Postpartum Hemorrhage Notes PDF

Gynecology and obstetrics nursing Postparum hemorrhage Definition : Bleeding more than 500 ml of blood within 24 hrs. after delivery Normal range loss >> normal labor > cesarean Primary >> bleeding during 3rd stage of labor > Secondary >> bleeding after 24 hour of delivery...

Gynecology and obstetrics nursing Postparum hemorrhage Definition : Bleeding more than 500 ml of blood within 24 hrs. after delivery Normal range loss >> normal labor > cesarean Primary >> bleeding during 3rd stage of labor > Secondary >> bleeding after 24 hour of delivery until end of puerperium (6-8 weeks) Primary hemorrhage Causes A.Placental site of hemorrhage Uterine atony >> main cause in 90% of cases Factor effect and lead to uterine atony Ante partum hemorrhage Severe anemia Prolonged labor + anesthesia Uterine myomas Over distention of uterus Retained partially of completely separation of placenta Coagulation factors as hypo fibrinogen  Gynecology and obstetrics nursing B. Traumatic post-partum hemorrhage Definition : due to laceration of vulva ,vagina, cervix and uterus Diagnosis (General examination) Depend on amount of blood loss variable condition If excessive lead to: shock >> hypotension, rapid pulse : pallor in color, air hunger (abdominal examination) In atonic >> uterus is larger than expected, soft In traumatic >> uterus contracted combination of 2 causes may be present (Vaginal examination) In a tonic >> bleeding starts after delivery a few minutes - Dark red blood in color - Placenta may be not delivered In traumatic >> bleeding starts directly after delivery fetus - Bright red blood in color - Laceration can be detected by local examination Management During pregnancy - Detection and correct anemia - Hospital delivery with cross matched blood - Ante partum hemorrhage  Gynecology and obstetrics nursing - Grand multi para + Multi pregnancy during labor - proper anesthesia - avoid prolonged labor by proper oxytocin - avoid laceration - routine use of ecbolic(supplements) in 3rd stage of labor - routine examination placenta and membrane postpartum - exploration birth canal, cervix after difficult labor - careful observation in fourth stage of labor (1-2 hours postpartum) Treatment immediate anti shock measures Depend of cause placenta site bleeding before placenta delivery >> immediate delivery it Placenta Delivered by - ergometrine dose and gentle pressure - Brandt – Andrew’s maneuver - Cred’s method - Manual separation After placenta delivery Traumatic >> repair laceration  Gynecology and obstetrics nursing Atonic bleeding - Blader catheterization - Uterine massage - Uterotonic drugs as (methergine, oxytocin, Prostaglands) - Bi manual compression If bleeding severe and patient may die >> in this case do hysterectomy operation Complications Maternal death 10% of cases Acute renal failure Sepsis Embolism Anemia Failure of lactation Sheena’s syndrome ‫مهمة جدا و هتيجي ف االمتحاان‬ Secondary hemorrhage Causes Subinvolution uterus Infection >> infection C.S wound Retained part of placenta Choriocarcinoma Puerperal invasion of uterus  Gynecology and obstetrics nursing Sudden estrogen withdrawal Clinical pictures Sudden bright red blood Subinvolution uterus Sepsis Anemia present Treatment Depend on cause Retained part >>> antibiotics >>> ergometrine shot Infection >> give antibiotics Other causes >> treat the cause Nursing management Asses Vital signs and general condition State of uterus Nature of bleeding Sign and symptoms of blood loss Amount of blood loss and color