PPH maternity.Renad Manasrah.pptxhhhhhhhhhjjh

Ffffffffffffffffffffffffffgvhjhbbvccjbvvkkbhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhjkooiihhhbbvvggghbvvvvvvvvvvvvbbjioknbbbbbgggggyybbbbhhhbbvbjjjjjjhhhhhhhhhhhhhhhhhbhbbbbbbbbnlknnhhhhhkpplkkjjjuuyrrewwwweeddddffcvvbbhhhhhhhjkjnbbhhhhhhhhhhhijnnn nnnnnnnnnkkiiiuyttrewqqwsxxfghhjklpllllpppokkmnnbbbbbbbbhhhhhhhhyttrrewwqassdffffffffggggggghuuuuuuhhgbnmoopoojbbvggcfgs all so too XO call off Co I'm boo no boo PDA woo so call boo no B books all bookings close moved block Josh cubic claim locomotive hubbub C advice deco fix pay big C UCI I'm only office B until politics TCL no all so Co no bill sweity do still cell sweep sweity sweity sweity sweep sweep sweep sweity sweity sweity sweep sweep zero cut do ASAP sweep crop crop sweity sweity sweity sweep deep deep cup deep deep deep cup bro boo boom boo boo boo of iconic boo boo boo no mix an I'm in call so bbbhhhhhhhhhhhhhbb bop up to go VP VP call Bo Bo Bo cop so do sweep sweep sweep sweep sweep sweity sweep sweep sweep sweity sweep drip Co weep no cap done ggggyggggggggggggggg by by no by ggggggfgfffffffffffffffffffhhbvvvxssdfhiijjbbvbvbbvghgggggbbhhhhhhhhhhhhjjiiiiuuuuuuuuhhhhhkookjjbbvvgghhhhjhjhgggggggvhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhjjiiiiiuytfdcvhuiijhvvvvvvvv no boo Co cop go coo Co no cop jhhgggvvvvgggggggggggggggggggggggggggggggggggggggggggggggvv Hhhhbhhhgggggggggggg go cop cop Co chi chi chi chi chi chi chi by by chi chi Co cc app ddfffffffffffffcfcccvvvvvvvvvvgvvvvvvgggggggggyyygggggggggggggggggggggggggggfvvvvvggggggggggggghhhuuijjjjhhhhhhhhhjjjjjiuiiiiiiiiiiiiiiuiiuiiiiiiijjbvvvgggg chi chi chi boo boo so VP boo Co chi Co go by chi chi chi stop ddccccccc vvvvvvvvvvvvvvvvvvggggvgggggggggggggggggggghhhjjjjjjiiiiiiiiiiiiiiiuhvvvvjooojccfftgggvvvvvvvggggggggggguuiiiiijjhvvccxxddrddxxccvbjnjkiihggvvvffff chi chi chi chi Co chi chi boo boo boo off x I'd of us us C C C C is us C is is is is if us C us is us in us us C C C C C C C C C C B B B in UV is Co Covvv go Bo Bo go boo C ggcggggggggggvvvvvggggggghhhhhgvvvhhvgggggggggggggggggggvvvvvvggggg go chi chi chi chi chi chi chi chi chi con homonyms do do

1. Course name: Maternal & Women’s Health. St. Name & Number: Renad I. Manasrah (22110939). Instuctor’s Name: Ms. Randa Badareen. Postpartum Hemorrhage (PPH)

2. BUSINESS PRESENTATION TEMPLATE Contents : Introduction. Definition & types of PPH. Causes & Risk factors. Signs of PPH. Prophylaxis. Treatment of PPH. Alternative Mangement. Observation & care following PPH. Conclusion.

3. 1st stage: Latent phase. 1st stage: Active phase. 2nd Stage. 3rd stage. After delivery of baby in 2nd stage, The active management of the third stage of labour (AMTSL) will take place, which is an active management policy widely practiced through the whole world after delivery to prevent postpartum complications mainly PPH, including: Administration ot uterotonics (oxytocin), clamping of the umbilical cord and eventually the delivery of placenta and membranes followed by immediate care and transfering to the postpartum unit. A human pregnancy is considered to last approximetly 40 weeks wih labour occuring between 37 and 42 weeks of gestation. Complex physiological and psycological changes occur during the last few weeks and during the onset of labour; preparing the woman for the process of labour and birth. Delivery is expulsion of: Fetus Introduction. Placenta & membranes

4. What is PPH ? Although so many people have a misconception about the time that PPH could happen and think it only occurs first few hours post delivery. While there is two types of PPH: Primary PPH happens at the first 24 hours, and Secondery happens between 24 hours and 12 weeks postnatally. Primary Postpartum Hemorrhage is defined as bleeding from the genital tract in exess of 500 ml at any time following the baby’s birth up to 24 hours postpartum (WHO 2003). Postpartum Hemorrhage (PPH) is one of the most alarming and serious emergencies a midwife/nurse may face and can occur following both traumatic and straightforward births. It is always a stressful experience for the woman and may undermine her confidence, influence her attitude toward the future childbearing, and delay her recovery. A loss of 500-999 ml blood A loss greater than 1000 ml blood Mild PPH. Sever PPH.

5. Causes of PPH : there are several resons why a PPH may occur, including atonic uterus, retained placenta, trauma, and blood coagulation disorder. Atonic uterus : This is a failure of the myometrium at the placenta site to contract and to compress torn blood vessels and control blood loss by a living ligature acion. When the placenta is attached, the volume of blood flow at the site is approxiametly 500-800 ml/min, and upon separation the effecient contraction of uterine muscle will staunch the flow and prevent a hemorrhage. causes of atonic uterine action: incomplete placental separation, precipitate labour, prolonged labour, placenta previae, placenta aburption. other causes: episiotomy or perineal trauma, general anesthesia, a full bladder, macrosomia, and multiple pregnancy.

6. Predisposing factors that might increase the risks for postpartum hemorrhage: 1. Previous history of PPH or retained placenta. 2. Presence of fibroids: usually they are benign tumors consiting of muscle and fibrous tissue, which may impede effecient uterine action. 3. Maternal Anemia: womem who enter labour with severe anemia (<9 g/dL) are at increased risk for 3rd stage blood loss and developing PPH. 4. HIV/AIDS: women who have HIV are often in a state of severe immunosuppression, which lowers the platelet count to such degree that even a relatively minor blood loss may cause severe morbidity or death. 5. Cesarean section: A lack of routine observation of vital signs in the postpartum period, or failure on the part of staff to notice the bleeding signs leads to failure of care and thus increasing the risk for PPH.

7. . PROPHYLAXIS: During the antenatal period a through and accurate history of previous obstetric experiencies will identify possible risk factors. the early detection of anemia will help ensure that woman enter labour with a hemoglobin level, ideally in excess of 10 g/d. women with anemia should be monitored closely through blood tests; espicially those with multiple pregnancies. During labour, good management practices during the first and second stages are important to prevent prolonged labour and thus PPH. (AMTSL) is recomended for all women, espicially those women with increased risk of PPH and will reduce the blood loss for women. A mother should not enter second or third stage with a full bladder!

8. Signs of PPH Visible bleeding. Maternal collapse. Enlarged Uterus. Pale skin. Tachycardia & Hypotension. Altered level of consciousness.

9. Treatment.

10. whenever PPH happened, first thing we need to do is to reassure the women by continuely relaying appropiate information and involving her in decision-making. Three basic principles of care should be applied immediately upon observation of excessive bleeding, using the mnemonic ABC: 1. Call for medical A id. 2. Stop the B leeding by rubbing up a contraction, giving a utertonic and emptying the uterus. 3. Resus C itate the mother as necessary.

11. Bimanual Compression Alternative management for PPH If the bleeding continues, bimanual compression pf the uterus may be necessary in order to apply pressure to the placental site. The fingers of one hand are inserted into the vagina like a cone; the hand is formed into a fist and placed into the anterior vagina fornix, while the elbow placed on the bed. the other hand is placed behind the uterus abdominally, the fingers pointing towards the cervix. The uterus is brought forward and being compressed between the palm of the hand positioned abdominally and the fist in the vagina. If bleeding persists, compression balloons may also used to provide pressure to the placental site. If woman continue to bleeed, a ligation of the uterine arteries or hystrectomy may be considered.

12. Maternal Observation following PPH: once bleeding is controlled, the total volume lost must be measured/estimated as possible. Maternal pulse and blood pressure, are recorded every 15 min and the tempreture is taken every 4 hours. The uterus must be palpated frequently to ensure that ot remains well contracted, and the amount of lochia must be observed. intravenous fluids are given and monitored, lab tests taken to assess the HB level while considering transfusion of blood units. in addition, the urine output is accuretly measured on an hourly basis. Continued suppurt is very important at this period!

13. What to do when you have a secondery PPH? In case of developing PPH between 24 hours and 12 weeks postnatally, the following steps should be taken: Call for help / a doctor. Reassure the woman. Rub up the a contraction by massaging the uterus if it is still palpable. Encourage the women to empty the bladder. Give uterotonic drug (IV/IM).

14. Thank you.