tailieunhanh - obstetrics_part8

- Truyền máu nếu mất máu nặng (1500 ml) và / hoặc nếu cục máu đông không còn hình thành (sử dụng máu đã được sàng lọc ít nhất là cho HIV-1, HIV-2, viêm gan B và C). | Postpartum haemorrhage Figure 72 Bimanual compression of the uterine body Figure 73 Uterine compression through the vagina Figure 74 Uterine compression through the vagina This is trial version 148 7. Third stage of labour - Transfuse if blood loss was heavy 1500 ml and or if clots are no longer forming use blood that has been screened at least for HIV-1 HIV-2 hepatitis B and C . - Arrange to have the patient transferred for surgery if the situation is not controlled. While waiting put a bend in the uterine vessels to stop the bleeding place four forceps the least traumatic possible around the cervix and pull the cervix to the vaginal opening while pushing the uterine fundus with a hand on the abdomen. Pulling the uterus to the vaginal opening puts a bend in the uterine arteries. Applying torsion to the cervix with forceps also puts a bend in the cervicovaginal arteries. - Further surgical procedures might include Stepwise ligation of the uterine blood supply round ligaments utero-ovarian arteries uterine arteries Uterine compression suture Subtotal hysterectomy - After the acute episode ferrous sulfate folic acid PO 2 to 3 tab day in 2 to 3 divided doses for 3 months Delayed detection of postpartum haemorrhage Combination of foul-smelling bleeding fever a uterus that is soft and larger than expected general deterioration anaemia. It is usually caused by retained placenta or blood clots with secondary infection. Hospitalize. - Administer antibiotics immediately amoxicillin-clavulanic acid co-amoxiclav IV 6 g amoxicillin day divided into 3 injections administered 8 hours apart gentamicin IM 5 mg kg once daily Continue this treatment for 48 hours until fever disappears then change to co-amoxiclav PO 3 g day in 3 divided doses to complete 5 days of treatment. or ampicillin IV 6 g day divided into 3 injections administered 8 hours apart metronidazole IV g day divided into 3 injections administered 8 hours apart gentamicin IM 5 mg kg once daily .