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.