AT THE DELIVERY ROOM

1
AT THE DELIVERY ROOM
???????????????????????? Hypotonic uterine
contraction ??? plan ?? Forceps delivery
2
??????????????????????????????????????
3

?????????????? 1)Laceration of the birth
canal 2)Postpartum hemorrhage 3)Infection 4)Pelvic
floor relaxation 5)??????????????????????????
??????? sacral-iliac 6)????????????????????????
?????????? ???? ????????
?????????????? ????
cephalohematoma,subconjunctival
hemorrhage,intracranial hemorrage,facial
palsy, celebral palsy
4
AT THE DELIVERY ROOM
LABOR
ONSET OF LABOR 05.00 FULL DILATATION
10.00 BIRTH OF CHILD 11.47 BIRTH OF
PLACENTA 12.55
1ST STAGE 6 HRS 2ND STAGE 47
MINS 3RD STAGE 8 MINS DURATION OF LABOR
6 HRS 55 MINS
DELIVERY ABNORMAL
POSITION LOA OPERATION
F/E INDICATION PROPHYLACTIC ANESTHTIC 1
XYLOCAINE OXYTOCIC DRUG SYNTOCINON 10 U
5

INJURIES TYPE OF EPISIOTOMY LEFT
MEDIOLATERAL METHOD OF REPAIR SUBCUTICULAR
PLACENTAMEMBRANES SPONTANEOU
S DELIVERY NORMAL,WEIGHS 800 GMS,COMPLETE,CORD
LENGTH 50 CMS NO ABNORMALITIES OF PLACENTACORD
6
POSTPARTUM CONDITION ESTIMATED
BLODD LOSS 1000 ML BP 80/60 MMHG PR 76/MIN
NEWBORN FEMALE,WEIGHS
3070 GMS,LENGTH 48 CMS APGARS SCORE 1 MIN
7 5MIN 9 NO
ANORMALIES AT BIRTH
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?????????????????????
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1)???????????? (1000ml) 2)BP DROP
????????????????????????????????????
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IMMEDIATE
POSTPARTUM HEMORRAGE ???????
??????????????????????????????????????????????????
??? ??????? 500 ml ?????????? 1
??????????????????????????????? 24
???????????????????
??????????? 1) ??????? 2)
ESTIMATION OF BLOOD LOSS
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CLINICAL SYMTOMS AND SIGHS OF BLOOD LOSS
CORRELATED TO THE AMOUNT OF BLODD LOSS
BLOOD LOSS()OF BLOOD VOLUME ARTERIAL BLOOD
PRESSURE(SYSTOLICMMHG) SYMTOMS AND SIGNS 10-15

NORMAL
POSTPARTUM HYPOTENTION


MILD
TACHYCARDIA 15-30
SLIGHT FALL

TACHYCARDIA


THIST


WEAKNESS 30-40

60-80
PALLOR


OLIGURIA



CONFUSION


RESTLESSNESS 40

40-60
ANEMIA


AIR HUNGER


COMA


DEATH

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3) ?????????????????????????? 4)??????????????????
????????????????? ???????????? ???????? ????????
????????????????????? 5)??????????????????????????
???????????? 6)U/S
??????????????????????????????????????????????????
???
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CAUSES OF IMMEDIATE POSTPARTUM
HEMORRAGE 1)UTERINE ATONY 2)TRAUMA 3)COAGULATION
DISORDERS
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UTERINE ATONY
????? 90 ???IMMEDIATE POSTPARTUM HEMORRHAGE
PREDETERMINED FACTORS 1) UTERINE
OVERDISTENSION 2) PAST OBSTETRIC HISTORY 3)
MULTIPARITY 4) ANTEPARTUM HEMORRHAGE 5) POOR
UTERINE CONTRACTION CONTROLLABLE
FACTORS 1) OPERATIVE DELIVERIES ANS ANSTHESIA 2)
PROLONGED LOBOR 3) MISMANAGEMENT OF THE THIRD
STAGE
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TRAUMA SECOND MOST COMMON CAUSE
1)UNSUTURED EPISIOTOMY 2)MULTIPLE LACERATIONS
FROM PRECIPITATE LABOR 3)UTERINE
RUPTURE 4)CERVICAL TEARS FROM SHOULDER
DYSTOCIA 5)DESTRUCTIVE OPERATIONS
COAGULATION DISORDERS INHERENT
VON WILLEBRANDS DISEASE,IDIOPATHIC
THROMBOCYTOPENIA ACQUIRED LIVER DISEASE
HEPATITIS ANTICOAGULANT THERAPY
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????????MANAGE????????????????????
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PLACETA UNDELIVERED
-ASSESS BLOOD LOSS.V/S.CONSCIOUS LEVEL -IV
INFUSION LINE (RINGER LACTATE OR NSS 1000 ML
OXYTOCIN 10-20 UNITS RAPIDLY -HEMATOCRIT,XMATCH
AT LEAST 2 UNITS BLOOD -IV METHERGIN 1 AMP.(IF
NOT GIVEN PREVIOUSLY)
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?????????????????? manage ?????? 1)
????????VAGINAL CANAL UNDER GA --gt ???? BLEED
?????? HEMATOMA 2 CM ??? FOURCHETTE 2) 0.9 NSS
1000 CC IV 3) METHERGIN O.2 MG IV --gt WELL
CONTRACTED 4) HAEMACEEL 500 CC 5) WB 1U IV 6) 5
D/N/2 1000 CC SYNTO 40 U RATE 40 CC/HR PLAN 1)
ADMIT ICU 2) RECORD V/S , OBSERVE VAGINAL
BLEEDING 3) CBC , UA , CERVICAL SWAB 4) WB 2
U 5) AMPICILLIN , GENTAMYCIN
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PROGRESS NOTE (28 ?.?. 44 , 23.15 ?. ) S
????????????? ?????????????????? ???????????????
???????????????????????? ???????????? 2
PADS O BT 37 PR 70/MIN BP 90/50 MMHG RR
20/MIN HEENT NOT PALE
HEART NORMAL S1 , S2 , NO MURMURS
LUNGS CLEAR ABD SOFT,NOT
TENDER, GOOD CAPILLARY REFILL UT
FUNDAL HEIGHT AT UMBILICUS , WELL CONTRACTED
URINE OUTPUT 90 CC/HR ????
EPISIOTOMY ?????? , NO ACTIVE BLEEDING A G1PO
GA 396 WKS S/P F/E WITH PPH WITH R/O
CHORIOAMNIONITIS WB 2 UNITS --gt HCT
25 P OBSERVE V/S , BLEEDING PER VAGINA
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PROGRESS NOTE ( 29
?.?.44 ) S ??????????? ???????????
????????????? ???????????????????? O BT 37
BP 100/70 MMHG PR 80/MIN RR 20/MIN
HEENT NOT PALE HEART NORMAL
LUNGS CLEAR ABD SOFT,NOT TENDER
FUNDAL HEIGHT AT UMBILICUS,WELL
CONTRACTED NO ACTIVE BLEEDING PER
EPISIOTOMY , NO EDEMA A G1P0 GA 396 WKS WITH
PPH DAY 1 CLINICAL IMPROVED P OBSERVE
CLINICAL , V/S
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LABOR RECORD DATE/TIME INT DUR EFF
DIL STA POS MEM FHS BP PR
REMARKS
28 ?.?.44
5.00 2 30 45 90 6CM
0 CEPH ARM 140/R 120/80 80
7.35 --------------------AUGMENTATION-----
------------------
------------------------ SEDATION
---------------------------
IMP 2 ARREST OF DILATATION HYPOTONIC UT
CONTRACTION PLAN -AUGMENTATION -SEDATION -REEVALUT
E IN THE NEXT 2 HRS
80 6CM 0 MR 156/R
11.00
FD 1 MR 140/R