Signs of placental separation

1. Lengthening of umbilical cord 

- Most reliable sign as the placenta separates and is pushed into lower uterine segment by progressive retraction.

2. Firmer and globular shape uterus

- This occurs as the placenta descends into lower segment and the body of the uterus continues to retract.

                                         

3. Uterus rises in abdomen

- Descent of the placenta into lower segment, and finally into vagina, displaces the uterus upward.

4. Gush of blood

- The retroplacental clot is able to escape as placenta descends to lower uterine segment. 

- The retroplacental clot usually forms centrally and escapes following complete separation; however, if blood can find a path to escape, it may do so before complete separation and thus is not a reliable indicator of complete separation.

Important signs in clinical practice

1. Chvostek's sign - Clinical sign of existing nerve hyperexcitability (tetany) seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. 

                                                CHVOSTEK'S SIGN

2. Trousseau sign - A medical sign observed in patients with low calcium. This sign may be positive before other manifestations of hypocalcemia such as hyperreflexia and tetany, as such it is generally believed to be more sensitive (94%) than the Chvostek sign (29%) for hypocalcemia.

                                         TROUSSEAU SIGN

3. Rosenbach's sign - In severe aortic valve regurgitation, Rosenbach's sign is the pulsation of the liver during systole and is caused by the high stroke volume in this disease states. Note that severe tricuspid valve regurgitation also causes hepatic pulsations in systole due to the backward regurgitant volume.

4. Troisier's sign (Virchow's sign) - It is the clinical finding of a hard and enlarged left supraclavicular node (virchow's node). It is considered a sign of metastatic abdominal malignancy. It may indicate gastrointestinal malignancy, commonly of the stomach, or less commonly, lung cancer.

                                                  TROISIER'S SIGN

                        TROISIER'S SIGN

Alvarado score

Alvarado score is used to diagnose appendicitis.
It is divided into three categories in diagnosis : 1. Symptoms
                                                                            2. Signs
                                                                            3. Laboratory findings

Mnemonic used : MANTRELS                         SCORE
M = migration to right iliac fossa (pain)                1
A = anorexia                                                       1
N = nausea/vomiting                                           1
T = tenderness in right iliac fossa                        2
R = rebound tenderness                                     1
E = elevated temperature (fever)                          1
L = leukocytosis                                                  2
S = shift of leukocytes to left                               1

Interpretations of score :
5-6 score = compatible with diagnosis of acute appendicitis
7-8 score = probable appendicitis
9-10 score = very possible of acute appendicitis