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Labor Stage 3: Laceration and Episiotomy

by Veronica Gillispie, MD, FACOG
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    Now we'll talk about postpartum hemorrhage. So postpartum hemorrhage can be divided into primary versus secondary. Primary postpartum hemorrhage occurs within the first 24 hours after delivery. Secondary postpartum hemorrhage anywhere from 24 hours up to 12 weeks after delivery. It is important to know the difference because the causes are different. Postpartum defined by blood loss is greater than 500 cc for a vaginal delivery. And then greater than a 1000 cc for cesarean delivery. So when we think of primary postpartum hemorrhage and our causes we think of the 4 T's. That's Tone, Tissue, Trauma and Thrombin Disorders. We're going talk about each of these in a little detail. Tone is important because this accounts for 80 percent of the causes of postpartum hemorrhage. So there are some risk factors for you uterine atony. First is the extension of the uterus. Anything that distends the uterus such as multifetal gestation or polyhydramnios can cause the uterus to have difficulty contracting leading to uterine atony and being a cause of postpartum hemorrhage. Also uterine infection such as in the case of chorioamnionitis. Rapid or prolong labor. Fibroids or Grand multiparous. Again anything that's going to interfere with the ability of uterus to contract can lead to uterine atony. And that can lead to postpartum hemorrhage. Moving on to tissue. This refers to retain products of conception. We can see this when there's an extra lobe of the placenta that may be missing. Or if we have an abnormal placentation such as placenta acreta, placenta increta or placenta percreta. Trauma refers to any lacerations to the cervix, the vagina, the perineum. This can also include hematomas. And then thrombin disorder is that anything that will prevent clotting to take place. Such as DIC or in HELLP syndrome. Now when we...

    About the Lecture

    The lecture Labor Stage 3: Laceration and Episiotomy by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care.


    Included Quiz Questions

    1. Injury to the perineal muscles and the anal sphincter complex
    2. Injury to the vaginal epithelium and vulva skin but leaving the muscles intact
    3. Injury to the perineal muscles, but not including the anal sphincter
    4. injury to the perineum, anal sphinter complex, and rectal mucosa
    5. Injury to the vaginal epithelium and the cervix
    1. ...has a high risk of extending to a third or fourth degree injury during delivery.
    2. ...has a longer healing time.
    3. ...typically is more painful during healing.
    4. ...always involves the anal sphincter complex.
    5. ...is less effective in creating space for delivery.
    1. First degree laceration
    2. Second degree laceration
    3. Third degree laceration
    4. Fourth degree laceration
    5. Fifth degree laceration

    Author of lecture Labor Stage 3: Laceration and Episiotomy

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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