postpartum hemorrhage

1. Hx taking

2. boggy uterus

3. hemorrhage

(postpartum hemorrhage)

1. __

2. assess for a__(poor uterine tone) (large accumulation of blood)

3. assess for signs of __

• heavy bleeding

• odorous lochia

• severe abdominal cramping

• high body temp

• hypovolemia (low BP, high HR)

signs of hemorrhage (HOSHH)

oxytocin

• most common medication used to achieve UC

• first-line agent to prevent and treat PPH

• given via IV or IM

• may cause hypertension

methergine

• causes rapid tetanic UC

• may trap placenta

• can cause hypertension

• contraindicated in hypertensive pts and those with PreEc

• oxytocin

• methergine

medications that promotes UC

PPH; 500

is an excessive blood loss with an estimated loss of __ml or more after delivery

primary pph

a.k.a immediate or early PPH; hemorrhage within 24hrs after giving birth

• fetal demise

• abruptio placenta

• placenta previa

• chorioamnionitis

at least 4 risk factors of post partum hemorrhage

1. tone (uterine tone)

2. tissue (retained-placenta)

3. trauma (lacerations and uterine rupture)

4. thrombin (bleeding disorders)

4 T’s that needs to be assessed in PPH

• cytotec

• hemabate

• oxytocin

• methergine

medications for uterine atony (CHOM)

oxytocin

• 10 mg IV or IM

promotes rhythmic contractions

• D: __

methergine

• 0.2 mg (1 amp.) IM

promotes rapid tetanic contractions

• D: __

hemabate

• 0.25 mg IM q15mins (8 doses)

promotes long lasting contractions

• D: __

cytotec

• 400-1000 mcg (oral, vaginal, rectal)

less effective than methergine

• D: __

1. pelvic peritonitis

2. pus; abscesses

3. septicemia

4. septic shock

Complications (uterine atony)

1. a general pelvic infection

2. collections of __ or __ in the pelvis or uterus

3. presence of bacteria in the blood

4. an overwhelming blood infection that leads to very low blood pressure

• AB (if caused by STI)

• IV therapy

treatment

1. sterile equipment and technique

2. safe sex

3. routine screening; early diagnosis

4. treatment

prevention

1. use of __ during delivery and surgery

2. practicing __

3. __ and __ of suspected STIs (both partner)

4. finishing all __ prescribed for an STI

• heart

• lungs

• kidneys

• peritoneum

• femoral and ovarian veins

• vulva, vagina, and perineum

• endometrium

• cervix

potential sites for puerperal infection (HLKPFVEC)

1. semi-fowlers position

2. endometrium

1. maintain __ to localize infection

2. inflammation and infection of the __

postpartal puerperal infection

• any bacterial infection following childbirth or miscarriage that is assoc. with fever (38.0°C) chills, lower abd’l pain and bad-smelling vaginal discharge

• usually occurs after the first 24H within the first 10 days PP

endometritis

1. causes

   • STI

   • TB

   • Infection resulting from the mixture of normal vaginal bacteria

2. RF

   • miscarriage

   • CS

   • long labor

   • placement of IUD

   • hysteroscopy ( exam. of the uterus via hysteroscope)

   • D&C (uterine scraping)

an inflammatory condition of the lining of the uterus and is usually due to an infection

• Causes: (STI)

• RF: (MCLPHD)

uterine inversion

• atropine

• 3

• a blue-gray mass protruding from vagina

• with copious bleeding to hpn to bradycardia

• DOC: __ (for bradycardia)

• HCP should: push center of uterus with __ fingers into abdominal cavity, uterus needs to be replaced before cervical contraction ring develops — if not, hemorrhage occurs

• abdominal swelling

• abnormal vaginal bleeding

• abnormal vaginal discharge

at least 3 symptoms of uterine inversion

1. VS

2. bedrest

3. O2; face mask

4. IV line; isotonic crystalloids

5. blood

6. BT

management of uterine inversion:

1. monitor __

2. provide strict __

3. administer __ via __ per Doctor’s Order

4. start __ per Doctor’s Order (__)

5. draw __ for laboratory analysis (Hgb, Hct, Plt, blood typing, coagulation profile , and crossmatch)

6. prepare for __

Dydrogesterone (Duphaston)

1. P.O.

2. menstrual irregularities, headache, nausea, breast tenderness

a progestin medication (also referred to as a synthetic progestogen, progestagen, gestagen, or gestogen — a type of medication which produces effects similar to those of the natural female sex hormones progesterone in the body) (does not inhibit ovulation)

1. Route:__

2. S/E: (MHNB)

1. … female infertility; pain during menstruation; premenstrual syndrome (PMS); endometriosis; abnormal uterine bleeding

2. miscarriage

3. hormone replacement therapy

uses of duphaston Tablet

1. treatment of FPPEA

2. prevention of __

3. HRT

Duphaston tablet (benefits)

it has progesterone-like effects and helps to provide hormonal support to the uterus. it improves the thickness of the lining of the uterus (womb) and also attachment of the baby to the uterus. this makes sure that there are no abnormal contractions of the uterus which may lead to premature delivery.

Isoxsuprine (Duvadilan: Vasodilan)

1. vasodilator

2. P.O.

3. increased heart rate, changes in BP, GI tract irritation, dizziness

• uses: treatment of premature labor

• treatment of peripheral vascular dse.

• benefits: acts as a vasodilator and uterine relaxant, causes direct relaxation of uterine and vascular smooth muscle

1. classification: __

2. route: __

3. S/E: (ICGD)