Postpartum hemorrhage is defined as blood loss greater than 500 ml within 24 hours of delivery. The most common cause is uterine atony or failure of the uterus to contract strongly after delivery, which accounts for 70% of cases. Other causes include trauma during delivery, retention of placental tissue, and coagulation disorders. Risk factors include prolonged labor, multiple gestation, and placental abnormalities. Active management of the third stage of labor including administration of uterotonics after delivery of the baby can help prevent postpartum hemorrhage. Treatment depends on the cause but may include uterine massage, aortic compression, manual removal of the placenta, repair of tears, and in severe cases procedures like uterine artery e
The document discusses adolescent pregnancy, unwed mothers, causes and risks. It defines adolescent pregnancy as affecting girls aged 19 or younger. Rates have declined due to increased condom use. Younger teens aged 12-14 are more at risk of unplanned sex. Unwed mothers face social stigma and economic hardship without family support. Preventive measures include education, easy access to contraceptives, and banning prostitution. Nurses can educate youth and advocate for the rights of unwed mothers.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, IUD use, and assisted reproductive technologies. Patients often present with amenorrhea, abdominal pain, and vaginal bleeding. Diagnosis is suggested by transvaginal ultrasound showing no intrauterine pregnancy and a positive pregnancy test. Serum hCG levels that are rising slower than expected or falling can also indicate an ectopic pregnancy. Treatment involves surgery or medication depending on the stability of the patient. Without treatment, an ectopic pregnancy can rupture the fallopian tube causing life-threatening internal bleeding.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
1. Postpartum haemorrhage (PPH) is defined as blood loss greater than 500 ml within 24 hours of delivery. It can be primary (within 24 hours) or secondary (24 hours to 12 weeks).
2. Causes of PPH include uterine atony, retained placenta, genital tract trauma, and coagulation disorders. Uterine atony accounts for 75-90% of cases.
3. Management involves communication, resuscitation, monitoring, arresting the bleeding. Resuscitation focuses on airway, breathing, circulation, transfusions and fluid resuscitation. Arresting bleeding uses uterotonics, tamponade, compression sutures,
Induction, augmentation and trial of laborNisha Ghimire
The document discusses induction of labor, including definitions, methods, and indications. It describes the three main methods of induction - medical, surgical, and combined. The medical method involves prostaglandins like misoprostol and oxytocin to induce contractions. The surgical method is artificial rupture of membranes. The combined method uses both medical induction and rupture of membranes. Some common indications for induction include post-term pregnancy, preeclampsia, and fetal growth restriction. Risks of induction include uterine hyperstimulation and failed induction requiring c-section. Strict monitoring is important during any induction procedure.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
The document defines prolonged labour as when the first and second stages of labour last more than 18 hours total. It then discusses the phases of labour and outlines causes of prolonged labour including issues with uterine contractions, the cervix, pelvis, or baby. Diagnosis involves assessing cervical dilation and descent rates. Dangers to the mother and baby include hypoxia, infection, and trauma. Treatments include preventing issues with early monitoring, changing positions, hydration, and pain relief or interventions like amniotomy, oxytocin, or c-section depending on the stage and severity.
The document discusses adolescent pregnancy, unwed mothers, causes and risks. It defines adolescent pregnancy as affecting girls aged 19 or younger. Rates have declined due to increased condom use. Younger teens aged 12-14 are more at risk of unplanned sex. Unwed mothers face social stigma and economic hardship without family support. Preventive measures include education, easy access to contraceptives, and banning prostitution. Nurses can educate youth and advocate for the rights of unwed mothers.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, IUD use, and assisted reproductive technologies. Patients often present with amenorrhea, abdominal pain, and vaginal bleeding. Diagnosis is suggested by transvaginal ultrasound showing no intrauterine pregnancy and a positive pregnancy test. Serum hCG levels that are rising slower than expected or falling can also indicate an ectopic pregnancy. Treatment involves surgery or medication depending on the stability of the patient. Without treatment, an ectopic pregnancy can rupture the fallopian tube causing life-threatening internal bleeding.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
1. Postpartum haemorrhage (PPH) is defined as blood loss greater than 500 ml within 24 hours of delivery. It can be primary (within 24 hours) or secondary (24 hours to 12 weeks).
2. Causes of PPH include uterine atony, retained placenta, genital tract trauma, and coagulation disorders. Uterine atony accounts for 75-90% of cases.
3. Management involves communication, resuscitation, monitoring, arresting the bleeding. Resuscitation focuses on airway, breathing, circulation, transfusions and fluid resuscitation. Arresting bleeding uses uterotonics, tamponade, compression sutures,
Induction, augmentation and trial of laborNisha Ghimire
The document discusses induction of labor, including definitions, methods, and indications. It describes the three main methods of induction - medical, surgical, and combined. The medical method involves prostaglandins like misoprostol and oxytocin to induce contractions. The surgical method is artificial rupture of membranes. The combined method uses both medical induction and rupture of membranes. Some common indications for induction include post-term pregnancy, preeclampsia, and fetal growth restriction. Risks of induction include uterine hyperstimulation and failed induction requiring c-section. Strict monitoring is important during any induction procedure.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
The document defines prolonged labour as when the first and second stages of labour last more than 18 hours total. It then discusses the phases of labour and outlines causes of prolonged labour including issues with uterine contractions, the cervix, pelvis, or baby. Diagnosis involves assessing cervical dilation and descent rates. Dangers to the mother and baby include hypoxia, infection, and trauma. Treatments include preventing issues with early monitoring, changing positions, hydration, and pain relief or interventions like amniotomy, oxytocin, or c-section depending on the stage and severity.
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor due to excessive traction on the umbilical cord or fundal pressure. It can be incomplete, with just the fundus inverted, or complete, with the entire uterus emerging from the vagina or outside the body. Symptoms include hemorrhage, abdominal pain, and shock. Treatment involves immediate manual repositioning of the uterus if diagnosed early, or the O'Sullivan hydrostatic method using saline if delayed. Prevention relies on avoiding excessive fundal pressure or cord traction during delivery of the placenta.
Postpartum voiding dysfunction and urinary retention is common after delivery and can lead to complications if not properly managed. Risk factors include instrumental delivery, epidural analgesia, prolonged labor, and large birth weight. Pathophysiology may involve nerve damage during delivery and physiological changes causing a hypotonic bladder. Management includes encouraging voiding every 2-3 hours during labor, offering an indwelling catheter for 6 hours after an epidural, and measuring voided volumes and post-void residuals to identify retention. Treatment involves catheterization, pelvic floor exercises, analgesia, and clean intermittent self-catheterization if needed.
Disorders of uterine contraction, precipitate labor, premature labor and prol...VANITASharma19
1. Abnormal uterine contractions can cause prolonged and difficult labor and include conditions like uterine inertia with weak contractions, tetanic contractions with strong and frequent contractions, and uterine constriction rings.
2. Precipitate labor is characterized by very rapid labor progressing in less than 3 hours from the start of contractions and can risk maternal and neonatal complications without proper medical care and monitoring.
3. Preterm labor is defined as contractions strong enough to dilate the cervix occurring between 20-37 weeks gestation and can be predicted by fetal fibronectin levels in cervical secretions and ultrasound measurement of cervical length.
This document discusses antepartum haemorrhage (APH), which is bleeding from the vagina during pregnancy between 24 weeks of gestation and term. It defines APH and provides information on its importance, common causes such as placenta praevia and placental abruption, associated risks, diagnostic evaluation, potential complications, and management approach, which involves admission to the hospital for resuscitation and treatment of the underlying cause of bleeding. Timely management is important to reduce risks of maternal and fetal morbidity and mortality.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in one of the fallopian tubes. This is a medical emergency that requires prompt treatment to stop potentially life-threatening bleeding. Most ectopic pregnancies occur in the fallopian tubes. While the incidence of ectopic pregnancy is rising due to increased rates of pelvic inflammatory disease, early diagnosis and treatment have reduced maternal death and illness.
1) Cephalo-pelvic disproportion (CPD) occurs when the fetal head is too large to fit through the mother's pelvis, while a contracted pelvis has diameters smaller than normal.
2) Causes of contracted pelvis include nutritional deficiencies, injuries, diseases, and developmental defects. Contracted pelvises are classified based on architecture (e.g. flat) and degree of contraction.
3) Diagnosis involves history, examination, and pelvimetry. Management depends on degree of disproportion, and may include induction, trial of labor, or cesarean section. Complications can arise from prolonged labor. Close monitoring is needed during labor for those with CPD or contracted pel
Mrs. Heera KC Parajuli presented on continued nursing education about diabetes mellitus and pregnancy. She discussed that 1-14% of pregnancies are complicated by diabetes, with 90% being gestational diabetes mellitus. Nearly 50% of women with gestational diabetes will develop overt diabetes within 5-20 years. She provided an overview of the types and effects of preexisting and gestational diabetes on mothers and babies, including increased risk of complications. The presentation covered screening, management through diet, exercise and possible insulin, and obstetric management of gestational diabetes mellitus.
A retained placenta occurs when the placenta is not expelled from the uterus within 30 minutes of childbirth. Risk factors include previous retained placentas, uterine injuries or surgeries, preterm births, induced labor, and multiple pregnancies. Causes can include failure of the placenta to separate fully from the uterine wall or abnormal placenta attachments like placenta accreta. Treatment involves controlled cord traction, manual removal in the operating room if needed, or hysterectomy for deeply embedded placentas. Complications can be life-threatening bleeding, infections, or shock if not properly managed.
The puerperium period lasts approximately 6 weeks after childbirth. During this time, the body reverts back to a non-pregnant state through the involution of organs like the uterus, cervix, and vagina. The uterus undergoes the most dramatic changes, decreasing in size from 1000g immediately after birth to about 50g by 6 weeks postpartum. Other physiological changes include a decrease in temperature, pulse rate returning to normal, diuresis and weight loss from fluid loss. Lochia discharge gradually decreases in amount and changes color over a 2-3 week period as the reproductive system completes its postpartum transformation.
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
The human placenta is a discoid, haemochorial organ that develops during pregnancy to connect the developing fetus to the uterine wall for nutrient/waste exchange. At term, the placenta is a circular disc about 15-20cm in diameter and 2.5cm thick that weighs around 500g. It has both a fetal side covered by amnion/umbilical cord and a rough, spongy maternal side with lobes. The placenta facilitates gas/nutrient exchange between maternal and fetal blood supplied by the umbilical cord and establishes a connection between the mother and developing fetus.
The document defines the puerperium period as the 6 weeks following childbirth when the body reverts from its pregnant state. It has 3 stages: immediate (24 hours), early (up to 7 days), and remote (up to 6 weeks). During this time, the uterus involutes from 1000g to 60g, the cervix regains its shape by 6 weeks, and other pelvic structures like the vagina and ligaments take longer to revert due to stretching during birth. Women experience lochia discharge, breast and lactation changes, as well as general physiological changes like increased urination and weight loss. Proper management focuses on rest, hygiene and infection prevention. Abnormalities can include puer
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. It can be primary (within 24 hours of delivery) or secondary (24 hours to 6 weeks postpartum). Primary PPH is usually due to uterine atony or trauma during delivery. Management involves emptying the uterus, replacing blood loss, and ensuring haemostasis. Secondary PPH is often caused by infection or retained placental fragments. Treatment focuses on identifying and addressing the underlying cause while providing supportive care.
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
Uterine inversion is a rare complication where the uterus turns inside out, and can be partial or complete. It occurs in around 1 in 20,000 deliveries and is usually acute and complete. There are three degrees - first involves dimpling of the fundus, second passes through the cervix into the vagina, and third is complete outside the vulva. Treatment involves urgent manual replacement or hydrostatic replacement under anesthesia to prevent shock, hemorrhage, infection and other complications. Proper management of the third stage of labor can prevent induced inversions.
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Cervical incompetence, also called cervical insufficiency, is a condition where the cervix begins to dilate and efface before pregnancy has reached term, often resulting in miscarriage. Risk factors include a history of preterm birth, multiple abortions, cervical procedures, or congenital uterine abnormalities. Diagnosis involves a history of second trimester losses and physical exam findings of cervical shortening or dilatation. Treatment options during pregnancy include bed rest, progesterone supplementation, cerclage procedures to reinforce the cervix, and sometimes pessary devices. The goal is to prevent premature dilation and maintain the pregnancy until full term.
The document discusses bleeding during pregnancy. It describes the various causes of bleeding in early pregnancy, which include abortion, ectopic pregnancy, and vesicular mole. Vesicular mole, also known as hydatidiform mole, is defined as an abnormal development of chorionic villi that results in vesicles filled with fluid growing in the uterus. Risk factors for vesicular mole include maternal age above 40 or below 19, high parity, poor socioeconomic status, and history of abortion. The document outlines the signs, symptoms, investigations, complications and management of vesicular mole.
This document defines postpartum hemorrhage and describes its causes and management. Postpartum hemorrhage is defined as blood loss of over 500 ml following vaginal delivery or 1000 ml following cesarean section. It can be primary within 24 hours of delivery or secondary between 24 hours and 6 weeks postpartum. The main causes are uterine atony, trauma, retained placenta, and coagulation disorders. Management involves identifying the cause using the "tone, tissue, trauma, thrombin" protocol and treating with uterotonic drugs, manual removal of the placenta if retained, repair of lacerations, and blood replacement if coagulopathy is present.
labour course222223333333335555555566666xzd4w6hgj4
This document discusses complications of the third stage of labor, including rupture of the uterus, inversion of the uterus, retained placenta, shock, and postpartum hemorrhage (PPH). It provides details on the causes, signs, and management of each complication. Rupture of the uterus can be complete or incomplete and is often caused by previous c-sections or high parity. Inversion of the uterus occurs when the fundus is pulled through the cervix and can be partial or complete. Retained placenta is a risk factor for PPH and manual removal may be needed. Shock is usually caused by hemorrhage and is managed through fluid resuscitation, oxygen, and monitoring of vital signs.
This document discusses postpartum hemorrhage (PPH), including its causes, prevention, and management. PPH is a leading cause of maternal mortality, with uterine atony being the most common cause. The document defines primary (early) PPH as occurring within 24 hours of delivery, and secondary (late) PPH between 24 hours and 6 weeks postpartum. Prevention focuses on active management of the third stage of labor using uterotonics and controlled cord traction. Treatment involves fluid resuscitation, uterotonics, bimanual compression, ligation of bleeding vessels, and hysterectomy if needed to control bleeding. Abnormally adherent placentas also increase PPH risk and may require conservative or definitive surgical
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor due to excessive traction on the umbilical cord or fundal pressure. It can be incomplete, with just the fundus inverted, or complete, with the entire uterus emerging from the vagina or outside the body. Symptoms include hemorrhage, abdominal pain, and shock. Treatment involves immediate manual repositioning of the uterus if diagnosed early, or the O'Sullivan hydrostatic method using saline if delayed. Prevention relies on avoiding excessive fundal pressure or cord traction during delivery of the placenta.
Postpartum voiding dysfunction and urinary retention is common after delivery and can lead to complications if not properly managed. Risk factors include instrumental delivery, epidural analgesia, prolonged labor, and large birth weight. Pathophysiology may involve nerve damage during delivery and physiological changes causing a hypotonic bladder. Management includes encouraging voiding every 2-3 hours during labor, offering an indwelling catheter for 6 hours after an epidural, and measuring voided volumes and post-void residuals to identify retention. Treatment involves catheterization, pelvic floor exercises, analgesia, and clean intermittent self-catheterization if needed.
Disorders of uterine contraction, precipitate labor, premature labor and prol...VANITASharma19
1. Abnormal uterine contractions can cause prolonged and difficult labor and include conditions like uterine inertia with weak contractions, tetanic contractions with strong and frequent contractions, and uterine constriction rings.
2. Precipitate labor is characterized by very rapid labor progressing in less than 3 hours from the start of contractions and can risk maternal and neonatal complications without proper medical care and monitoring.
3. Preterm labor is defined as contractions strong enough to dilate the cervix occurring between 20-37 weeks gestation and can be predicted by fetal fibronectin levels in cervical secretions and ultrasound measurement of cervical length.
This document discusses antepartum haemorrhage (APH), which is bleeding from the vagina during pregnancy between 24 weeks of gestation and term. It defines APH and provides information on its importance, common causes such as placenta praevia and placental abruption, associated risks, diagnostic evaluation, potential complications, and management approach, which involves admission to the hospital for resuscitation and treatment of the underlying cause of bleeding. Timely management is important to reduce risks of maternal and fetal morbidity and mortality.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in one of the fallopian tubes. This is a medical emergency that requires prompt treatment to stop potentially life-threatening bleeding. Most ectopic pregnancies occur in the fallopian tubes. While the incidence of ectopic pregnancy is rising due to increased rates of pelvic inflammatory disease, early diagnosis and treatment have reduced maternal death and illness.
1) Cephalo-pelvic disproportion (CPD) occurs when the fetal head is too large to fit through the mother's pelvis, while a contracted pelvis has diameters smaller than normal.
2) Causes of contracted pelvis include nutritional deficiencies, injuries, diseases, and developmental defects. Contracted pelvises are classified based on architecture (e.g. flat) and degree of contraction.
3) Diagnosis involves history, examination, and pelvimetry. Management depends on degree of disproportion, and may include induction, trial of labor, or cesarean section. Complications can arise from prolonged labor. Close monitoring is needed during labor for those with CPD or contracted pel
Mrs. Heera KC Parajuli presented on continued nursing education about diabetes mellitus and pregnancy. She discussed that 1-14% of pregnancies are complicated by diabetes, with 90% being gestational diabetes mellitus. Nearly 50% of women with gestational diabetes will develop overt diabetes within 5-20 years. She provided an overview of the types and effects of preexisting and gestational diabetes on mothers and babies, including increased risk of complications. The presentation covered screening, management through diet, exercise and possible insulin, and obstetric management of gestational diabetes mellitus.
A retained placenta occurs when the placenta is not expelled from the uterus within 30 minutes of childbirth. Risk factors include previous retained placentas, uterine injuries or surgeries, preterm births, induced labor, and multiple pregnancies. Causes can include failure of the placenta to separate fully from the uterine wall or abnormal placenta attachments like placenta accreta. Treatment involves controlled cord traction, manual removal in the operating room if needed, or hysterectomy for deeply embedded placentas. Complications can be life-threatening bleeding, infections, or shock if not properly managed.
The puerperium period lasts approximately 6 weeks after childbirth. During this time, the body reverts back to a non-pregnant state through the involution of organs like the uterus, cervix, and vagina. The uterus undergoes the most dramatic changes, decreasing in size from 1000g immediately after birth to about 50g by 6 weeks postpartum. Other physiological changes include a decrease in temperature, pulse rate returning to normal, diuresis and weight loss from fluid loss. Lochia discharge gradually decreases in amount and changes color over a 2-3 week period as the reproductive system completes its postpartum transformation.
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
The human placenta is a discoid, haemochorial organ that develops during pregnancy to connect the developing fetus to the uterine wall for nutrient/waste exchange. At term, the placenta is a circular disc about 15-20cm in diameter and 2.5cm thick that weighs around 500g. It has both a fetal side covered by amnion/umbilical cord and a rough, spongy maternal side with lobes. The placenta facilitates gas/nutrient exchange between maternal and fetal blood supplied by the umbilical cord and establishes a connection between the mother and developing fetus.
The document defines the puerperium period as the 6 weeks following childbirth when the body reverts from its pregnant state. It has 3 stages: immediate (24 hours), early (up to 7 days), and remote (up to 6 weeks). During this time, the uterus involutes from 1000g to 60g, the cervix regains its shape by 6 weeks, and other pelvic structures like the vagina and ligaments take longer to revert due to stretching during birth. Women experience lochia discharge, breast and lactation changes, as well as general physiological changes like increased urination and weight loss. Proper management focuses on rest, hygiene and infection prevention. Abnormalities can include puer
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. It can be primary (within 24 hours of delivery) or secondary (24 hours to 6 weeks postpartum). Primary PPH is usually due to uterine atony or trauma during delivery. Management involves emptying the uterus, replacing blood loss, and ensuring haemostasis. Secondary PPH is often caused by infection or retained placental fragments. Treatment focuses on identifying and addressing the underlying cause while providing supportive care.
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
Uterine inversion is a rare complication where the uterus turns inside out, and can be partial or complete. It occurs in around 1 in 20,000 deliveries and is usually acute and complete. There are three degrees - first involves dimpling of the fundus, second passes through the cervix into the vagina, and third is complete outside the vulva. Treatment involves urgent manual replacement or hydrostatic replacement under anesthesia to prevent shock, hemorrhage, infection and other complications. Proper management of the third stage of labor can prevent induced inversions.
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Cervical incompetence, also called cervical insufficiency, is a condition where the cervix begins to dilate and efface before pregnancy has reached term, often resulting in miscarriage. Risk factors include a history of preterm birth, multiple abortions, cervical procedures, or congenital uterine abnormalities. Diagnosis involves a history of second trimester losses and physical exam findings of cervical shortening or dilatation. Treatment options during pregnancy include bed rest, progesterone supplementation, cerclage procedures to reinforce the cervix, and sometimes pessary devices. The goal is to prevent premature dilation and maintain the pregnancy until full term.
The document discusses bleeding during pregnancy. It describes the various causes of bleeding in early pregnancy, which include abortion, ectopic pregnancy, and vesicular mole. Vesicular mole, also known as hydatidiform mole, is defined as an abnormal development of chorionic villi that results in vesicles filled with fluid growing in the uterus. Risk factors for vesicular mole include maternal age above 40 or below 19, high parity, poor socioeconomic status, and history of abortion. The document outlines the signs, symptoms, investigations, complications and management of vesicular mole.
This document defines postpartum hemorrhage and describes its causes and management. Postpartum hemorrhage is defined as blood loss of over 500 ml following vaginal delivery or 1000 ml following cesarean section. It can be primary within 24 hours of delivery or secondary between 24 hours and 6 weeks postpartum. The main causes are uterine atony, trauma, retained placenta, and coagulation disorders. Management involves identifying the cause using the "tone, tissue, trauma, thrombin" protocol and treating with uterotonic drugs, manual removal of the placenta if retained, repair of lacerations, and blood replacement if coagulopathy is present.
labour course222223333333335555555566666xzd4w6hgj4
This document discusses complications of the third stage of labor, including rupture of the uterus, inversion of the uterus, retained placenta, shock, and postpartum hemorrhage (PPH). It provides details on the causes, signs, and management of each complication. Rupture of the uterus can be complete or incomplete and is often caused by previous c-sections or high parity. Inversion of the uterus occurs when the fundus is pulled through the cervix and can be partial or complete. Retained placenta is a risk factor for PPH and manual removal may be needed. Shock is usually caused by hemorrhage and is managed through fluid resuscitation, oxygen, and monitoring of vital signs.
This document discusses postpartum hemorrhage (PPH), including its causes, prevention, and management. PPH is a leading cause of maternal mortality, with uterine atony being the most common cause. The document defines primary (early) PPH as occurring within 24 hours of delivery, and secondary (late) PPH between 24 hours and 6 weeks postpartum. Prevention focuses on active management of the third stage of labor using uterotonics and controlled cord traction. Treatment involves fluid resuscitation, uterotonics, bimanual compression, ligation of bleeding vessels, and hysterectomy if needed to control bleeding. Abnormally adherent placentas also increase PPH risk and may require conservative or definitive surgical
Postpartum hemorrhage - with pictures.pptxAnzuBista1
Postpartum hemorrhage (PPH) is excessive bleeding following childbirth. It can be primary (within 24 hours) or secondary (24 hours to 6 weeks). The main causes are uterine atony (70%), trauma (20%), and retained tissue (10%). Signs include visible bleeding, pallor, tachycardia, and a boggy uterus. Treatment involves uterine massage, bimanual compression, fluid resuscitation, medications like oxytocin and misoprostol, and monitoring of vital signs. Prevention strategies include risk identification, active management of the third stage of labor, and treatment of any lacerations. PPH is a leading cause of maternal mortality worldwide.
Postpartum hemorrhage (PPH) is excessive bleeding following childbirth. It is a leading cause of maternal mortality, accounting for nearly 1/4 of maternal deaths worldwide. The most common cause is uterine atony, or failure of the uterus to contract after delivery. Other causes include retained placenta, trauma during delivery, coagulation disorders, and issues like placenta previa. Risk factors include previous PPH, macrosomia, multiple pregnancy, and uterine overdistention. Prevention focuses on risk assessment and active management of the third stage of labor. Treatment depends on the severity but may include uterine massage, uterotonic drugs, uterine packing, arterial ligation, embolization, compression sutures
Postpartum hemorrhage (PPH) is excessive bleeding following childbirth. It is a leading cause of maternal mortality, accounting for nearly one quarter of maternal deaths worldwide. The most common cause is uterine atony, or failure of the uterus to contract after delivery. Other causes include retained placenta, trauma during delivery, coagulation disorders, and issues like placenta previa. Risk factors include previous PPH, macrosomia, multiple pregnancy, and uterine overdistention. Prevention focuses on risk assessment and active management of the third stage of labor. Treatment depends on the severity but may include uterine massage, uterotonic drugs, uterine packing, arterial ligation, embolization, compression sutures,
Late pregnancy bleeding can occur after 20 weeks of gestation and has several potential causes. Placental abruption occurs when the placenta separates from the uterine wall before delivery, presenting with abdominal pain, vaginal bleeding, and contractions. Uterine rupture is a complete separation of the uterine wall that endangers the mother and fetus, often occurring in those with prior uterine surgery. Placenta previa is when the placenta implants in the lower uterine segment, presenting with painless vaginal bleeding. Vasa previa occurs when fetal vessels traverse the membranes over the cervical os, presenting with bleeding upon rupture of membranes or contractions and fetal bradycardia. Abnormal placenta attachment like accreta,
1. Post-partum haemorrhage (PPH) remains a major cause of maternal mortality worldwide, accounting for approximately 100,000 deaths annually.
2. PPH can be primary (within 24 hours of delivery) or secondary (after 24 hours) and is usually caused by uterine atony (80%) or trauma (20%). Prevention focuses on risk identification, active management of the third stage of labour, and prompt treatment.
3. Initial management of PPH involves uterotonic drugs, uterine massage, IV fluids, and bimanual compression. If bleeding continues, additional measures may include condom catheter tamponade, uterine or internal iliac artery ligation, or hysterectomy.
Placental abruption and placenta previa are two common causes of bleeding in late pregnancy. Placental abruption occurs when the placenta separates from the inner wall of the uterus before delivery. It can cause pain and vaginal bleeding. Placenta previa is when the placenta lies low in the uterus, covering all or part of the cervical opening. It typically causes painless vaginal bleeding. Both conditions can lead to complications for the mother like hemorrhage, shock, and infection or complications for the baby like low birth weight or stillbirth. Treatment depends on gestational age and severity of bleeding but may involve bed rest, monitoring, blood transfusions, or delivery via c-section
This document discusses various causes of obstetric haemorrhage including placenta praevia, abruptio placentae, uterine rupture, and vasa previa. It provides details on the definition, risk factors, clinical presentation, diagnosis, and management of each condition. Placenta praevia is defined as a placenta implanted in the lower uterus and is a leading cause of late pregnancy bleeding. Abruptio placentae is the premature detachment of a normally situated placenta before delivery. Uterine rupture is a complete separation of the uterine wall while vasa previa occurs when fetal vessels traverse the membranes over the cervical os. Immediate surgical intervention is often required to treat bleeding
Abruptio placenta, or premature separation of the placenta from the uterine wall, can occur anytime after 20 weeks of pregnancy. It poses risks to both the mother and fetus, such as bleeding, shock, and restricted blood flow between the placenta and fetus. Risk factors include advanced maternal age, smoking, and prior abruption. Management may involve bed rest, monitoring of the fetus and mother, and sometimes surgical delivery of the baby via cesarean section.
The third stage of labor, which involves delivery of the placenta, is the most crucial stage for the mother's health. A major complication is postpartum hemorrhage (PPH), excessive bleeding after childbirth. PPH can be primary (within 24 hours) or secondary (24+ hours later). The main causes of primary PPH are uterine atony (95%), retained tissue, trauma, and coagulopathy. Treatment involves controlling bleeding through uterine massage, medications, and in severe cases, surgery. While clinical examination and ultrasound are used for diagnosis, homeopathy may also help prevent PPH complications.
Obstetrical emergencies are life-threatening medical conditions that occur in pregnancy, during labor and delivery, or after childbirth. They can endanger the health and lives of both the mother and baby. Common obstetric emergencies include ectopic pregnancy, placental abruption, preeclampsia, premature rupture of membranes, uterine inversion or rupture, prolapsed umbilical cord, shoulder dystocia, and postpartum hemorrhage. Diagnosis involves medical history, examination, and tests, while treatment depends on the specific emergency but may include bed rest, medications, premature delivery by c-section or other surgery, or hysterectomy in severe cases.
This document discusses third-trimester bleeding during pregnancy. It can be caused by conditions like abruptio placentae (AP), placenta previa (PP), and vasa previa (VP). AP is the premature separation of the placenta from the uterine wall. PP is the presence of placental tissue over the cervical os. VP occurs when umbilical cord vessels lie in the membranes over the cervical os. These conditions can lead to significant maternal and fetal risks if not properly managed. The document outlines the epidemiology, etiology, complications, diagnosis, and management considerations for each condition.
This document discusses different causes of antepartum hemorrhage (bleeding after 24 weeks of pregnancy), including placenta previa, abruptio placenta, and vasa previa. Placenta previa occurs when the placenta is abnormally situated in the lower uterine segment or covers the cervical os, often presenting as painless vaginal bleeding in the third trimester. Abruptio placenta is the premature separation of a normally situated placenta, which can lead to retroplacental bleeding. Vasa previa occurs when blood vessels run across or near the cervical os, putting them at risk of rupture during membrane rupture. Management depends on the severity of bleeding and gestational
Postpartum hemorrhage (PPH) is a potentially life-threatening complication that occurs after childbirth. It is defined as excessive bleeding, either visible or concealed, that occurs within 24 hours of delivery and results in a decrease in hemoglobin concentration or requires transfusion of blood products.
There are several causes of PPH, including uterine atony (failure of the uterus to contract properly), trauma to the birth canal, retained placenta, and coagulation disorders. Risk factors for PPH include previous PPH, multiple gestation, prolonged labor, large fetal size, and placenta previa.
Symptoms of PPH can include heavy or continuous bleeding, a decrease in blood pressure, an increase in heart rate, and signs of shock. If PPH is suspected, immediate medical attention is required. Treatment may include medication to stimulate uterine contractions, manual removal of any retained placental tissue, or surgery.
Prevention of PPH can be achieved through proper management of labor and delivery, including active management of the third stage of labor (delivery of the placenta) and early recognition of risk factors. Close monitoring of the patient's vital signs, blood loss, and hemoglobin levels is also essential.
PPH is a serious and potentially life-threatening complication, but with appropriate management and early intervention, the risk of morbidity and mortality can be minimized.
This document discusses postpartum hemorrhage, which is defined as blood loss of 1000 mL or more within 24 hours of delivery. It is a leading cause of maternal mortality globally and in the US. Risk factors include previous hemorrhage, uterine issues, and medical/surgical history. Causes ("4 Ts") include tone (uterine atony), trauma, tissue (retained placenta), and thrombin (coagulopathy). Diagnosis involves assessment of vital signs and blood loss. Treatment involves oxytocin, uterine massage, fluids and identifying the cause. Early diagnosis and a coordinated response are important to reduce mortality from postpartum hemorrhage.
Late pregnancy bleeding can be caused by placental, fetal, or maternal factors. Placental causes include placental abruption and placenta previa. Initial evaluation includes assessing vital signs, fetal heart tones, nature of bleeding, and ultrasound to locate the placenta. Placental abruption involves premature separation of the placenta and can range from mild to severe. Placenta previa occurs when the placenta covers all or part of the cervical os, posing risks of hemorrhage. Morbidly adherent placenta like placenta accreta involves abnormal invasion of the placenta into the uterine wall. Vasa previa is a rare condition where fetal vessels cross the internal
A uterine rupture is a serious tear in the wall of the uterus. It is most common in women with a previous c-section scar, though other risk factors exist like induced labor or uterine abnormalities. Symptoms include vaginal bleeding, abdominal pain, and changes in contractions. Immediate surgery is required to deliver the baby via c-section and repair the tear within 10-35 minutes of a complete rupture. Nursing care focuses on rapid intervention, monitoring for signs of rupture and complications like shock, and providing physical and emotional support for the patient and family during surgery.
B.Sc (N) IV Yr - MID - Lesson Plan on Cord Prolapse.pdfNimmykutti
This lesson plan discusses cord prolapse, including its definition, types, signs and symptoms, risk factors, diagnostic evaluation, complications, preventive measures, and management. Cord prolapse occurs when the umbilical cord descends through the cervix alongside or past the presenting fetal part, either before or after rupture of membranes. It can lead to fetal hypoxia and death if not promptly recognized and managed. The teacher reviews cord prolapse in detail and emphasizes the importance of vigilant monitoring to prevent complications through early detection and emergency treatment when needed.
1 Unit - I Introduction to genetics, Practical implications & Impact of genet...Nimmykutti
This document provides an introduction to genetics. It defines key genetics terms like gene, alleles, and chromosomes. It explains that genes are segments of DNA that carry hereditary information and are passed from parents to offspring. Alleles are variants of the same gene that determine inherited traits. Chromosomes are structures that contain DNA and genes. The document discusses Gregor Mendel's contributions to genetics and defines genetics as the study of heredity and variation in organisms. It also outlines some practical applications of genetics knowledge for nurses, such as genetic counseling, interviewing families, interpreting pedigrees, and educating about inheritance of genetic conditions.
This document discusses human relations, which refers to how people interact and behave socially. It provides definitions of human relations from various scholars and outlines several principles and pre-requisites for effective human relations, such as treating workers with dignity, clear communication, and allowing employee participation. The document also examines key themes in human relations like motivation, roles, and groups. It analyzes important studies from Hawthorne Works that demonstrated how social and environmental factors impact productivity. Overall, the document emphasizes the importance of positive social interactions and relationships in organizations and workplaces.
4 Unit - I Chromosomal aberrations, Patterns of Inheritance.pptxNimmykutti
This document provides information on chromosomal aberrations and patterns of inheritance. It discusses that chromosomal aberrations are changes in chromosome structure or number, and can be numerical (changes in total number) or structural (changes in chromosome shape). It describes several types of numerical aberrations like trisomy, monosomy, and polyploidy. It also discusses structural aberrations including translocations, inversions, deletions, and more. The document then covers patterns of inheritance, explaining Mendel's laws of segregation, independent assortment, and dominance in transmitting traits from parents to offspring.
Manual removal of retained placenta (MRP) is performed when the placenta is not delivered within 30 minutes of childbirth. It involves inserting the hand into the uterus through the vagina to detach and extract the placenta. Risk factors include previous retained placenta, uterine abnormalities, and uterine atony. The procedure is done under general anesthesia or deep sedation, with the bladder catheterized and the patient in lithotomy position. The hand is used to locate the placenta, separate it from the uterine wall, and withdraw it from the uterus while providing counter-traction. Oxytocin is given to encourage uterine contraction and prevent hemorrhage. Complications can include shock, hemorrhage
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Postpartum Hemorrhage
• Postpartum bleeding or postpartum
hemorrhage (PPH) is often defined as the loss of
more than 500 ml or 1,000 ml of blood within
the first 24 hours following child birth. The
condition can occur up to six weeks following
delivery.
• Hemorrhage most commonly occurs after the placenta
is delivered. The average amount of blood loss after the
birth of a single baby in vaginal delivery is about 500
ml.
• The average amount of blood loss for a cesarean birth
is approximately 1,000 ml. Most postpartum
hemorrhage occurs right after delivery, but it can occur
later as well.
3. Definition
• Postpartum haemorrhage refers to any amount
of bleeding from or into the genital tract
following birth of the baby upto the end of
puerperium.
4. Definition
• Postpartum hemorrhage, defined as the loss of
more than 500 ml of blood after delivery, occurs
in upto 18 percent of births.
• Blood loss exceeding 1,000 ml is considered
physiologically significant and can result in
hemodynamic instability.
• Even with appropriate management,
approximately 3% of vaginal deliveries will result
in severe post-partum hemorrhage.
• It is the most common maternal morbidity in
developed countries and a major cause of death
worldwide.
5. Background
• Postpartum hemorrhage (PPH) is the leading cause of
maternal mortality.
• All women who carry a pregnancy beyond 20 weeks’
gestation are at risk for PPH and its sequelae.
• Although maternal mortality rates have declined greatly
in the developed world, PPH remains a leading cause of
maternal mortality elsewhere.
• The pregnancy-related mortality ratio in the United
States was 17. 3 deaths per 100,000 live births in 2013
• About 1 to 5 percent of women have postpartum
hemorrhage and it is more likely with a cesarean birth.
6. Incidence
• The most common cause is poor contraction of the
uterus following childbirth.
• Not all of the placenta being delivered, a tear of the
uterus, or poor blood clotting are other possible causes.
• It occurs more commonly in those who: already have a
low amount of red blood, are Asian, with bigger or more
than one baby, are obese or are older than 40 years of
age.
• It also occurs more commonly following caesarean
sections, those in whom medications are used to start
labor, those requiring the use of a vacuum or
forceps, and those who have an episiotomy.
7. Incidence
In the developing world about 1.2% of deliveries are
associated with PPH and when PPH occurred about 3%
of women died.
World Health Organization statistics suggest that 25%
of maternal deaths are due to PPH, accounting for
more than 100,000 maternal deaths per year.
Globally it occurs about 8.7 million times and
results in 44,000 to 86,000 deaths per year making
it the leading cause of death during pregnancy.
About 0.4 women per 100,000 deliveries die from PPH
in the United Kingdom while about 150 women per
100,000 deliveries die in Sub-Saharan Africa.
8. Contd…
• PPH is a leading cause of maternal mortality and morbidity
worldwide and accounts for nearly one-quarter of all maternal
pregnancy-related deaths.
• Multiple studies have suggested that many deaths associated
with PPH could be prevented with prompt recognition and
more timely and aggressive treatment.
• Morbidity from PPH can be severe with sequelae including
organ failure, shock, edema, compartment syndrome,
transfusion complications, thrombosis, acute respiratory
distress syndrome, sepsis, anemia, intensive care, and
prolonged hospitalization.
9. Contd…
• The most common etiology of PPH is uterine atony
(impaired uterine contraction after birth), which occurs
in about 80 percent of cases.
• Atony may be related to over distention of the uterus,
infection, placental abnormalities, or bladder distention.
• Though the majority of women who develop PPH have
no identifiable risk factors, clinical factors associated
with uterine atony, such as multiple gestation,
polyhydramnios, high parity, and prolonged labor, may
lead to a higher index of suspicion.
• Other causes of PPH include retained placenta or clots,
lacerations, uterine rupture or inversion, and inherited
or acquired coagulation abnormalities.
11. Types
• Primary postpartum hemorrhage is the
hemorrhage occurring during the third stage of
labor and within 24 hours of delivery.
• Secondary postopartum hemorrhage is
hemorrhage occurring after 24 hours of
delivery and within 6weeks of delivery. It is
also referred to as puerperal hemorrhage.
12. Contd..
• Primary postpartum hemorrhage are:
Atonic uterus
Trauma
Mixed ( combination of both atonic and
trauma)
Retained product of conception
Uterine rupture
Uterine inversion
Blood coagulopathy
13. Contd..
• Secondary postpartum haemorrhage include:
Retained bits of cotyledon or membranes.
Infection
Cervico-vaginal laceration
Endometritis
Subinvolution of the placental site
Secondary hemorrhage from caesarean section
Other rare causes – chorion epithelioma,
carcinoma cervix, placental polyp, fibroid polyp
and puerperal inversion of uterus.
14. Risk factors
Normal
• Once a baby is delivered,
the uterus normally
continues to contract
(tightening of uterine
muscles) and expels the
placenta.
• After the placenta is
delivered, these contractions
help compress the bleeding
vessels in the area where the
placenta was attached.
Abnormal
• If the uterus does not
contract strongly enough,
called uterine atony, these
blood vessels bleed freely
and hemorrhage occurs.
This is the most common
cause of postpartum
hemorrhage.
• If small pieces of the
placenta remain attached,
bleeding is also likely.
15. Contd…
Some women are at greater risk for postpartum hemorrhage than
others.
• Placental abruption. The early detachment of the placenta
from the uterus.
• Placenta previa. The placenta covers or is near the cervical
opening.
16. Contd…
• Over distended uterus.
Excessive enlargement of the
uterus due to too much
amniotic fluid or a large baby,
especially with birth weight
over 4,000 grams (8.8
pounds).
• Multiple pregnancy. More
than one placenta and over
distention of the uterus.
• Gestational hypertension or
preeclampsia. High blood
pressure of pregnancy
17. • Postpartum hemorrhage may
also be due to other factors
including the following:
• Tear in the cervix or vaginal
tissues, Tear in a uterine
blood vessel
• Bleeding into a concealed
tissue area or space in the
pelvis which develops into a
hematoma, usually in the
vulva or vaginal area
• Blood clotting disorders,
such as disseminated
intravascular coagulation
18. Contd…
• Placenta accreta. The placenta
is abnormally attached to the
inside of the uterus (a condition
that occurs in one in 2,500 births
and is more common if the
placenta is attached over a prior
cesarean scar).
• Placenta increta. The placental
tissues invade the muscle of the
uterus.
• Placenta percreta. The
placental tissues go all the way
into the uterine muscle and may
break through (rupture).
19. Contd…
• Having many previous births
• Prolonged labor
• Infection
• Obesity
• Medications to induce labor
• Medications to stop contractions (for preterm
labor)
• Use of forceps or vacuum-assisted delivery
• General anesthesia
20. Major Causes
• Causes of postpartum hemorrhage are uterine
atony, trauma, retained placenta or placental
abnormalities and coagulopathy, commonly
referred as the “Four T’s”
Cause Incidence
Uterine Atony 70%
Trauma 20%
Retained Tissue 10%
Coagulopathy 1%
21. (Contd..)
• Tone: Uterine atony is the inability of the uterus to
contract and may lead to continuous bleeding.
Retained placental tissue and infection may
contribute to uterine atony. Uterine atony is the most
common cause of postpartum hemorrhage.
22. Contd…
• Predisposing factors for Uterine Atony:
• Prolonged labour
• Over distension of the uterus
• Multiple pregnancy
• Excessive stimulation of uterus by pitocin &
use of analgesics & anaesthesia
• Grand multiparity
• Trauma due to the obstetrical procedures
23. Contd…
• Trauma: Injury to the birth canal which includes the
uterus, cervix, vagina and the perineum which can
happen even if the delivery is monitored properly.
The bleeding is substantial as all these organs become
more vascular during pregnancy.
24. Contd…
Predisposing factors for Trauma
1. Spontaneous or Precipitous delivery
2. Size, Presentation, and Position of baby
3. Contracted Pelvis
4. Bleeding from or into genital tract due to trauma to uterus,
vulvar, cervical, perineal, uretheral area and vaginal varices
25. (Contd..)
• Tissue: Retention of tissue from the placenta
or fetus as well as placental abnormalities such
as placenta accreta and percreta may lead to
bleeding.
26. Contd…
Predisposing Factors for tissue damage:
Failure of placenta to be expelled within 30 mts after
expulsion of fetus.
Bleeding continues at the separation site because the uterus
is unable to contract due to reained placenta.
Traction applied on the cord before the placenta has
separated.
**Don’t pull on the cord unless the placenta has separated.
Incorrect traction and pressure applied to the fundus,
especially when the uterus is flaccid
**Don’t use the fundus to “push the placenta out”
27. Contd…
• Thrombin: a bleeding disorder occurs when
there is a failure of clotting, such as with
diseases known as coagulopathies.
29. Prevention
• Compared to expectant management, active management of
the third stage of labour (AMTSL) is associated with reduced
maternal blood loss, reduced postpartum hemorrhage,
reduced postpartum anemia, reduced need for blood
transfusions and a decrease in the incidence of prolonged
third stage of labour.
30. AMTSL (Active management of
the third stage of labour)
• AMTSL includes the following procedures:
• 1. Following the delivery of the baby, palpate the abdomen to
rule out the presence of an additional baby, and give oxytocin
10 units IM. Never give an uterotonic before the delivery of
the anterior shoulder. Oxytocin may also be give by other
routes including 5 units IV push or 20-50 units in 1L of
normal saline at 60 drops/minute.
• 2. If oxytocin is not available, give: Ergometrine 0.2 mg IM OR
Syntometrine (1 ampoule) IM OR Misoprostol 400–600 µg
orally
31. AMTSL (Active management of the
third stage of labour)
• 3. After delivery of the baby, wait until pulsation has stopped (approximately
2 to 5 minutes) before clamping and dividing the cord. Clamp the cord close
to the perineum. If it is your institutional policy, take the cord blood samples
including blood gases.
• 4. Keep slight tension on the cord while waiting for a strong uterine
contraction (approximately 2–3 minutes)
• 5. With the strong uterine contraction, encourage the mother to push, and
very gently pull downward and outward on the cord to deliver the placenta
while applying suprapubic counter-pressure on the uterus with the other
hand. Pulling too hard on the cord may cause the cord to tear off the
placenta or cause uterine inversion—an acute obstetrical emergency.
32. AMTSL (Active management of the
third stage of labour)
• 6. If the placenta does not descend during 30-40 seconds
of controlled cord traction , do not continue to pull on the
cord: a. Continue to gently hold the cord, and wait until
there is another strong contraction. b. With the next
contraction, repeat controlled cord traction with counter-
pressure.
• 7. As the placenta delivers, hold the placenta in both
hands. Gently turn it until the membranes are twisted.
Gently pull to complete the delivery.
33. AMTSL (Active management of the
third stage of labour)
• 8. If the membranes tear, gently examine the
upper vagina and cervix wearing sterile gloves.
Use a ring (sponge) forceps to grasp and
remove any pieces of membranes.
• 9. Examine the placenta carefully to ensure
that it is complete.
• 10.Check the fundus to ensure that it is well
contracted. Palpate for a contracted uterus
every 15 minutes and repeat uterine massage
as needed during the first 2 hours.
34. Management
• External and internal bi-manual uterine massage
• Aortic compression
• Umbilical vein injection (injection of uterotonic into the
umbilical cord attached to the undelivered placenta)
• Manual exploration of the uterus and manual removal of the
placenta
• Repair of perineal trauma including repair of episiotomy
• Repair of cervical and high vaginal tears
• Use of an anti-shock garment to treat shock
• Use of a hydrostatic balloon tamponade
• Uterine compression sutures
• Systematic pelvic devascularization
• Uterine artery embolization
• Total or sub-total hysterectomy.
35. Review
• Uterine atony is responsible for most cases and can be managed
with uterine massage in conjunction with oxytocin, prostaglandins,
and ergot alkaloids.
• Traumatic causes include lacerations, uterine rupture, and uterine
inversion.
• Retained placenta is a less common cause and requires
examination of the placenta, exploration of the uterine cavity, and
manual removal of retained tissue. Rarely, an invasive placenta
causes postpartum hemorrhage and may require surgical
management.
• Coagulopathies require clotting factor replacement for the
identified deficiency. Early recognition, systematic evaluation and
treatment, and prompt fluid resuscitation minimize the potentially
serious outcomes associated with postpartum hemorrhage.