This is a timely intervention by the midwife to a pregnant woman who is bleeding from the genital tract. The bleeding may occur between 24 to 28 weeks of pregnancy and before the delivery of the baby.
Aims
· Prevent further vaginal bleeding
· Prevent hypovolemic shock
· Provide initial and subsequent management
· Determine the cause of bleeding
· Prevent post-partum haemorrhage
· Reduce maternal and neonatal morbidity and mortality
Types
· Conservative management
· Surgical management
Requirements
A trolley containing:
a. APH pack
b. Cannular (16/18 guage)
c. Isotonics IV fluids
d. Blood volume expanders
e. Perineal pad
f. Sterile gallipot
g. Sterile swabs
h. Adhesive tape
i. Vital signs tray
j. Blood sample bottles
k. Request form
l. Foetal Stethoscope
m. Antiseptic lotion
n. Oxygen
o. Facemask/nasal prong
p. Suction apparatus
q. Receiver
r. Uterotonic drugs
Steps
1. Establish rapport (refer steps)
2. Explain procedure to client (refer steps)
3. Call for immediate help or support
4. Assess client’s condition
5. Take history of description of bleeding (Onset nature and amount)
6. Set up IV line and take blood sample for laboratory investigations and arrange for whole blood frozen plasma if necessary
7. Assess clotting status using the bedside clotting test
8. Start IV infusions e.g. normal saline or Ringer’s Lactate
9. Check vital signs (Temperature, pulse, respiration and SPO2)
10. Elevate the foot-end- of bed to aid circulation to the brain
11. Perform thoroughly examination to assess maternal and foetal wellbeing
12. Perform gentle abdominal examination noting areas of tenderness, gestational age and presentation and position of foetus
13. Assess for signs and symptoms of shock and resuscitate
14. Auscultate fetal heart sound
15. Identify and diagnose cause of bleeding
16. Manage in accordance with WHO/GHS protocols
17. Counsel mother and family on her condition and that of the foetus
18. Arrange for transfer to higher level if bleeding persists
19. Prepare client for surgery if indicated
20. Record all procedures in the Maternal and Child Health Record Book (Manual/Electronic)
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