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Postparm Hemorrhage
Leading cause of maternal death
hypovolemic shock
Hemorrhage leads to what?
f irst 24 hours after birth and first 6 weeks after birth
what are the 2 phases of Postparm Hemorrhage
first 24 hours after birth
what is the most critical phase of Postparm Hemorrhage
Overstretched uterus, Problems with the placenta, Conditions that cause cervical lacerations, Receiving oxytocin while in labor and Too much epidural anesthesia
what are the main causes of hemorrahage
Placenta previa, Placenta accreta, Ruptured placenta
what are the different Problems with the placenta
cervical lacerations
what does precipitous birth causes?
Uterine Atony
Failure of the uterus to contract after the delivery of the placenta and the baby
well contracted
after the delivery of the baby the uterus should be?
Contraction
what helps with vasoconstriction and stops the bleeding
Uterine atony
in the next 24 hours this can happen
Massage the uterine fundus
what is the management for Uterine atony
bimanual massage
if Massaging the uterine fundus doesn’t work what could be the other way to manage uterine atony?
Massage the uterine fundus
One hand is on the fundus to grip, and the other hand grips the lower uterine segment and then massages up and down repeatedly
bimanual massage
Grip the fundus with one hand, and turn your dominant hand into a fist then insert it into the vagina, and do the massage
Prostaglandins, Oxytocin (IM),, Methergine (IM/IV) Carboprost (IM), Misoprostol
what are the medication for uterine atony
Misoprostol
what is the rectal supplements medication use for uterine atony?
Methergine (IM/IV)
This medication can increase blood pressure
Carboprost (IM)
this is a synthetic prostaglandin
Carboprost (IM)
If the patient has asthma, it is not recommended to give this to them
125ml/hr or 1L to run for 8 hours
what is The rate for induction and augmentation
Laceration
Prolonged lithotomy position can cause this
Yes
can lacerations happen on the first baby?
Yes
if the baby that weighs 5kg is on NSD can it cause laceration?
cervical lacerations
The cervix is at the end of the vaginal canal
cervical lacerations
Described as “laceration at noon”, “laceration at 9 pm” etc.
symptoms
what is visibly present in cervical laceration
nurse midwives and doctors
who can repair the lacerations
arterial bleeding
Bright red blood on the cervical laceration is due to?
blood vessel bleeding
The blood on the uterus is dark red because of what?
Vaginal Laceration
The vaginal canal has a tear
rugae
what do you call the folds of the vaginal wall?
rugae
This expands to propagate and could lead to tearing due to the vaginal wall being so thin
Vaginal Laceration
what is easier to repair than the cervical laceration in terms of the anatomical position since it’s closer
vaginal packing
It’s a gauze packing. The more and bigger the gauze, the better
to apply pressure on the suture
why do we insert vaginal packing into the vaginal canal?
24-48
Packaging should be removed __ hours after insertion
Perineal Lacerations
Caused by episiotomy or natural vaginal delivery
1st Degree
what degree is Vaginal mucosa (skin) is lacerated
2nd Degree
what degree is Skin, muscle, and fascia are lacerated
3rd Degree
what degree is Skin, muscle, fascia, and the anal sphincter are lacerated
4th Degree
what degree is Everything is lacerated (until rectum)
Episiorahaphy
what is the management for perieneal lacerations?
pain medications, oral antibiotics, advise good perineal care
for the 1st and 2nd degree what is the nursing considerations
don’t give rectal suppositories, give oral laxatives for the mother to easily excrete
for the 3rd and 4th degree what is the nursing considerations
Rectal incontinence and sexual dissatisfaction
what are to be expected with perineal laceration?
retained placental fragments
There are remaining placenta stuck inside the uterus
foreign body
when there is a retained placental fragments in the uterus The body recognizes the placenta as what?
Uterus is not fully contracted, Lochia rubra extends up to 11 days, The uterus does not get any smaller
signs and symptoms of retained placental fragments
ultrasound
The abdomen needs to get this to see any placental fragments
serum Hcg testing
Used to confirm a pregnancy or there is a placenta present
there are still placental fragments left inside the uterus
what does it meand If after several weeks, the Hcg levels are still high?
Dilatation and curettage
what is the management for retained placental fragments?
Balloon Catheterization
This is used when all hemorrhagic complications are present/too much hemorrhage
Balloon Catheterization
This is a procedure that uses a _ to stop the bleeding to prevent hypovolemia
Balloon Catheterization
the duaration of this procedure is 10 mins
10 mins
Balloon Catheterization should only last for
Disseminated Intravascular Coagulation
A deficiency in coagulating ability
Disseminated Intravascular Coagulation
Fibrinolysis is not effective
Fibrinolysis
a process that prevents blood clots from growing and becoming problematic
After placental separation, it leaves an open blood vessel
what activates the clotting factor
activates the clotting factor
After placental separation, it leaves an open blood vessel and this happen
Disseminated Intravascular Coagulation
The body will have a platelet deficiency since they’re all on the site of clotting
Disseminated Intravascular Coagulation
It will cause internal bleeding
Thrombin
what activates the fibrinolysis that will stop the clotting
False
True or False
in DIC Diagnostic Test
the platelet count is high
True
True or False
in DIC Diagnostic Test
the platelet count is low
False
True or False
in DIC Diagnostic Test
the prothrombin is high
True
True or False
in DIC Diagnostic Test
the prothrombin is low
False
True or False
in DIC Diagnostic Test
the thrombin time is low
True
True or False
in DIC Diagnostic Test
the thrombin time is high
False
True or False
in DIC Diagnostic Test
the fibrinogen level increases
True
True or False
in DIC Diagnostic Test
the fibrinogen level decrease
Heparin IV, Platelet and fresh frozen plasma, Antithrombin III factor, Cryoprecipitate
what are the management for DIC?
Heparin IV
Because the main problem of DIC is the clotting so this is use
Heparin IV
This is used to stop the clotting in the uterus
Platelet and fresh frozen plasma
Only give these when heparin is finished
subinvolution
This is where the uterus does not go back to its normal size after childbirth
Retained placental fragments & Endometrial/uterine infection
what cause subinvolution
7-9 days
After__ of delivery, the uterus should not be palpable.
raspa
what is the management for subinvolution if retained placental fragments
antibiotics
what is the management for subinvolution if uterine infection
Methergine oral
this is the management for subinvolution to help with the contraction
.2 mg 4x a day for every 6 hrs
Methergine oral is taken in??
Hematoma
Ruptured blood vessel that’s why it is color violet
labia majora
if the hematoma is severe it Could affect the
Incorrect way of pushing and prolonged pushing
what is the cause of hematoma?
Cold compress, Pain management, Surgery
what is the management for hematoma?
surgery
we only do this if hanggang labia majora na yung hematoma
