After Geriatric Case Management, within the same day (monday 8th sept. 2008), we browse into the world 'down under' (as the aussies always said) haha!! you guy know what i mean....
so APH and PPH....triggers emergency nurses plus the gynae nurses (a.k.a bidanz)....to deal such patients..even though emergency nurses only handle the first what-to-do kinds of stuffs....we measure BP, fetal HR, blood routines plus bleeding time and cross match....we do have to know what exactly happens in the uterus...why bleeding, why so important? YES, we try to save some lives here okay....so here i go again....
The lecture presentation given was a bit on a fast pace...probably some of us were not concentrated during the lecture...REMINDERS FOR STAFFS ALIKE!! NO VE TO BE EXAMINE IN ANY PREGNANT LADY!!!
APH...u think about placental abruption or placental praevia...these two were the most thinkable diagnosis or thoughts we might have to think about when a pregnant lady comes via the AED.
Assessment includes most of the statements i mentioned above...CARE TO ADD MORE IN THE COMMENT AREA..
Worst comes when continuous bleeding will lead the mother to experience blood loss (hypovolaemic shock) so IV hydration needed to be sustained along with blood 'O' negative (which are obtained from the cross match....
P. Previa - occurs when the placenta is in the lower segment of the uterus. Consists of four types. Risk factors include; increase of age, previous history, smoking and cocaine use...
When the mother is in the 3rd trimester, this case should be a concern but before that is not a worry (as mentioned by the lecturer).
Danger for mom, haemorrhage, sepsis and placenta accreta (p.accreta describe as abnormal attachment of the placenta in the myometrium-mid layer of the uterus wall) which leads to further bleeding worse is death...happens in 1:2500 birth (wikipedia,2008).
Danger for fetus, preterm birth, groth restriction, malformation....what do u expect if the baby was delivered for the expected delivery date (EDD)?
P.Abruption - from wikipedia 2008 stated that, this is when the placenta is detached from the uterus while the fetus is still inside...this results, of course, bleeding. Lecturer stated that bleeding PV but the placenta is in normal position. Risky moms are with history of hypertension, increase of age, lower socioeconomic status and smoking.
TO NOTE HERE...BOTH RESULTS BLEEDING SO WHEN IT OCCURS IT NEEDS TO BE WITHHOLD OR STOP
Mx is to save the life of the mother first (gynae issue)....
So, if not settled? mother will experience, Shock, Disseminated Intravascular Coagulation (DIC) and PPH.
POST PARTUM HAEMORRHAGE
Blood loss of +- 500 ml after delivery and continuous for more than 24 hrs.
2 types, first and second....1. occurs in delivery and the first 24hr. 2. bleeding continues upto 6 weeks post partum.
Causes? No contraction of uterus, Haematoma, Vaccum effect, remnants of placenta
Who will be at risk? For emergency C-section, Elective admission mothers, Big baby, Haemophilia, Von Willebrand's disease (jarang di brunei).
Rx? Blood transfusion O negative, FFP (i think Frozen Fresh PLasma-check again ok)
They did include medications but i dont dare to state it here ..do add kan for me in the comment area......to suggest syntocinon, carboprost, oxytocin....to check again if these drugs included ...
okay guys ....arghh wats on my head now???!!
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