Page 309 - Critical Maternity & Newborn Health Nursing

• Follow the instructions for instrumental delivery (see later).

4. Routine use of ecbolic in the 3rd stage of labor.

5. Routine examination of the placenta and membranes for completeness.

(III) Postpartum:

1. Exploration of the birth canal after difficult or instrumental delivery as

well as precipitate labor.

2. Careful observation in the fourth stage of labor (1-2 hours

postpartum).

(B) Treatment:

(I) Immediate antishock measures:

Urgent cross-matched blood transfusion with the other antishock

measures is given. Colloids and/or crystalloids therapy can be started till

availability of the blood.

(II) Management depends up on the cause:

i) Placental site bleeding:

(a) Before delivery of the placenta: Immediate placental delivery.

The placenta should be delivered by:

• Ergometrine and massage with gentle cord traction if failed,

• Brandt -Andrews maneuver if failed do,

• Crede's method if failed do,

• manual separation of the placenta.

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