ANTEPARTUM HAEMORRHAGE (APH) PRIMARY POST PARTUM SECONDARY PPH POSTABORTION HAEMORRHAGE: Definition Definition Definition Definition Vaginal bleeding from 28 weeks of pregnancy to before delivery Increased vaginal bleeding (500 ml or Increased vaginal Vaginal bleeding DIFFERENTIAL DIAGNOSIS of major obstetric causes of APH greater and or causing worsening of bleeding occurring before 28 weeks of pulse rate and blood pressure) within between the first 24 pregnancy due to the first 24 hours after childbirth hours after childbirth and an abortion Management Management six weeks postpartum. Placenta in: Rub up uterine Symptoms Call for help contraction (in Genital bleeding or Inform the mother that urgent case of late increase in red lochia measures to stop the bleeding are Fever abortion) needed. Signs Give oxytocic Lay flat, keep warm Offensive vaginal drug bleeding or discharge Continuous fundal massage until Empty the from the cervical os uterus hard bladder Variable degrees of Give or repeat oxytocin 10 U IM Put up an IV shock Ask the assistant to insert a urethral drip with saline Pallor catheter for continuous drainage. and run it fast Sub-involuted tender Put up IV line with large bore and Do VE and uterus. remove take blood for Hb, Grouping and Management cross matching, put up normal products of Give oxytocin 10 saline or Ringer's lactate and run it conception IUnits IM fast from vaginal Rub up a contraction canal If peripheral veins are collapsed and Empty bladder hard to find, perform a saphenous Check vital Set up IV line , Check cut-down immediately anterior to signs Hb and X-match 2 the medial ankle. If SEPTIC, give units of blood and Ask the assistant to record vital put up with saline or signs every 15 minutes. 1g IV stat Ringer's lactate run If vital signs deteriorate, urgently Counsel and L fast in the first 2 refer patient to hospital with an refer to hospital hours if patient is in escorting nurse and potential blood with donors shock. donors. Put 40 units of If placenta retained, repeat
ANTEPARTUM HAEMORRHAGE (APH) PRIMARY POST PARTUM HAEMORRHAGE: SECONDARY PPH POSTABORTION Definition Vaginal bleeding from 28 weeks of pregnancy to before delivery DIFFERENTIAL DIAGNOSIS of major obstetric causes of APH Definition Increased vaginal bleeding (500 ml or greater and or causing worsening of pulse rate and blood pressure) within the first 24 hours after childbirth Management Placenta in: Call for help Inform the mother that urgent measures to stop the bleeding are needed. Lay flat, keep warm Continuous fundal massage until uterus hard Give or repeat oxytocin 10 U IM Ask the assistant to insert a urethral catheter for continuous drainage. Put up IV line with large bore and take blood for Hb, Grouping and cross matching, put up normal saline or Ringer's lactate and run it fast If peripheral veins are collapsed and hard to find, perform a saphenous cut-down immediately anterior to the medial ankle. Ask the assistant to record vital signs every 15 minutes. If vital signs deteriorate, urgently refer patient to hospital with an escorting nurse and potential blood donors. If placenta retained, repeat Definition Increased vaginal bleeding occurring between the first 24 hours after childbirth and six weeks postpartum. Symptoms Genital bleeding or increase in red lochia Fever Signs Offensive vaginal bleeding or discharge from the cervical os Variable degrees of shock Pallor Sub-involuted tender uterus. Management Give oxytocin 10 IUnits IM Rub up a contraction Empty bladder Set up IV line , Check Hb and X-match 2 units of blood and put up with saline or Ringer's lactate run L fast in the first 2 hours if patient is in shock. Put 40 units of Definition Vaginal bleeding before 28 weeks of pregnancy due to an abortion Management Rub up uterine contraction (in case of late abortion) Give oxytocic drug Empty the bladder Put up an IV drip with saline and run it fast Do VE and remove products of conception from vaginal canal Check vital signs If SEPTIC, give 1g IV stat Counsel and refer to hospital with donors
guidelines_for_malawi_and_tanzania_with_foreword_20.11.13.docx