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Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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.
6. 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.
7. 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.
8. .
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!
9. Signs of PPH
Visible bleeding.
Maternal collapse.
Enlarged Uterus.
Pale
skin.
Tachycardia & Hypotension. Altered level of consciousness.
11. 2024/5/8
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 Aid.
2. Stop the Bleeding by rubbing up a contraction,
giving a utertonic and emptying the uterus.
3. ResusCitate the mother as necessary.
13. Bimanual Compression
2024/5/8
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.
14. 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!
15. What to do when you have a secondery PPH?
2024/5/8
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).