nursing intervention for retained placental fragments

These are: (i) communication, (ii) resuscitation, (iii) monitoring and investigation (as described in the investigation section) and (iv) arresting the bleeding (with uterotonics/surgical measures, depending on the suspected cause). In the case of massive secondary PPH, management includes four components, which should be undertaken simultaneously. In continuing haemorrhage, insertion of a balloon catheter into the uterus may be effective. Surgical measures should be undertaken if there is excessive or continuing bleeding (irrespective of ultrasound findings). Uterotonics – examples include syntocinon (oxytocin), syntometrine (oxytocin+ergometrine), carboprost (prostaglandin F2) and misoprostol (Prostaglandin E1).Note: antibiotic regimes will differ according to local hospital Trust anti-microbial guidelines.Gentamicin should be added to the above combination in cases of endo myometritis (tender uterus) or overt sepsis.Antibiotics – usually a combination of ampicillin (clindamycin if penicillin allergic) and metronidazole.The mainstay of treatment in secondary PPH is with antibiotics and uterotonics: Speculum examination is important in order to assess the amount of bleeding, and a high vaginal swab should be taken at the same time. On abdominal examination, the patient may complain of lower abdominal tenderness (usually a sign of endometritis), or the uterus may still be high (sign of retained placenta). For example, women with endometritis may also present with fever/rigors, lower abdominal pain or foul smelling lochia (the normal discharge from the uterus following childbirth). However, approximately 10% of cases will present with massive haemorrhage – and this can quickly lead to hypovolemic shock.Īdditional clinical features will depend on the underlying cause.

The patient may complain of spotting on-and-off for days after her delivery, with an occasional gush of fresh blood. In contrast to primary PPH (an acute condition requiring immediate management), the bleeding in secondary post-partum haemorrhage is usually not as severe. The main symptom of secondary post-partum haemorrhage is excessive vaginal bleeding.

Nursing intervention for retained placental fragments