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Early Post Partum Haemorrhage (PPH), Information, Meaning, Causes and Risk…
Early Post Partum Haemorrhage (PPH)
Information
Name : Sukhon Prasu
Age : 31 years old
Diagnosis : G1P0A0L0 GA 38+5 wks. with Labor pain with Membrane Leak
LMP : 28 th Dec 2019
EDC : 25 th Sep 2020
Date of admission : 23 th Sep 2020
Date of care : 23 th Sep 2020
Meaning
Theory
Effect to the baby
The baby's head was harmed from taking the baby on time.
Babies are at risk of developing cerebral hemorrhage.
Risk of broken umbilical cord
defined as the loss of 500 ml of blood from aVaginal delivery
or blood loss greater than or equal to 500 ml from a caesarean section.
or 1 percent of the mother's body weight after the third trimester ends
Or concentration10% reduction in blood within the first 24 hours after birth
andLoss of maternal blood from a caesarean section greater than 1,000 milliliters
Causes and Risk Factors
Tone
is the cause of abnormal
uterine contractions.
Overdistention of uterus
Twins
Polyhydramnios
Fetal macrosomia
Multiparity
Prolonged oxytocin use
Prolonged of labor
Trauma
is a tearing cause of
the vaginal canal
Tear cervix
Tear vaginal
Tear perineal
Hematoma
Fetal macrosomia
Fetalmalpresentation
Forceps or vacuum
Episiotomy, especially mediolateral
Rapid or precipitate of labor
Tissue
Retained products of conception
Mid trimester delivery
Chorioamnionitis and accessoryplacental lobes
Previous uterine fibroid surgery
Elderly pregnancy
Thrombin
Defects in coagulation
Massive antepartum hemorrhage or PPH
Sepsis
Severe preeclampsia
Retained intrauterine fetal demise
Placental abruption
Steroid was given to treat the baby while pregnant
Pre-pregnancy blood diseases
Classification
Early or immediatePPH
Bleeding within the first 24 hours after delivery
Late or delayedPPH
Bleeding after 24 hours to 6 Weeks after birth
Treatment
Order for one day
23/09/63
PV, Nitrazine test +
On EFM
NPO
on 0.9% NSS 1000 ml V drip 120 cc/hr x III
wear pad obs. AF
CBC, E'lyte
G/M for PRC 1 U
obs. UC,FIO2,FHS
pregnant woman with more frequently labor pain PV: cx.8 cm, eff.100%, MR, station 0 notify doctor accept observer Preg for Labor pain
Post-Partum Order
23/09/63 : 10.29
Order for one day
Record v/s q 15 min x IV
q 30 min x II
q 1 hr until stable then as usual
if can't void in 6 hrs please intermittent cath and notify
syntocinon 10 u Intramuscular
On 0.9% NSS 1000 ml + syntocinon 10 U IV drip 40 cc/hr
Order for continuation
Regular dict
Record v/s
Perineum care
Stimulate breast feeding
Medication
Obimin 1 tab oral pc morning
Paracetamol (325mg) 2 tabs oral pm for pain q 4-6 hrs
Nursing Diagnosis
1.The maternal postpartum has hemorrhage.
Due to tear vaginal wall
support data
s: -
O:
maternal postpartum have perineal tear RML episiotomy 3-4 cm, 2nd degree and tear of vagina wall
Total blood loss 500 cc
Implementation
Evaluate the signs and symptoms of shock in mother,The expression was pale and cold, the level of consciousness decreased.
Evaluate the perineal tear and nearby tissue for swelling, redness, and bleeding. May represent a separate wound and hematoma.
Evaluate uterine contractions and measure high of fundus its should usually be no more than 6 inches above the pubis. If the uterus is poorly contracted, massage the top of the uterus and advise the mother to manually stretch the uterus every 15 minutes.
wear a pad for observe bleeding per vagina and record. If the amount of bleeding during the first 2 hours is greater than 100 ml, there may be postpartum hemorrhage.
Observe v/s q 4 hr
On 0.9% NSS 1000 ml + syntocinon
10 U IV drip 40 cc/hr
Retain foley cath
Drawing a Hct.
Evaluation
maternal postpartum mild fatigue, perineal incisions stick together well, no bleeding, The uterus is contracted, round, solid. No bladder full, V/S stable T= 37°C,P= 86/min, R= 20/min, BP= 132/86 mmHg, Post-partum: Hct 32 vol%
Discomfort and pain due to Tissue and nerves are damaged by a perineal tear.
support data
S: Mother said "Pain in the perineal region"
O:
maternal postpartum tired expression have perineal tear RML episiotomy 3-4 cm, 2nd degree and tear of vagina wall
Pain score 10
Evaluation
Maternal postpartum mild fatigue, said " Pain in the perineal region" Pain score 8 can rest, perineal incisions stick together well, no bleeding, no hematoma, has not received any pain medication
Implementation
Evaluate of pain by observing facial expressions, behavior, and asking pain scale
Make sure to sleep in a comfortable position, such as lying on your side or with your head high.
Recommended to reduce the tension of the wound. such as careful movement
Giving nursing care softly and quickly and encouraging
Give the mother an opportunity to speak and express pain
Recommended to avoid abrasion of the perineal, pressure on the wound, perineal and adjacent tissues and bed rest
Observe and record the pain area. The nature, intensity and frequency of pain If the pain is very painful, report the carpool boss.To provide analgesic Paracetamol (325mg) 2 tabs oral pm for pain q 4-6 hrs
Care and assistance in doing various activities
CC :
Labor pain with membranes leak
3 hr prior to admission
PI :
G1P0A0L0 GA 38+5 wks.with Labor pain with Membrane Leak, LMP 28 th Dec 2019, EDC 25 th Sep 2020 by date, ANC at yangtalad hospital and clinic Dr.Worawit 4/12 times. First ANC at GA 13 wks. No underlying disease. Not allergic to the drug and food. Never had surgery 3 hr prior to admission has labor pain with membranes leak, First receive PV : cx 2 cm,Eff soft, station -1, Membranes leak, ROA FHS 142 /min
Signs and symtomps :
Maternal postpartum mild fatigue is on the bed, She has perineal tear RML episiotomy 2nd degree and tear of vagina wall, Total blood loss 500 cc, Pain score 10 On 0.9% NSS 1000 ml + syntocinon 10 U IV drip 40 cc/hr
Lab
lab1: VDRL NR, Anti HIV Neg, HBsAg Neg, MCV 88 fl, Hct 34 vol%
lab2: Anti HIV Neg, Hct 34 vol%
Post-partum: Hct 32 vol%
Panattha Wongpakdee No.55 Student number 602701055