Showing posts with label postpartum. Show all posts
Showing posts with label postpartum. Show all posts

Monday, April 15, 2013

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

Management of Postpartum Collapse - AMNIOTIC FLUID EMBOLISM


Presentation
  • Extremely sudden severe shock with severe dyspnoea, cyanosis Pulmonary oedema
  • Blood stained frothy sputum
  • Convulsions may occur  
Onset
  • Usually immediately after membranes rupture however it can occur even with intact membranes occurs during strong uterine contractions
  • Usually fatal 

Saturday, April 13, 2013

Management of Postpartum Collapse - CONVULSIONS

Convulsions may be due to eclampsia, epilepsy, malaria, head injury, cerebral abscess, meningitis, encephalitis, etc.

Whatever the cause, initial steps are the same.
  • Stop the fits
  • Maintain airway
  • Prevent aspiration
  • Prevent injuries
Immediate care :
  • Position the patient - head low, turn to a side
  • airway - plastic or metal
  • Suck the mouth and pharynx
  • Place cushions around the patient or tie the limbs loosely with soft cloth  
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