Management of Post Party Bleeding Due to Uterine Atonia

MANAGEMENT OF POST PARTY BLEEDING DUE TO UTERINE ATONIA STEPS / ACTIVITIES Preparation PATIENT PREPARATION Explain to the patient and family the actions that will be taken Prepare approval for medical treatment for the patient's family Prepare the patient for the procedure:The mother is in the lithotomy position on the bedlabor. TOOLS PREPARATION Prepare the necessary tools and medicines: Parturition set: Sterile handscreen Like an instrument Amnitom (1/2 kocher) Episiotomy scissors Umbilical cord clamp Cut the umbilical cord Central cord tying Crooked De Lee slime sucker Long sterile gloves Hold the placenta Sterile gauze, 3 ml DTT syringe cotton and needle no. 23G Cuching medicine Heacting set: Like an instrument Nailpouder 10 cc syringe Handscoen Tweezers Nail heacting (for skin, for muscles) Cut gut thread Doek is sterile Stethoscope Spighnomanometer Thermometer Baby resuscitation equipment Cunam piper/ long cunam Apron, mask, protective glasses, boots (PPE) cloth cover (blanket, cover) Mom's clothes Baby clothes Towels, washcloths Plastic basin Iron basin Book/pen for documentation DTT/sterile gloves 0.5% chlorine solution Uterotonics (Ergometrine maleate, Oxytocin) Local anesthetics (Lidocaine 2%) Aquabidest Povidone-iodine Catheter Standard infusion Infusion set (abocath 16 or 18) RL Infusion Fluid HELPING PREPARATIONS Wear an apron, mask and protective glasses Wear sterile gloves. Wash hands Implementation After the placenta is delivered, massage the uterine fundus for a maximum of 15 seconds. Advise the patient to stimulate the nipples If the uterus does not contract, clean the blood clot and/or amniotic membrane from the vagina and cervix. Make sure the bladder is empty, if it is full, catheterize it Carry out a proper examination so that it can be confirmed that this is bleeding caused by uterine atony INTERNAL BIMANUAL COMPRESSION (KBI) Do KBI for 5 minutes Put on high-level disinfection or sterile gloves, gently insert them obstetrics (bringing together the five fingertips) through the introitus into the mother's vagina. Examine the vagina and cervix. If there are amniotic membranes or blood clots in the uterine cavity, Maybe this causes the uterus to not be able to contract fully. Make a deep fist and place it in the anterior fornix, pressing against the anterior wall of the uterus towards the outer hand which holds and pushes the posterior wall of the uterus forward so that the uterus is pressed forward and backward. Press firmly on the uterus between both hands. This uterine compression provides pressure directly on the open blood vessels (forms of placental implantation) in the uterine wall and also stimulates the myometrium to contract. If the uterus contracts, continue KBI for ± 2 minutes then remove your hand and do it Monitor the IV stage closely. EXTERNAL BIMANUAL COMPRESSION If the uterus is still not contracting, advise the family to do KBE. External Bimanual Compression (KBE) Place one hand on the abdominal wall and the front wall of the uterine body and on above the symphysis pubis. Place the other hand on the abdominal wall and the back wall of the uterine corpus, parallel with the anterior wall of the uterine corpus. Try to cover/hold the back of the uterus as much as possible. Perform uterine compression by bringing your front and back hands closer together so that the blood vessels in the myometrium can be clamped manually. This method can clamp the uterine blood vessels and help the uterus contract. Remove your hand slowly. Give ergometrine 0.2 mg IM or misoprostol 600-1000 mcg rectally. Infuse with a 16 or 18 gauge needle & give RL+ 20 UI oxytocin, finish as quickly as possible (grojok). Repeat KBI If the uterus has contracted, monitor the IV stage closely. If it does not contract, immediately refer to BAKSOKUDA. Accompany the mother to the referral place while still carrying out KBI. Continue infusion of RL+ 20 UI oxytocin in 500 cc of solution at a rate of 500 cc/ hour until the reference point or until you have used up 1.5 liters. Then 125 ml/ hour. If fluid is not enough, give a second 500ml at medium speed & give a drink to rehydrate. ABDOMINAL AORTA COMPRESSION Lay the mother down, legs placed on a flat base (without support) Feel the pulsation of the femoral artery by placing the tips of your index and middle fingers at the intersection of the groin line parallel to the upper edge of the pubic symphysis. Make a fist, press the back of your index finger to your little finger on the umbilicus slightly to the left in a perpendicular direction. The other hand feels for the pulsation of the femoral artery. Do compressions for 5 ‒ 7 minutes. Release the pressure for about 30 ‒ 60 seconds so that other parts do not lack blood. If the pulsation is still palpable, the compression pressure is not yet strong If it decreases/stops, the compression has reached the abdominal aorta. The bleeding stops, maintain this position and massage the uterus (assistant) until the uterus is contracting well. POST-ACTION INFECTION PREVENTION & CONTINUOUS CARE Pay attention to vital signs, bleeding and uterine contractions every 10 minutes in the first 2 hours Write follow-up care instructions, keep records of patient condition and postmonitoring action