Causes and treatment of postpartum hemorrhage?
First, systemic factors: expectant mothers are extremely nervous, excessively afraid of childbirth, especially lacking sufficient confidence in vaginal delivery; Excessive use of sedatives, anesthetics or uterine contraction inhibitors after delivery; Combined with chronic systemic diseases; Physical weakness can cause uterine contraction weakness.
Second, obstetric factors: prolonged labor, excessive physical exertion of expectant mothers, or accelerated labor can all cause uterine inertia. Obstetric complications and complications such as placenta previa, placental abruption, hypertensive disorder complicating pregnancy, intrauterine infection, etc. It may be uterine weakness caused by uterine muscle edema or oozing blood.
Third, uterine factors: uterine muscle fiber dysplasia, such as uterine malformation or uterine fibroids; Excessive stretching of uterine fibers, such as macrosomia, multiple pregnancies and polyhydramnios; Coin collection of damaged uterus, such as cesarean section, uterine perforation and other uterine surgery history; Too many births and times can cause uterine atony.
Fourth, excessive use of sedatives or anesthetics and uterine contraction inhibitors after delivery will also lead to postpartum hemorrhage. If you have complicated chronic systemic diseases in your body, physical weakness will also lead to postpartum hemorrhage.
Nursing care of postpartum hemorrhage
2. 1. Prevention and monitoring of postpartum hemorrhage,
2. 1. 1. For obstetric patients at risk, the hospital should organize and set up a maternal rescue organization with sufficient manpower and material resources, pay attention to the professional training of obstetricians at ordinary times, improve the awareness of obstetric first aid, and minimize obstetric medical disputes and errors. Nurses engaged in obstetric work must master the monitoring and nursing of emergency, danger and heavy rescue, master the conventional rescue and first aid technology, and master the performance, principle and usage of various first aid equipment and instruments.
2. 1.2. Postpartum hemorrhage mostly occurs in pregnant women with abnormal delivery and complications. It is necessary to carefully screen expectant mothers with high-risk pregnancy through prenatal monitoring and prepare for rescue before delivery.
2. 1.3. During delivery, we should strengthen delivery monitoring, pay attention to the rest and nutritional supplement of expectant mothers, understand the psychological communication between expectant mothers, conduct psychological counseling, empty the bladder, prevent prolonged labor and the failure of expectant mothers from causing postpartum uterine contraction weakness. If antihypertensive drugs and sedatives are used, they should be used in moderation to avoid excessive dosage, so as not to affect uterine contraction.
2. 1.4. For expectant mothers who may have postpartum hemorrhage, such as twins, polyhydramnios, delayed delivery, placenta previa, placental abruption, severe pregnancy-induced hypertension, expectant mothers, and those with a history of postpartum hemorrhage, intramuscular injection or intravenous infusion of oxytocin can be given immediately after delivery of the fetal front shoulder to promote uterine contraction.
2. 1.5. postpartum hemorrhage mostly occurs within 2 hours after delivery, and uterine atony is the most common cause. The key to prevent postpartum hemorrhage is to strengthen uterine contraction. Therefore, when postpartum hemorrhage is found, no matter what the reason, the uterus should be massaged first, and the contractions should be strengthened with contractions to further check the reasons. The vital signs, uterine involution and vaginal bleeding of expectant mothers should be closely observed within 2 hours after delivery.
2.2. Prenatal and intrapartum monitoring
2.2. 1. Prenatal check-ups should be conducted regularly, health education should be strengthened, members of society should be educated on high-risk pregnancy factors and prenatal care, pregnant women's awareness of pregnancy care should be improved, pregnancy-related knowledge should be understood, and pregnant women should be taught self-monitoring skills (self-checking fetal movement, identifying abnormal fetal movement, mastering the time of prenatal check-up, expected date of delivery, etc.). ). Try to improve the health care quality and skills of pregnant mothers. We medical workers should pay special attention to identify high-risk factors, strengthen the management of high-risk pregnant women, and follow up regularly.
2.2.2. Intrapartum monitoring
2.2.2. 1. In the first stage of labor, we should pay close attention to the changes of labor, fetal heart rate and uterine contraction, conduct regular anal examination, understand the position of uterine dilatation and fetal presentation decline, describe and monitor the progress of labor with labor chart, find and deal with the delay and stagnation of labor in time, and make various preoperative preparations to prevent postpartum hemorrhage, and use oxytocin.
2.2.2.2. During the second stage of labor, we should pay attention to the changes of fetal heart rate, deliver scientifically, pay special attention to the protection of perineum and prevent the injury of soft birth canal, monitor the amount of vaginal bleeding immediately after delivery, and collect the amount of bleeding by volume method.
2.2.2.3. Pay attention to identify the signs of placental abruption in the third stage of labor, avoid squeezing the uterus or pulling the umbilical cord prematurely, correctly assist the delivery of placenta, carefully check whether the placenta membrane is complete, carefully check whether the soft birth canal is torn after the delivery of placenta, and suture it in time.
2.2.2.4. Accurately collect and measure postpartum hemorrhage. If the amount of vaginal bleeding exceeds 200ml within 2 hours, we should actively find out the reasons and deal with the symptoms. Close observation of vital signs, complexion and general condition, examination of uterine fundus and vaginal bleeding, mastering and identifying some symptoms of shock caused by massive bleeding of expectant mothers, such as thirst, yawning, dizziness, nausea, vomiting, irritability, chest tightness, shortness of breath, cold sweat and pallor.