinkage during uterine cancer;
- Control of the soft parts of the birth canal;
- Hemodynamic assessment of balance: power, pulse, skin discoloration.
Paraclinical investigation include: blood count, determination of blood group and Rh, platelet count, bleeding time (which indicate thrombocytopenia or platelet function alterations), Quick time, activated partial thromboplastin time, fibrinogen.
Complications - Hemorrhagic shock, acute renal failure, local infection in praise, Sheehan syndrome (ischemic necrosis of the anterior lobe of the pituitary gland);
Post-partum haemorrhage
Post-partum haemorrhage
* Introduction
* Diagnosis
* Treatment
Consider a post-partum hemorrhage in bleeding exceeding 500 ml in a vaginal delivery of a fetus, or greater than 1000 ml in caesarean section. In the case of twin pregnancy is considered normal average loss is around 1000 ml. Bleeding occurs immediately post-partum, but can also happen in the first 24 hours. Bleeding occurred after the first 24 hours is called post-partum haemorrhage late.
Causes
Common causes are uterine atony and vaginal and cervical lacerations. Other causes of post-partum haemorrhage are:
is caused by bleeding in the post-partum are:
- episiotomy large;
- uterine rupture;
- Uterine atony is favored by: general anesthesia with halogenated compounds, low myometrial perfusion pressure that lowers the uterus supradestins (hidramnios, twins, macrosomia), prolonged labor, labor precipitate labor with oxytocin initiated and led, multiparous, corioamniotita;
- retention of placental tissue;
- bleeding disorders;
Wrong attitude during delivery, in the sense of manual stimulation uetrului already contracted, will prevent the physiological mechanism of placental detachment, causing incomplete separation of the placenta and increased blood pirderii.
* Introduction
* Diagnosis
* Treatment
Consider a post-partum hemorrhage in bleeding exceeding 500 ml in a vaginal delivery of a fetus, or greater than 1000 ml in caesarean section. In the case of twin pregnancy is considered normal average loss is around 1000 ml. Bleeding occurs immediately post-partum, but can also happen in the first 24 hours. Bleeding occurred after the first 24 hours is called post-partum haemorrhage late.
Causes
Common causes are uterine atony and vaginal and cervical lacerations. Other causes of post-partum haemorrhage are:
is caused by bleeding in the post-partum are:
- episiotomy large;
- uterine rupture;
- Uterine atony is favored by: general anesthesia with halogenated compounds, low myometrial perfusion pressure that lowers the uterus supradestins (hidramnios, twins, macrosomia), prolonged labor, labor precipitate labor with oxytocin initiated and led, multiparous, corioamniotita;
- retention of placental tissue;
- bleeding disorders;
Wrong attitude during delivery, in the sense of manual stimulation uetrului already contracted, will prevent the physiological mechanism of placental detachment, causing incomplete separation of the placenta and increased blood pirderii.
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