PPH - Prompts

Question 1

placenta is out…. what are you doing

Answer 1

1. direct for fundal massage- expel clots
2. assess for completeness
3. direct for maternal vitals
4. Assess bleeding, determine if clots are sitting in cervix or posterior fornix

Question 2

When would you suspect a clot is blocking the cervix

Answer 2

signs of hypovolemic shock with minimal or no bleeding, sometimes intense abdominal pain or cramps

Question 3

If placenta is in what is the number one thing you do not do

Answer 3

TOUCH THE FUNDUS

Question 4

what does ergonovine do?

Answer 4

causes muscles of uterus to contract, produces arterial vasoconstriction by stimulation of alpha-adrenergic and serotonin receptors and inhibition of endothelial-derived relaxation factor release

Question 5

Placenta is in, client is stable… management

Answer 5

• do not touch fundus
• follow cord up to see if entrapment in cervix
• consider umbilical cord drainage
• consider umbilical vein injection
• transfer care for manual removal of placenta w/in 60 minutes

Question 6

what to do if need to transport/ consult for severe cervical tears/ perineal lacerations

Answer 6

apply direct pressure, or consider packing with sterile gauze

Question 7

when to suspect uterine inversion

Answer 7

• placenta appearing at introitus with mass attached
• during abdominal palpation, fundus not felt
• sudden onset of heavy bleeding with associated hemodynamic instability and shock
• symptoms of shock = disproportionate to blood loss estimated
• severe abdominal pain with or without a bearing down or pressure sensation
• bimanual exam may reveal presence of firm round mass in birth canal

Question 8

What can cause thrombin to be an issue

Answer 8

severe blood loss - leads to consumption of clotting factors
- consider bedside clot observation test
- consider TXA as adjunct PPH treatment

Question 9

describe CCT

Answer 9

1. one hand above pubic bone to stabilize uterus
2. with strong contraction, encourage client to push while applying downward pressure on the umbilical cord
3. if no descent within 30-40 seconds - release tension
4. repeat during next contraction

Question 10

explain guarding of uterus

Answer 10

apply firm upward pressure just above symphysis pubis with non-dominant hand
* important to prevent uterine prolapse/ inversion

Question 11

explain what bimanual compression is

Answer 11

simplest form of uterine tamonade, useful and potentially life-saving method to temporarily control acute bleeding that has not responded to uterine massage and or uterotonic agents

Question 12

how to do internal bimanual compression

Answer 12

insert hand in cone shape, make fist, apply pressure to anterior wall of uterus. external hand hand cups uterus
- consider team method

Question 13

What is a Bakri

Answer 13

surgical obstetric silicone balloon - 500ml capacity with outflow port that permits monitoring of bleeding

Question 14

describe the initial stage of shock - effect and signs

Answer 14

increased pulse, BP drops, - decreases supply of oxygen to the tissue, hypothermia due to decreased perfusion, cellular function begins to be affected
SIGNS: pale, mild anxiety, cool extremities