This is an obstetric emergency care given by the midwife to a postpartum woman bleeding excessively and progressively (500ml or more) that can cause deterioration in the client’s condition within or after 24 hours of delivery. It can be due to trauma, atonic uterus or infection.
Aims
· Resuscitate client
· Manage hypovolemic shock
· Prevent atonic uterus
· Identify and repair vaginal or cervical tears
· Prevent maternal morbidity and mortality
Requirements
A trolley containing:
1. PPH pack
2. Cannular (16/18 guage)
3. Isotonics IV fluids
4. Blood volume expanders
5. Perineal pad
6. Sterile gallipot
7. Speculum
8. Urine catheter
9. Urine bag
10. Sterile vaginal
11. Sterile swabs
12. Adhesive tape
13. Vital signs tray
14. Blood sample bottles
15. Request form
16. Foetal Stethoscope
17. Antiseptic lotion
18. Oxygen apparatus
19. Facemask/nasal prong
20. Suction apparatus
21. Receiver
22. Uterotonic drugs
23. Sponge holding forceps
24. Blood Pressure apparatus
25. Thermometer
26. Pulse oximeter
27. Sanitary pad
28. Gynaecological gloves
29. Antiseptic lotion (Methylated spirit, Savlon, Dettol, Hibitane)
30. Intravenous. Fluids (Normal Saline, Ringers Lactate)
31. Intravenous cannula (various sizes)
Steps
1. Establish rapport (refer steps)
2. Explain procedure to client (refer steps)
3. Call for immediate help or support
4. Perform rapid assessment of client’s general condition
5. Massage uterus to promote contractions and expel clots
6. Give uterotonic drugs e.g. oxytocin 10 IU IM
7. Set up IV line and take blood sample for laboratory investigations and arrange for whole blood frozen plasma
8. Start IV infusion e.g. normal saline and Ringer’s Lactate
9. Pass indwelling urethral catheter and connect to bag
10. Monitor intake and output
11. Assess for signs and symptoms of shock and resuscitate
12. Assess cause of bleeding
13. Manage as per WHO/GHS protocols
14. Counsel mother and family on her condition
15. Arrange for transfer to higher level if bleeding persists
16. Prepare client for surgery if indicated
17. Record all procedures in the Maternal and Child Health Record Book (Manual/Electronic)
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