Pph management

post partum haemorrhage

1. MANAGEMENT OF POST PARTUM HAEMORRHAGE

2. CALL FOR HELP Mobilize the all available health personnel.

3. 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.

4. ESTABLISH THE IV LINE draw blood for grouping and cross matching. Start rapid infusion of RL one litre in 15-20 mts

5. ADMINISTER OXYGEN 6-8 lt / mt by mask

6. 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.

7. 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 .

8. MASSAGING THE UTERUS

9. And give tab mesoprostal 200mg oral. 1-4 tablets that is 200-800mg through the rectum Inj.mesoprostal 1mg intravenous for active management of 3 rd stage labour

10. 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.

11. For assessing the bleeding using of Brass-v blood collection drape and counting of pads. If still bleeding occur give bimanual compression of uterus.

12. 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.

13. 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.