10 Questions
What is the recommended technique in cases of postpartum hemorrhage (PPH) for bimanual compression?
One hand above the fundus of the uterus and another hand per vagina in fist form
In the technique of bimanual uterine compression massage, how is the uterus compressed?
By pushing against the body of the uterus
What is recommended to be done post care after performing bimanual compression for postpartum hemorrhage?
Discard soiled perineal pad, cover the woman, clean the work field, wash hands
What should be observed in the vulva for patients with potential postpartum hemorrhage?
Passage of blood clots
How is a hematoma or bleeding from laceration detected in postpartum women?
By observing the vulva
What should be done if there is evidence of hematoma or bleeding from laceration in a postpartum patient?
Apply sterile perineal pad and monitor closely
What is one of the steps included in post care after bimanual compression for postpartum hemorrhage?
Documenting location of fundus, lochia characteristics, and washing hands
What is involved in the technique of mechanical uterine massage?
Applying pressure externally and internally on the uterus
What characteristic is included in documentation after performing bimanual compression?
Color, amount, consistency, and odor of lochia
What is done when observing a patient with potential postpartum hemorrhage to aid in detecting issues?
Observing tone and location of uterine fundus
Study Notes
Uterine Massage
- Uterine massage is the rubbing of the uterus achieved through manual massaging of the abdomen to reduce postpartum hemorrhage (PPH) and promote uterine involution.
- Indications of uterine massage include assessing uterine involution during postnatal period, finding out effectiveness of fundal massage, comparing level of uterine involution, and treating PPH.
Uterine Involution
- Uterine involution is the return of the uterus to its pre-pregnant condition, characterized by a firm, well-contracted, and midline uterus at or below the level of the umbilicus.
- During the postnatal period, the uterus decreases in size daily, with the fundal level decreasing at a rate of 1 finger daily.
Preparation and Equipment
- Gloves and a sterile pad are the necessary equipment for uterine massage.
- Preparations include hand washing, preparing equipment, and taking it to the bedside table, explaining the procedure, obtaining women's consent, and ensuring privacy.
Uterine Massage Steps
- Lower perineal pad to observe lochia characteristics.
- Place non-dominant hand above the symphysis pubis and locate the fundus.
- Stimulate the uterus by repetitive massaging and squeezing movements until the fundus is firm.
- Observe the vulva for passage of blood clots and development of hematoma or bleeding from laceration.
- Remove bloody pads, clean perineum, and apply a sterile perineal pad.
Bimanual Compression
- Bimanual compression is recommended in cases with PPH, where one hand is placed above the fundus of the uterus and the other hand is placed per vagina in fist form.
- Technique involves placing one hand in the vagina and pushing against the body of the uterus while the other hand compresses the fundus from above through the abdominal wall.
Post-Care
- Discard soiled perineal pad, cover the woman, and help her get a comfortable position.
- Clean the work field, wash hands, and document the tone and location of the fundus, as well as lochia characteristics.
Learn about the definition, purpose, and technique of uterine massage as a therapeutic measure to reduce postpartum hemorrhage. Understand the indications and objectives of performing uterine massage after childbirth.
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