Question

How will you manage PPH?

Hint:

Immediate action, including uterine massage, oxytocin administration, and addressing the underlying cause, is crucial in the management of PPH.

Answer 1

Step 1: Initial Management of PPH.
The management of PPH is a time-sensitive process aimed at stopping the bleeding, restoring blood volume, and preventing shock. The following steps are essential:
(1) Call for Help:
- Immediately activate the emergency response team and call for senior assistance. Early intervention is crucial.
(2) Assessment and Monitoring:
- Assess the vital signs (heart rate, blood pressure, respiratory rate) and level of consciousness. Monitor oxygen saturation, and initiate IV fluids (preferably crystalloids like Ringer's lactate or normal saline) to manage hypovolemia.
(3) Uterine Massage and Oxytocin Administration:
- Perform fundal massage to stimulate uterine contraction. - Oxytocin (10 IU) should be administered intravenously or intramuscularly to promote uterine contraction and minimize further bleeding.
Step 2: Additional Pharmacologic Management.
(4) Second-Line Uterotonic Agents:
If uterine atony persists after oxytocin, other uterotonics should be considered:
- Methylergonovine (Methergine): 0.2 mg IM every 2-4 hours (contraindicated in hypertension).
- Carboprost (Hemabate): 250 µg IM every 15-90 minutes (contraindicated in asthm.
- Misoprostol: 800 µg orally or rectally, especially in resource-limited settings.
(5) Empty the Bladder:
- A full bladder can prevent effective uterine contraction. Ensure the bladder is empty by catheterizing if necessary.
Step 3: Surgical and Interventional Management.
(6) Manual Removal of Retained Placenta:
- If retained placenta is suspected, manual removal under sterile conditions should be performed.
(7) Repair of Birth Canal Trauma:
- If trauma to the cervix, vagina, or perineum is suspected, suturing of the lacerations or episiotomy should be performed.
(8) Balloon Tamponade (Bakri Balloon):
- If uterine atony persists, a balloon tamponade can be inserted into the uterus to apply pressure and control bleeding.
(9) Surgical Intervention (Hysterectomy):
- If bleeding cannot be controlled with conservative methods, a hysterectomy may be necessary, particularly in the case of uterine rupture or severe atony.
Step 4: Post-Management Care.
- After controlling bleeding, closely monitor the patient for signs of shock or coagulopathy and provide supportive care, including blood transfusions if necessary.