Question

-15. How is postpartum hemorrhage treated?

16. What are the indications and contraindications of common medications (including oxytocin, methylergonovine, misoprostol, and carboprost) used to treat postpartum hemorrhage

Answer 1

15) Answer :

post partum haemorrhage : any amount of bleeding from or into the genital tract following birth of the baby up to the end of puerperium which adversely affect the general condition of patient evidenced by rise in pulse rate and falling blood pressure is called postpartum haemorrhage.

types :

1. primary PPH : haemorrhage occurs with in 24 hrs following birth of the baby .these are two types : third stage haemorrhage and true post partum haemorrhage
2. secondary PPH : haemorrhage occurs beyond 24 hrs .

Treatment of post partum haemorrhage :

management of third stage haemorrhage :

• Palpate the fundus and massage .
• start crystalloid sollution with oxytocin at 60 drops per minute and to arrange for blood transfution if necessory.
• Administration of oxytocin 10 units IM or methergin 0.2 mg IV .
• catheterise the bladder .
• give antibiotics such as ampicillin 2 gms and metronidazole 500mg IV .

if patient is in shock ,she should be resuscitated

management of true post partum haemorrhage :

• immediate measures to be taken for the true PPH.
• call for extra help
• put two large bore intravenous cannula
• Keep the patient flat and warm.
• send blood for group,cross matching ,diagnostic tests and ask for 2 units of blood.
• infuse rapidly 2 litres of normal saline to expand the vascular bed.
• give oxygen by mask if needed.
• start 20 units of oxytocin in 1 litre of normal saline at the rate of 60 drops per minute.
• transfuse the blood as soon as possible .
• record the vitals frequently .
• reassure the client .
• massage the uterus .

Management of secondary PPH :

commonest cause of secondary PPH is due to retained bits of the cotyledons and membranes ,it is preferable to explore the uterus urgently under general anaesthesia

- the products are removed by ovum forceps ,gentle curettage is done

- methergin 0.2 mg given intramuscularly .the materials removed are to be sent for histological examination.

16) answer :

indiactions of oxytocin :

• There are two types ,therapuetic indications and diagnostic indications .

Therapuetic indications :

1. to accelerate abortion .
2. to stop bleeding following evacuation of uterus .
3. to induce the labour .
4. to ripen the cervix before induction .
5. augumentation of labour.
6. inactive management of third stage of labour
7. following expulsion of placenta.
8. to control PPH .

Diagnostic indications :

1. Contraction stress test .
2. oxytocin sensitivity test .

Contraindications of oxytocin :

1. feto pelvic disproportion
2. previous uterine surgery .
3. over distened uterus .
4. previous caesarean section .
5. uterine rupture
6. in foetal distress .

Indications of methylergonovine :

1. Active management of third stage of labour .
2. to stop atonic uterine bleeding ,following delivery or abortion or expulsion of hydatiform mole

Contraindications

1. Suspected pleural pregnancy
2. organic cardiac disease.
3. severe pre eclampsia
4. Rh negative mother .

indications of misoprostol :

1. For cervical ripening
2. Induction of labour .
3. in case of gastric ulcers induced by NSAID therapy

Contra indications :

1. hypersensitivity to compound
2. uterine scar
3. active cardiac ,pulmonary ,renal ,hepatic disease .
4. bronchial asthma
5. fetal distress

Indications of carboprost :

1. Post partum haemorrhage

Contraindications :

1. Acute pelvic inflammatory disease.
2. severe cardiovascular ,renal ,hepatic diseases .