VAGINAL BLEEDING

Question 1

EARLY PREGNANCY BLEEDING (BELOW UMBILICUS)

Answer 1

POSSIBLE abortion,menorrhagia, ectopic pregnancy

Question 2

LATE PREGNANCY BLEEDING (ABOVE UMBILICUS)

CASES AND MANAGEMENT

Answer 2

POSSIBLE  Placenta previa, abruptio placenta, ruptured uterus
MANAGEMENT:
1. INSERT IV
2. RAPID IVF
3. REFER TO HOSP

Question 3

BLEEDING DURING LABOUR

CASES AND MANAGEMENT?

Answer 3

POSSIBLE placenta previa, abruptio placenta and ruptured uterus
MANAGEMENT: 
1. INSERT IV
2. RAPID IVF 
3. REFER TO HOSPITAL

Question 4

POST PARTUM BLEEDING

CASES AND MANAGEMENT

Answer 4

POSSIBLE uterine atony, retained placenta, ruptured uterus, vaginal or cervical tear
MANAGEMENT:
1. Call for extra help
2. massage uterus
3. give oxytocin 10 iu IM
4. INSERT IV with oxytocin 20 iu at 60 drops
5. empty bladder
6.check bp q 15

Question 5

CONTRAINDICATION OF OXYTOCIN

Answer 5

HYPOTENSION

Question 6

HEAVY BLEEDING MANAGEMENT

Answer 6

INSERT 2ND IVF
APPLY BIMANUAL UTERINE COMPRESSION
GIVE APPROPRIATE ANTIBIOTIC
REFER TO HOSP

Question 7

MANAGEMENT FOR POSTPARTUM BLEEDING AFTER PLACENTA IS DELIVERED OR UTERUS IS NOT WELL CONTRACTED. WHAT IS YOUR MANAGEMENT?

Answer 7

MASSAGE FUNDUS IN A CIRCULAR MOTION WITH CUPPED PALM UNTIL UTERUS IS WELL CONTRACTED

WHEN WELL CONTRACTED PLACE FINGERS BEHIND FUNDUS AND PUSH DOWN IN ONE SWIFT ACTION TO EXPEL CLOTS

MEASURE OR ESTIMATE BLOOD LOSS AND RECORD

Question 8

IF HEAVY POSTPARTUM BLEEDING PERSISTS DESPITE UTERINE MASSAGE, OXYTOCIN AND REMOVAL OF PLACENTA. MANAGEMENT?

Answer 8

DO BIMANUAL UTERINE COMPRESSION

INTRODUCE RIGHT HAND INTO THE VAGINA CLENCHED FIST WITH THE BACK OF THE HAND DIRECTED POSTERIORLY, AND THE KNUCKLES IN THE ANTERIOR FORNIX

PLACE THE OTHER HAND ON THE ABDOMEN BEHIND THE UTERUS AND SQUEEZE THE UTERUS FIRMLY BETWEEN THE TWO HANDS

CONTINUE COMPRESSION UNTIL BLEEDING STOPS ( NO BLEEDING IF THE COMPRESSION IS RELEASED)

IF BLEEDING PERSISTS, APPLY AORTIC COMPRESSION AND TRANSPORT WOMAN TO HOSPITAL

Question 9

IF HEAVY POSTPARTUM BLEEDING DESPITE BIMANUAL UTERINE COMPRESSION. MANAGEMENT?

Answer 9

DO AORTIC COMPRESSION

FEEL FOR FEMORAL PULSE

APPLY PRESSURE ABOVE THE UMBILICUS TO STOP BLEEDING. APPLY SUFFICIENT PRESSURE UNTIL FEMORAL PULSE IS NOT FELT

CONTINUE PRESSURE UNTIL BLEEDING STOPS. IF BLEEDING PERSISTS KEEP APPLYING PRESSURE WHILE TRANSPORTING WOMAN TO HOSPITAL

Question 10

WHEN GIVING OXYTOCIN WHAT IS THE INITIAL, CONTINOUS AND MAXIMUM DOSE IF HEAVY BLEEDING PERSISTS?

Answer 10

INITIAL DOSE: 10 IU IM/IV
CONTINOUS: REPEAT 10 IU AFTER 20 MINUTES IF HEAVY BLEEDING PERSISTS

IV INFUSION
INITIAL DOSE: 20 IU IN 1L AT 60 GTTS
CONTINUOUS: 10 IU IN 1L AT 30 GTTS
MAX: NOT MORE THAN 3L of IV FLUIDS CONTAINING OXYTOCIN