Survival-Austere-Medicine by 未知

Author:未知
Language: eng
Format: epub
Tags: Complete Home Medicine
Published: 2014-06-13T16:00:00+00:00

Most heavy bleeding occurs simply because the uterus will not contract or a piece of placenta is left behind. Nipple stimulation either through breastfeeding or direct stimulation releases the hormone oxytocin which stimulates contractions and is the first treatment choice. Gentle rubbing of the fundus also stimulates contractions and should be tried. If large and soft, firm pressure on the fundus may expel accumulated blood clots and assist contraction. Also encourage or assist the mother to empty her bladder as this helps the lower part of the uterus to contract.

The second priority is to ensure the placenta is delivered if it hasn’t been already and that it is complete. If the placenta is still inside or incomplete and bleeding continues to be heavy consider exploring inside uterus with a gloved hand for the retained placenta or pieces of placenta. You can also assess for inversion or uterine tear – this is very painful for mom if no anaesthesia is available, and there is a significant infection risk. Broad-spectrum antibiotics should be given if available.

If the uterus is empty and will not contract with nipple stimulation or rubbing of the fundus then bimanual compression should be considered. One hand is placed inside the vagina and the other hand is used to compress the uterus from the outside down onto the hand the vagina. This is painful and also carries an infection risk but can be life saving. Ice water lavage may also help slow bleeding – do this just like an enema.

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