Postparm Hemorrhage

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