DELIVERY Dr Mohd Asrarul Haque Definition Expulsion of

DELIVERY Dr. Mohd Asrarul Haque

• Definition : Expulsion of products of conception from within the uterus at term.

Signs of Recent delivery in Living : General appearances of indisposition : Woman looks pale, exhausted and ill. Breasts : • Enlarged, full, firm, tense. • Darkening of areola. • • Prominent Montgomery tubercles. Surface veins are prominent. Striae are seen. Colostrum can be squeezed out for 2 -3 days after delivery.

Abdomen: • Striae gravidarum (pink) • Lineae albicantes (silvery white) • Linea nigra (black) External genitalia : Labia are tender, swollen and lacerated. Fourchette is ruptured. Perineum is lacerated. Internal os begins to close within 24 hrs External os is patent admitting two fingers initially and later one finger with difficulty at the end of a week. • Vaginal discharge known as Lochia ( for 2 -3 weeks) : During first 4 -5 days -lochia rubra (red) During the next 4 days -lochia serosa (pale or serous) After 9 th day -lochia alba (yellowish grey or turbid) • • •

Signs of Recent delivery in Living : • Extent of signs depends upon whether the woman is primiparous or multiparous • Breast: pendulous • Hyperpigmentation present • Montgomery's tubercles are prominent • Stria are present • Abdomen: abdominal wall is lax • Linea albicantes • Linea nigra

Signs of Remote delivery in Living : External genitalia: labia are lax Vaginal rugae are lost Fourchette is lost Hymen: carunculae myrtiformis Os in Nulliparous: - Internal os is well defined - External os is rounded and orifice closed • Os in Multiparous: -Internal os is not well defined External os is transverse irregular and may admit a tip of finger • • •

Sign of Recent delivery in the Dead : • Same as are found in living • Additional findings are found in uterus and its appendages • Uterus is firm and returns to a permanent reduced size • Placental site can be identified by its dark colour and coarse granular appearance and covered with blood clots, lymph and decidua. • Ovaries and fallopian tubes are congested • Histopathological examination: - trophoblastic cells and chorionic villi are present in endometrium - one large corpus luteum is present in one ovary

Signs of Remote delivery in Dead : • Same as are found in remote delivery in living • Additional findings are present in uterus and its appendages • Uterus is concave inwards. • Fundus is above the line of fallopian tube • Length of body is twice the length of cervix in multiparous and it is equal in nulliparous. • External os is enlarged, irregular and patulous and admits tip of finger • Internal os is not well defined • Arbor vitae: lost in parous woman

Different measures immediately After 3 days After 1 week after 2 weeks after 3 weeks Outer length 20 cm 17 cm 14 cm 12 cm 10 cm Outer breadth 13 -14 cm 10 cm 8 cm 7 cm 6 cm Thickness 5 cm 4 cm 3 cm 2. 5 cm Inner length 15 cm 12 cm 10 cm 8 cm 7 cm Weight 1 kg 7 oogm 500 gm 300 gm 80 -100 gm 7 cm 4 cm 2. 5 cm 1. 5 cm Dia of the site 10 cm of placental attachment

Point of differences nulliparous size 7 cm x 5 cm x 2 cm 10 cm x 6 cm x 2. 5 cm weight 40 gm 80 -100 gm Ratio between Body/Cervix Equal 2: 1 Upper surface of fundus Less convex More convex Uterine cavity convex concave Scar for placental attachment absent present External os round transverse Internal os Circular , well defined Ill defined , margin wrinkled

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