Management of Postpartum Collapse

COLLAPSE

Before delivery	After delivery	After 3rd stage
Rupture uterus	PPH – During 3rd stage	Ruptured uterus
Amniotic fluid embolism		Uterine inversion

 

RUPTURED UTERUS

History

• Past caesarean section
• Grand multigravida
• Multigravida given oxytocin during labour
• Almost never in primigravida - except following manipulations or previous uterine scar e.g. myomectomy

Presentation

Unexplained tachycardia in labour

Shock (collapse)

            Hypotension

            Pallor sweating

            Cold extremities

Sudden disappearance of painful uterine contractions followed by continuous dull abdominal pain

Absent FHS or fetal distress associated with above mentioned features easily palpable fetal parts

Presenting part may disappear from the pelvis

Fresh bleeding PV

May feel the contracted uterus

 Treatment

               Resuscitation

               I.V.  Hartmann's or N.saline via I.V. cannula

               Inform specialist unit by telephone and transfer

INVERSION OF THE UTERUS

Prevention

Manage the 3'rd stage of labour properly

Avoid traction on the cord until uterus is well contracted

                     I.e. Always palpate the uterus before applying controlled cord traction

Diagnosis - Complete inversion

Lump at the vulva after the delivery of the baby. Placenta may or may not be attached to it. Uterus is not palpable abdominally.

 

Partial inversion

Suspect if a mother collapses with severe pain and sweating soon after removal of placenta - without much bleeding.

 

 

Diagnosis  

• Palpate the abdomen - may feel a dimple on the fundus
• PV - can feel a round, fleshy mass
• Do not wait mistaking this for fibroids

Treatment

Palpate the abdomen - may feel a dimple on the fundus PV - can feel a round, fleshy mass

Do not wait mistaking this for fibroids

If seen immediately - replace it.

Do not attempt to remove the placenta before reduction

 

If seen later-

Resuscitate – I.V. drips - Hartmann’s, N. saline pack the vagina to elevate the inverted uterus

No ergometrine or oxytocin (Syntocinon)

morpihine 15 mg I.M..

Telephone specialist unit

Transfer