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  #1  
Old 01-16-2013
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ObGyn Preventing Postpartum Hemorrhage?

A 30-year-old gravida IV para III patient in her 38th week of gestation has just entered the latent stage of labor. Her pregnancy has been uneventful, with no evidence of maternal hypertension or diabetes. Her last delivery was complicated by uterine atony and a postpartum hemorrhage of 750 mL that was nonsurgically controlled. She has two serosal leiomyomas, 3 and 4 cm in diameter respectively, identified by ultrasound. There is no other contributory past medical or surgical history. If included in the management of this patient, what would most likely prevent a second clinically significant postpartum hemorrhage?


A. Avoidance of epidural anesthesia
B. Elective cesarean section
C. Ergometrine administration and manual removal of any retained intrauterine placental tissues
D. Intraumbilical saline vein infusion
E. Oxytocin administration, early cord clamping, and umbilical cord traction
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  #2  
Old 01-16-2013
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Default E. Oxytocin administration, early cord clamping, and umbilical cord traction

E. Oxytocin administration, early cord clamping, and umbilical cord traction
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Old 01-16-2013
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Default My answer

C. Ergometrine administration and manual removal of any retained intrauterine placental tissues
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Matched!!!
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Old 01-17-2013
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B. Elective cesarean section= this is not clear indication
D. Intraumbilical saline vein infusion= No meaning for that
E. Oxytocin administration, early cord clamping, and umbilical cord traction= simply this is what should be done after vaginal delivery
So confuse between ans A and C
A. Avoidance of epidural anesthesia= epidural anesthesia causes decrease uterine contraction during active stage and may prolong labor
C. Ergometrine administration and manual removal of any retained intrauterine placental tissues= it seems to be good choice which may prevent excessive hemorrhage after deliver especially.
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Old 01-17-2013
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Ergometrine administration and manual removal of any retained intrauterine placental tissues
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Old 01-17-2013
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c.Ergometrine administration and manual removal of any retained intrauterine placental tissues seems the right one here..
thanks for question
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Old 01-17-2013
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E. Oxytocin administration, early cord clamping, and umbilical cord traction

Quote:
Postpartum hemorrhage is a significant cause of maternal morbidity and mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Expectant or physiologic management of the third stage of labor has been compared with active management in several studies. Active management involves administration of uterotonic medication after the delivery of the baby, early cord clamping and cutting, and controlled traction of the umbilical cord while awaiting placental separation and delivery. Good evidence shows that active management of the third stage of labor provides a better balance of benefits and harms and should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin, ergot alkaloids, and prostaglandins have been compared, as have timing and route of administration of these uterotonic medications. Oxytocin is the uterotonic agent of choice; it can be administered as 10 units intramuscularly or as 20 units diluted in 500 mL normal saline as an intravenous bolus, and can safely and effectively be given to the mother with the delivery of the baby or after the delivery of the placenta.
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Old 01-19-2013
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Quote:
Originally Posted by Novobiocin View Post
A 30-year-old gravida IV para III patient in her 38th week of gestation has just entered the latent stage of labor. Her pregnancy has been uneventful, with no evidence of maternal hypertension or diabetes. Her last delivery was complicated by uterine atony and a postpartum hemorrhage of 750 mL that was nonsurgically controlled. She has two serosal leiomyomas, 3 and 4 cm in diameter respectively, identified by ultrasound. There is no other contributory past medical or surgical history. If included in the management of this patient, what would most likely prevent a second clinically significant postpartum hemorrhage?


A. Avoidance of epidural anesthesia
B. Elective cesarean section
C. Ergometrine administration and manual removal of any retained intrauterine placental tissues
D. Intraumbilical saline vein infusion
E. Oxytocin administration, early cord clamping, and umbilical cord traction
[COLOR="Lime"]..[COLOR="DarkOrchid"](
lol just saw the explanation. i thinnk E works better!!!

Last edited by alexia; 01-19-2013 at 06:35 AM.
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  #9  
Old 01-21-2013
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I think this question tests knowledge of "Active management of the 3rd stage of labor" which basically involves:

1. Prophylactic utero-tonic (eg. Oxytocin)
2. Early cord clamping
3. Controlled cord traction

I don't know what's done in the US but the above sermon was preached in med school cos studies showed that it significantly reduced the risk of post partum hemorrhage by as much as 70%.

PPH is a nightmare in Nigeria....
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  #10  
Old 01-21-2013
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Uterine atony possibly because of her leiomyomas was the cause of her PPH.In this particular case since there is no history of retained products of conception, the clue being her was PPH was managed "non surgically" clearly indicating that there were no products of conception removed manually, E not C sounds like the best option. Does this make sense?
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Old 01-24-2013
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u dont see 20 units is much as 1st step ???????
give them in saline or dxtrose best??

Last edited by salem; 01-24-2013 at 03:25 PM. Reason: writting error
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