Postpartum
hemorrhage (PPH) : Classically
is defined a greater than 500
ml blood loss at a vaginal delivery
and greater than 1000 ml during a
cesarean delivery . But in
practical terms this amount of bleeding is difficult to measure, Unit head said
. Prof XYZ reiterated that in simple
words , and to be very practical the working definition means
significant bleeding that may result
in hemodynamic instability
if unabated. Unit head also mentioned
that uterine atony implies lack of myometrial contraction , clinically manifested by a boggy uterus,
Postpartum hemorrhage
is defined as early and late , according to whether it occurs within
the first 24 hours or after that
period. The most common cause of early PPH
is uterine atony , with bleeding
arising from the placental implantation
site.
Any text
books said another Faculty members said
that A) The physical examination in case of atonic PPH reveals a boggy uterus .B) The
initial management should be uterine massage, best accomplished by
bimanual compression with an abdominal hand as well as vaginal
hand .
Out
of three commonly used drug which one to choose from?? Drug 1: Concurrently intravenous dilute oxytocin is given. If these maneuvers
are ineffective (not in this case) , other
pharmacological uterotonic agents may be given. Drug 2
:-These include intramuscular methylergonovine maleate (methergin ); An
ergot alkaloid agent that induces myometrial
contraction as a treatment of uterine
atony contraindicated in
hypertension. ) Drug 3 :-Third drug is , intramuscular , prostaglandin F2
alpha and Drug 4 : Buccal / Rectal misoprostol. As warned the faculty said to SRs
and House Officers that “Ergot alkaloids
should not be given in women with
hypertensive disease
because of the risk of stroke.” ,Faculty members also reminded
juniors ( SRs & House Officers
) that Prostaglandin F2 alpha should not be administered in those with asthma due to the potential for
bronchoconstriction ,This was however was used in this case of PIH as intravenous
dilute oxytocin didn’t
work well. Device 6: Condom is to be tied it over a 22 Fr Foley's, inserted the
system in the LUS, first inflated the Foley balloon and then pushed about 250
ml of saline into the condom using a 50 ml syringe. The condom tended to bulge
out through the os and we held it in place using a roller pack. One
can occasionally if comfortable instead of gauze vaginal pack, use 2 sponge forceps holding both
cervical lips to occlude slippage of condom through dilated OS. Use ultrasound guided insertion of condom on
catheter. . It can accommodate even 600 ml. For fast filling one may connect drip set to catheter. Some
even uses two condoms unroll one over other& to take 2 plastic nelton catheter keep one inside
the condoms tie the mouth with vicryl keep 2nd nelton outside the condom and
tie it with the first nelton.... 2nd nelton will drain the collecting blood
inside the cavity...take the condoms up to fundus pack the vagina...then
inflate it with 500ml normal saline
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