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topic 10 postpartum complication

topic 10 postpartum complication

Sample Answer 

topic 10 postpartum complication

What Is the Diagnosis?

The patient has Postpartum hemorrhage.

What Is Your Immediate Management Plan?

According to Dahlke et al. (2015), the patient’s uterus needs to be palpated to assess for atony. A uterine fundal massage should be performed. If there is no response, a bimanual compression should be applied with one hand in the vagina and below the uterus while the other hand compresses from above via the abdominal wall on the lower quadrants. Medications should be started to address the tone of the uterus. The patient will be administered oxytocin at ten units IM or 40 units in 1L NS. This will be run open until firmness is restored on the uterus and then at 200ml/hr. Other agents will be added as required, and these may include Misoprostol 800mcg rectally; Methylergonovine 0.2mg IM; Carboprost 250mcg IM

What Is Your Subsequent Management Plan?

Medication should commence curtailing any coagulopathy. The patient will be started with tranexamic acid 1 gram IV if unresponsive to oxytocin. Other medications that will be considered are cryoprecipitate for DIC, Factor replacement for hereditary hemophilia, DDAVP for potential von Willebrand disease, and FFP and platelets. The genital tract will also be examined for any trauma or retained products. A blunt dissection and finger will be used in removing any retained products, and any lacerations will be sutured. If bleeding continues, it will need to be tamponaded using a Rusch balloon filled with approximately 500ml of saline (Evensen, Anderson, & Fontaine, 2017).

Should an Ultrasound Be Ordered?

If bleeding continues even after tamponading, the patient will need to be transferred to have an ultrasound done and interventional radiology. This will help in uterine artery embolization. The patient may also need to be transferred to the OR for uterine artery ligation (Lockhart, 2015).

References

Dahlke, J. D., Mendez-Figueroa, H., Maggio, L., Hauspurg, A. K., Sperling, J. D., Chauhan, S. P., & Rouse, D. J. (2015). Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. American journal of obstetrics and gynecology213(1), 76-e1.

Evensen, A., Anderson, J. M., & Fontaine, P. (2017). Postpartum hemorrhage: prevention and treatment. American family physician95(7), 442-449.

Lockhart, E. (2015). Postpartum hemorrhage: a continuing challenge. Hematology 2014, the American Society of Hematology Education Program Book2015(1), 132-137.

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Question 


topic 10 postpartum complication

Discussion 

***The initial discussion response should be in the range of 250-300 words. All questions in the topic must be addressed. All discussions need to be supported by a minimum of two scholarly resource. Journals and websites must be cited appropriately (Citation and reference must adhere to APA format). All components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Case Study:

Topic 10 – Postpartum Complication

Topic 10 – Postpartum Complication

A 32 year old woman presents to the clinic for an acute visit 6 days following a vaginal delivery at 39 weeks gestation.  The pregnancy and labor had been unremarkable and the placenta was delivered by controlled cord traction.

Following delivery the woman had been discharged home after  48 hours.  She reported that the lochia had been heavy for the first 2 days but that it had settled to less than a period.  However, today she had suddenly felt crampy abdominal pain and felt a gush of fluid, followed by very heavy bleeding.  The blood soaked through clothes and she had passed large clots, which she describes as the size of her fist.  She feels dizzy when she stands up and is nauseated.

Examination

She is pale with cool and clammy extremities.  She is also drowsy.  Her blood pressure is 105/50 and heart rate is 112/min.  On abdominal palpation there is minimal tenderness but the uterus is palpable approximately 6 cm above the symphysis pubis.

Speculum examination reveals large clots of blood in the vagina.  When these are removed, the cervix is seen to be open.

Questions:

  1. What is the diagnosis?
  2. What is your immediate management plan?
  3. What is your subsequent management plan?
  4. Should an ultrasound be ordered?

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

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