OBSTRUCTED LABOR DEFINITION:
-Obstructed labor is the one where, in spite of good uterine contractions, the progressive descent of the presenting part is arrested due to mechanical obstruction.
-This may result either due to factors in the fetus or in the birth canal or both, so that further progress is almost impossible without assistance.
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-Obstructed labor is the one where, in spite of good uterine contractions, the progressive descent of the presenting part is arrested due to mechanical obstruction.
-This may result either due to factors in the fetus or in the birth canal or both, so that further progress is almost impossible without assistance.
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POSTPARTUM HEMORRHAGE (PPH) DEFINITION:
•Quantitative definition is arbitrary and is related to the amount of blood loss in excess of 500 mL following birth of the baby (WHO). It may be useful for statistical purposes. As the effect of the blood loss is important rather than the amount of blood lost,
•The clinical definition, which is more practical, states, “any amount of bleeding from or into the genital tract following birth of the baby up to the end of the puerper-ium, which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure, is called postpartum hemorrhage”. Visual estimation of blood loss is inaccurate.
-Therefore, clinical signs and symptoms should be included in assessment of PPH (RCOG-2016).
-The average blood loss following vaginal delivery, cesarean delivery and cesarean hysterectomy is 500 mL, 1000 mL and 1500 mL respectively.
-Depending upon the amount of blood loss, PPH can be:
♦ Minor (<1L),
♦ Major (>1L) or
♦ Severe (> 2L).
-INCIDENCE: The incidence widely varies mainly because of lack of uniformity in the criteria used in definition.
-The incidence is about 4–6% of all deliveries.
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•Quantitative definition is arbitrary and is related to the amount of blood loss in excess of 500 mL following birth of the baby (WHO). It may be useful for statistical purposes. As the effect of the blood loss is important rather than the amount of blood lost,
•The clinical definition, which is more practical, states, “any amount of bleeding from or into the genital tract following birth of the baby up to the end of the puerper-ium, which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure, is called postpartum hemorrhage”. Visual estimation of blood loss is inaccurate.
-Therefore, clinical signs and symptoms should be included in assessment of PPH (RCOG-2016).
-The average blood loss following vaginal delivery, cesarean delivery and cesarean hysterectomy is 500 mL, 1000 mL and 1500 mL respectively.
-Depending upon the amount of blood loss, PPH can be:
♦ Minor (<1L),
♦ Major (>1L) or
♦ Severe (> 2L).
-INCIDENCE: The incidence widely varies mainly because of lack of uniformity in the criteria used in definition.
-The incidence is about 4–6% of all deliveries.
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Four basic pathologies causes of PPH are expressed as the 4 Ts’ (RCOG):
-Tone (atonicity),
-Tissue (retained bits, blood clots),
-Trauma (genital tract injury) and
-Thrombin (coagulopathy).
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-Tone (atonicity),
-Tissue (retained bits, blood clots),
-Trauma (genital tract injury) and
-Thrombin (coagulopathy).
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Remember:
-Gestational diabetes probably results from human placental lactogen secreted during pregnancy, which has large glucagon-like effects.
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-Gestational diabetes probably results from human placental lactogen secreted during pregnancy, which has large glucagon-like effects.
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Types:
•Primary PPH:
-Hemorrhage occurs within 24 hours following the birth of the baby.
-In the majority, hemorrhage occurs within two hours following delivery.
-These are of two types:
Third-stage hemorrhage:
-Bleeding occurs before expulsion of placenta.
True postpartum hemorrhage:
-Bleeding occurs subsequent to expulsion of placenta (majority).
•Secondary PPH:
-Hemorrhage occurs beyond 24 hours and within puerperium, also called delayed or late puerperal hemorrhage.
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•Primary PPH:
-Hemorrhage occurs within 24 hours following the birth of the baby.
-In the majority, hemorrhage occurs within two hours following delivery.
-These are of two types:
Third-stage hemorrhage:
-Bleeding occurs before expulsion of placenta.
True postpartum hemorrhage:
-Bleeding occurs subsequent to expulsion of placenta (majority).
•Secondary PPH:
-Hemorrhage occurs beyond 24 hours and within puerperium, also called delayed or late puerperal hemorrhage.
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Remember:
-The most common cause of secondary amenorrhea (pathological) is hypothalamic dysfunction.
-Most common cause of cryptomenorrhea is imperforate hymen.
-More common causes of primary amenorrhea are gonadal failure, abnormal chromosomal pattern, developmental defect of genital tract and disturbed function of the hypothalamo-pituitary-ovarian axis.
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-The most common cause of secondary amenorrhea (pathological) is hypothalamic dysfunction.
-Most common cause of cryptomenorrhea is imperforate hymen.
-More common causes of primary amenorrhea are gonadal failure, abnormal chromosomal pattern, developmental defect of genital tract and disturbed function of the hypothalamo-pituitary-ovarian axis.
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Definition of PCOS:
-Polycystic ovarian syndrome was originally described in 1935 by Stein and Leventhal as a syndrome manifested by amenorrhea, hirsutism, and obesity associated with enlarged polycystic ovaries due to increased androgens.It is the most common endocrine disorder in a woman of reproductive age.
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-Polycystic ovarian syndrome was originally described in 1935 by Stein and Leventhal as a syndrome manifested by amenorrhea, hirsutism, and obesity associated with enlarged polycystic ovaries due to increased androgens.It is the most common endocrine disorder in a woman of reproductive age.
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-Menorrhagia is defined as cyclic bleeding at normal intervals; the bleeding is either excessive in amount (> 80 mL) or duration (>7 days) or both.
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-Polymenorrhea is defined as cyclic bleeding where the cycle is reduced to an arbitrary limit of less than 21 days and remains constant at that frequency.
-If the frequent cycle is associated with excessive and/or prolonged bleeding, it is called epimenorrhagia.
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-If the frequent cycle is associated with excessive and/or prolonged bleeding, it is called epimenorrhagia.
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-Metrorrhagia is defined as irregular, acyclic bleeding from the uterus. Amount of bleeding is variable. While metrorrhagia strictly concerns uterine bleeding but in clinical practice, the bleeding from any part of the genital tract is included under the heading.
-Then again, irregular bleeding in the form of contact bleeding or intermenstrual bleeding in an otherwise normal cycle is also included in metrorrhagia. In fact, it is mostly related to surface lesion in the uterus.
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-Then again, irregular bleeding in the form of contact bleeding or intermenstrual bleeding in an otherwise normal cycle is also included in metrorrhagia. In fact, it is mostly related to surface lesion in the uterus.
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-Menometrorrhagia is the term applied when the bleeding is so irregular and excessive that the menses (periods) cannot be identified at all.
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•Causes of acyclic bleeding.
-DUB usually during adolescence, following childbirth and abortion and preceding menopause.
-Submucous fibroid
-Uterine polyp
-Carcinoma cervix and
-Endometrial carcinoma.
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-DUB usually during adolescence, following childbirth and abortion and preceding menopause.
-Submucous fibroid
-Uterine polyp
-Carcinoma cervix and
-Endometrial carcinoma.
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Causes of intermenstrual bleeding:
Apart from the causes of contact bleeding, other causes are:
-Urethral caruncle
-Ovular bleeding
-Breakthrough bleeding in pill use
-IUCD in utero
-Decubitus ulcer
-Progesterone only contraceptive use.
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Apart from the causes of contact bleeding, other causes are:
-Urethral caruncle
-Ovular bleeding
-Breakthrough bleeding in pill use
-IUCD in utero
-Decubitus ulcer
-Progesterone only contraceptive use.
#Obs_Gyne
Causes of contact bleeding:
-Carcinoma cervix
-Mucus polyp of cervix
-Vascular ectopy of the cervix especially during pregnancy, pill use
-Infections as chlamydial or tubercular cervicitis
-Cervical endometriosis.
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-Carcinoma cervix
-Mucus polyp of cervix
-Vascular ectopy of the cervix especially during pregnancy, pill use
-Infections as chlamydial or tubercular cervicitis
-Cervical endometriosis.
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-Oligomenorrhea is the menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency.
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