ملتقى طلبة كليات التمريض العراقية

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ملتقى طلبة كليات التمريض العراقية

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    Postpartum hemorrhageالنزف بعد الولاده

    شاطر
    avatar
    سفير الكراده
    نائب المدير العام

    عدد المساهمات : 285
    تاريخ التسجيل : 21/03/2011
    العمر : 27
    الموقع : الكراده

    Postpartum hemorrhageالنزف بعد الولاده

    مُساهمة  سفير الكراده في السبت مايو 14, 2011 4:16 am

    Postpartum hemorrhage

    Postpartum hemorrhage :loss of more than 500 ml of blood following birth .

    Types:
    - primary pph
    -secondry pph
    primary pph:
    occur during the first 24hours after delivery.
    Secondary pph:
    hemorrhage may be delay occurring more than 24h
    after delivery.
    Risk factor for pph:
    *prior history.
    *high paritg for multi Para .
    *prior pph.
    *uterine fibroid.
    *systemic disease.
    Causes:
    *atonic uterus.
    *traumatic hemorrhage occurs due to truma of the uterus, cervix.
    *mixed: comination of atonic and traumatic causes.
    *blood coagulation disorder.
    Sings and symptoms:
    -uterus boggy.
    -blood pressure normal.
    -blood volume loss.
    -atonic uterus.
    -systolic.
    -moderate tachy cardia 100 to 120b/m.
    Control bleeding by using the following steps:
    -exploration of uterus under general anesthia.
    -Bimanual compression.
    -intra umatic pph.
    Review possible medical complications related to postpartum hemorrhage:
    • Blood loss .
    • Shock .
    • Septicemia .
    • Death due to blood loss.
    • more complications...».
    Management
    Medication:
    Intravenous oxytocin is the drug of choice for postpartum hemorrhage. Misoprostol may also be effective if oxytocin is not available.
    Protocol:
    A detailed stepwise management protocol has been introduced by the California Maternity Quality Care Collaborative. It describes 4 stages of obstetrical hemorrhage after a delivery and its application reduces maternal mortality.
    • Stage 0: normal - treated with fundal massage and oxytocin.
    • Stage 1: more than normal bleeding - establish large-bore intravenous access, assemble personnel, increase oxytocin, consider use of methergine, perform fundal massage, prepare 2 units of packed red cells.
    • Stage 2: bleeding continues - check coagulation status, assemble response team, move to operating room, place intrauterine balloon, administer additional uterotonics (misoprostol, carboprost tromethamine), consider: uterine artery embolization, dilatation and curettage, and laparotomy with uterine compression stitches or hysterectomy.
    • Stage 3: bleeding continues - activate massive transfusion protocol, mobilize additional personnel, recheck laboratory tests, perform laparotomy, consider hysterectomy.
    A Cochrane database study suggests that blood loss and the risk of postpartum bleeding will be reduced in women offered active management of the third stage of labour, rather than expectant management. However, that review was withdrawn in 2009 pending an update after the validity of its findings was questioned. An updated Cochrane database study in 2010 suggested that administration of oxytocin before and after the expulsion of placenta did not have any significant influence on many clinically important outcomes such as the incidence of postpartum haemorrhage, rate of placental retention and the length of the third stage of labour. The use of ergometrine for active management was associated with nausea or vomiting and hypertension, and controlled cord traction requires the immediate clamping of the umbilical cord.
    References:

    [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
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