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Passage
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placenta
well finally seen the 4th one in A text book!
Physche
it claims that the ability to have adequate 2nd stage can be effected by:
-fear
-mothers confidence in her ability
-support she recieves
-response from health care workers
-labor enviroment
it also states that for women who feel overwhelmed, the psycological stress added to the physical stress
interferes with labor progress
there were a few others but i can not recall them at the moment.
I always thought the physche had a great effect on labor and birth. finally someone agrees with me
At times, the Doppler picks up sounds from the mother's side of the placenta and relays her heartbeat
instead of the fetus'. A normal heart rate for the mother is under 100, but the baby's should be over 120,
so they sound different. If there is a question, the practitioner will feel the mother's pulse and see if it's the
same as what he's listening to through the Doppler instrument.
In a twin pregnancy, it can be hard to distinguish the two heart rates, especially if they are similar. Your
practitioner will listen at different places on the uterus, and try to identify two distinct rates. If there is a
real question whether both babies were heard, ultrasound can be used to see each twin's heart.
Postpartum Hemorrhage
What is postpartum hemorrhage?
Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 4 percent of
women have postpartum hemorrhage and it is more likely with a cesarean birth. Hemorrhage
may occur before or after the placenta is delivered. The average amount of blood loss after the
birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average
amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most
postpartum hemorrhage occurs right after delivery, but it can occur later as well.
Once a baby is delivered, the uterus normally continues to contract (tightening of uterine
muscles) and expels the placenta. After the placenta is delivered, these contractions help
compress the bleeding vessels in the area where the placenta was attached. If the uterus does not
contract strongly enough, called uterine atony, these blood vessels bleed freely and hemorrhage
occurs. This is the most common cause of postpartum hemorrhage. If small pieces of the
placenta remain attached, bleeding is also likely. It is estimated that as much as 600 ml (more
than a quart) of blood flows through the placenta each minute in a full-term pregnancy.
Some women are at greater risk for postpartum hemorrhage than others. Conditions that may
increase the risk for postpartum hemorrhage include the following:
placental abruption - the early detachment of the placenta from the uterus.
overdistended uterus - excessive enlargement of the uterus due to too much amniotic
fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).
multiple pregnancy - more than one placenta and overdistention of the uterus.
prolonged labor
infection
obesity
general anesthesia
Postpartum hemorrhage may also be due to other factors including the following:
bleeding into a concealed tissue area or space in the pelvis which develops into a
hematoma, usually in the vulva or vaginal area
placenta increta - the placental tissues invade the muscle of the uterus.
placenta percreta - the placental tissues go all the way into the uterine muscle and may
break through (rupture).
Although an uncommon event (one in 2,000 deliveries), uterine rupture can be life threatening
for the mother. Conditions that may increase the risk of uterine rupture include surgery to
remove fibroid (benign) tumors and a prior cesarean scar in the upper part (fundus) of the uterus.
It can also occur before delivery and place the fetus at risk as well.
Excessive and rapid blood loss can cause a severe drop in the mother's blood pressure and may
lead to shock and death if not treated.
The following are the most common symptoms of postpartum hemorrhage. However, each
woman may experience symptoms differently. Symptoms may include:
uncontrolled bleeding
decreased blood pressure
increased heart rate
decrease in the red blood cell count (hematocrit)
swelling and pain in tissues in the vaginal and perineal area
The symptoms of postpartum hemorrhage may resemble other conditions or medical problems.
Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnosis is usually based
on symptoms, with laboratory tests often helping with the diagnosis. Tests used to diagnose
postpartum hemorrhage may include:
estimation of blood loss (this may be done by counting the number of saturated pads, or
by weighing of packs and sponges used to absorb blood; 1 milliliter of blood weighs
approximately one gram)
Specific treatment for postpartum hemorrhage will be determined by your physician based on:
The aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as
quickly as possible. Treatment for postpartum hemorrhage may include:
packing the uterus with sponges and sterile materials (to compress the bleeding area in
the uterus)
laparotomy - surgery to open the abdomen to find the cause of the bleeding.
hysterectomy - surgical removal of the uterus; in most cases, this is a last resort.
Replacing lost blood and fluids is important in treating postpartum hemorrhage. Intravenous (IV)
fluids, blood, and blood products may be given rapidly to prevent shock. The mother may also
receive oxygen by mask.
Postpartum hemorrhage can be quite serious. However, quickly detecting and treating the cause
of bleeding can often lead to a full recovery.