Obsetrics Essay

2740 words - 11 pages

Pregnancy and childbirth is a natural process of life in result of timely ovulation and fertilization (Bledsoe, Porter & Cherry, 2011). Child delivery occurs daily, usually requiring minimal assistance, however complications can and do arise and as health care professionals it is in our duty to be able to recognise them quickly in order to manage them accordingly (Bledsoe et al., 2011). This essay will focus on complications of obstetric haemorrhage (OH) in the antepartum and postpartum periods. As described by Mosby, (2010) antepartum hemorrhage (APH) is any form of bleeding coming from a pregnant uterus with a normally positioned placenta, in particular after the 28th week of gestation. In comparison, postpartum hemorrhage (PPH) is classified as excessive amounts of bleeding immediately following childbirth. A small amount of bleeding is normal but if it amounts to more than 500ml intervention is required (Mosby, 2010). Additionally, this essay will discuss the epidemiology, assessment, presentation and pre-hospital management (PHM) principles for incidence of both types of OH while in conjunction it will explore critical appraisals of current treatments and discover ethical and cultural diversities within the medical sector of this specialised population.

OH is the leading cause of maternal mortality globally, responsible for approximately 25% of the 300,000 maternal deaths estimated annually (El Ayadi et al., 2013). Substandard care, which includes delayed diagnoses and institution of timely and appropriate treatment, was identified in 80% of maternal deaths (Ratnam et al., 2008). The majority of these maternal deaths occur in resource-limited settings (Sutherland et al., 2013). PPH causes the most maternal deaths and is largely preventable (Sidu et al., 2010). Often PPH will be caused by uterine autonomy, resultant from delivering larger infants, having multiple births, enduring prolonged labour or it can occur after precipitous deliveries (Bledsoe et al., 2011). When assessing such complications, it is important to be aware of these predisposing factors. It is crucial also, to be aware; due to the acute setting that heavy reliance will be based on the clinical presentation of the patient.

The PHM of PPH, in accordance with the St John (2013) protocols, states to compress the bleed, examine for the presence of obvious lacerations, and to estimate the total volume of lost blood. This is achieved by noting down any blood spillage in the primary setting and measuring the amount of blood lost en route by documenting the number and weight of sanitary pads used (Bledsoe et al., 2011). Due to the time critical element of the situation the patient will need to be transported immediately. If it is not a major hindrance to this, the midwife should be sought after to gain additional information. The uterotonic drug of choice is oxytocin. This can only be given after the birth of the last baby if multiple infants are being delivered. If oxytocin...

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