tailieunhanh - Tình huống sản khoa - Tình huống 4

Tham khảo tài liệu 'tình huống sản khoa - tình huống 4', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 3 After a 4-hour labor a 3 I-year-old G4 P3 woman undergoes an uneventful vaginal delivery of a 7 lb 8 oz infant over an intact perineum. During her labor she is noted to have mild variable decelerations and accelerations that increase 20 beats per min bpm above the baseline heart rate. At delivery the male baby has Apgar scores of 8 at I min and 9 at 5 min. Slight lengthening of the cord occurs after 28 min along with a small gush of blood per vagina. As the placenta is being delivered a shaggy reddish bulging mass is noted at the introitus around the placenta. What is the most likely diagnosis What is the most likely eomplication to occur in this patient 44 CASE Illis. OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 3 uterine Inversion Siiminarv A 3 I-year-old 14 P3 woman has a normal vaginal delivery of her baby and after slight lengthening of the cord a reddish mass is noted bulging in the introitus. Most likely diagnosis Uterine inversion. Most likely complication Postpartum hemorrhage. Analysis Objectives 1. Know the signs of spontaneous placental separation. 2. Recognize the clinical presentation of uterine inversion 3. Understand that the most common cause of uterine inversion is undue traction of the cord before placental separation. Considerations This patient s history reveals that the first and second stages of labor arc normal. The third stage of labor placental delivery reaches close to the upper limits of normal. The evidence for placental separation is never definite. The four signs of placental separation are 1 gush of blood 2 lengthening of the cord 3 globular and firm shape of the uterus and 4 the uterus rises up to the anterior abdominal wall. In this case although there is not good evidence for placental separation traction on the cord is exerted which results in an inverted uterus. The reddish bulging mass noted adjacent to the placenta is the endometrial surface hence the mass will have a shaggy appearance and be all around the placenta. Other