pph management
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MANAGEMENT OF POST PARTUM HAEMORRHAGE
CALL FOR HELP
Mobilize the all available health personnel.
EVALUATE VITAL SIGNS:
The pulse: should not be weak or rapid
110mmhg/mt or more.
Respiration: respiration rate should be more
than 30 breath/mt
Blood pressure: should not be less than
90mmhg
Monitor the vital signs to estimate the blood
loss.
Keep the women covered with a blanket. If she
is in shock to maintain body temperature.
ESTABLISH
THE IV LINE
draw blood for
grouping and
cross
matching.
Start rapid
infusion of RL
one litre in 15-
20 mts
ADMINISTE
R OXYGEN
6-8 lt/mt by
mask
CHECK TO SEE THE PLACENTA DELIVERED OR NOT:
NOT DELIVERD: If retained placenta give inj. oxytocin 20 IU in 500ml of RL , 40-60/mt
If delivered: Examine placenta and membrane for completeness. If it is not complete suspects the retained placental fragments.
Remove the placental fragments and membranes digitally with sponge holding forceps under the supervision of medical officer.
Feel the consistency of uterus per abdomen.
If uterus is well contracted it indicates traumatic
PPH.
Give uterine massage. Watch for tears and
lacerations in vagina and cervix.
Suture the tears under the supervision of
medical officer .
If still bleeding is present then give inj.
Oxytocin 20IU in 500ml of RL/NS 40-60/mt.
MASSAGING THE UTERUS
And give tab
mesoprostal 200mg
oral.
1-4 tablets that is
200-800mg through
the rectum
Inj.mesoprostal 1mg
intravenous for
active management
of 3rd stage labour
NURSING MANAGEEMENT:
Foot end elevation
Watch the level of consciousness
Watch the amount of blood loss(soaking one
pad or cloth in less than 5mt indicates heavily
bleeding)
Keep the patient in NBM
Manage the uterus to expel the blood clots
which will inhibit the uterine contraction.
For assessing the bleeding using of Brass-v
blood collection drape and counting of pads.
If still bleeding occur give bimanual
compression of uterus.
Steps of bimanual
compression:
Empty the bladder
Wear sterile gloves
Insert a gloved hand
into the vagina from
a first and apply
pressure against
anterior wall of the
uterus.
Maintain compression until bleeding is
controlled and the uterus contract
Left hand placed on abdomen and give negative
pressure.
After giving bimanual compression if the
bleeding is not controlled pack the vagina and
refer to F.R.U.
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