Management of Hemorrhage

Subject: Midwifery I (Theory)

Overview

Hemorrhage is also known as bleeding. Blood escapes from the circulatory system. Internal or external bleeding can occur. It is caused by traumatic injury and medical disorders. Pallor, heavy brilliant bleeding with or without clots, blood-soaked in towels, pads, or cloths, possible shock from hemorrhage, and dizziness are signs and symptoms. If a shocking symptom is present, shock management is critical. Uterine evacuation will be conducted to stop the bleeding caused by the retained product of conception. It includes manual vacuum aspiration, dilatation, and curettage. Repair any cervical or vaginal laceration because these are the causes of bleeding.

Hemorrhage is sometimes referred to as bleeding. The circulatory system allows blood to escape. Internal bleeding (blood leaking from blood veins within the body) or external bleeding (from a natural opening of a body like a nose, anus, mouth). It is caused by a traumatic injury as well as medical issues.

Signs and Symptoms

  1. Pallor
  2. Heavy brilliant bleeding, clots or no clots
  3. Towels, pads, or cloths saturated with blood
  4. Perhaps in shock as a result of the bleeding
  5. Dizziness

Management of Hemorrhage

- Shock management is necessary because the patient may experience shock as a result of the hemorrhage.

- Identifying the bleeding site, which could be the placental site owing to a retained result of conception, the vaginal tract or the cervical canal, a laceration, or an abdominal injury.

- Uterine evacuation

It is done to stop the bleeding caused by the retained product of conception. It consists of manual vacuum aspiration, dilatation, and curettage.

- Examination of the retained product of conception

The retained products extracted from the uterus will be evaluated.

  1. Put on clean gloves.
  2. Remove any blood or blood clots from the retained product and gently pour with clean water. Place the tissue in a clean container and cover it with a weakly acidic solution. Place the container in the shape of a window or lighting fixture.
  3. To examine, a magnifying lens or a microscope is employed.
  4. Normal tissue findings
  • Villi
  • Gestational Sac
  • Decidua
  • Fetal fragments

- Abnormal findings on tissue examination

  • Infection or sepsis is indicated by an old blood clot, pus, or a bad odor.
  • The presence of grape-like clusters suggests a molar pregnancy or hydatiform mole.

- Repair any cervical or vaginal laceration because these are the causes of bleeding.

- Managing uterine perforation

  • Aspiration must be halted quickly, and necessary procedures must be taken, such as starting IV infusion, Examination of bleeding, and the genital state of the lady (vital signs, I/O chart, skin, consciousness), as well as laboratory tests.

- Referral and transfer

References

  • HealthLine. 2005. 2017 http://www.healthline.com/symptom/hemorrhage
  • MedicineNet. 1996. 2017 http://www.medicinenet.com/script/main/art.asp?articlekey=14263
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
  • Postabortion care, a reference manual for improving quality of care, USAID/Nepal, FHD, HMG
Things to remember
  • Hemorrhage is sometimes referred to as bleeding. The circulatory system allows blood to escape.
  • Internal bleeding (blood leaking from blood veins within the body) or external bleeding (from a natural opening of a body like a nose, anus, mouth).
  • It is caused by a traumatic injury as well as medical issues.
  • Pallor, heavy brilliant bleeding with or without clots, blood-soaked in towels, pads, or cloths, possibly shock owing to hemorrhage, and dizziness are signs and symptoms.
  • If an indication of shock is present, shock management is critical.
  • Uterine evacuation is required to cease the bleeding caused by the retained product of conception.
  • It consists of manual vacuum aspiration, dilatation, and curettage.
  • Repair any cervical or vaginal lacerations because these are the causes of bleeding.
Questions and Answers

Signs and Symptoms

  • Pallor,
  • Heavy bright bleeding with or without clots,
  • Blood soaked in towels, pads or cloths,
  • May be in shock due to hemorrhage,
  • Dizziness.

 

Management of Hemorrhage

  • Management of shock because due to hemorrhage patient may go to shock.
  • Identification of bleeding site ie may be from the placental site due to retained product of conception, genital tract or cervical canal, laceration, abdominal injury.
  • Uterine evacuation
    • It is to be performed to stop the bleeding due to retained product of conception. It includes manual vacuum aspiration and dilatation and curettage.
  • Examination of retained product of conception

The retained products that are removed from the uterus are to be examined

  • Wear clean gloves.
  • Blood and blood clots from the retained product should be removed and gently pour with clean water. Place the tissue in a clean container by adding a weak acidic solution.
  • Hold the container in the form of a window or lighting place.
  • Magnifying glass or microscope is used to examine.
  • Normal findings of tissues
    • Villi,
    • Gestational Sac,
    • Decidua,
    • Fetal fragments.
  • Abnormal findings on tissue examination.
    • Old blood clot, pus, foul smell indicates the signs of infection or sepsis
    • Grape- like clusters indicates the possibility of a molar pregnancy or hydatiform mole.
  • Repair cervical or genital laceration because cervical and genital laceration is the sources of bleeding
  • Managing of uterine perforation
    • Aspiration must be stopped immediately and appropriate steps that should be taken i.e
  • Start IV infusion.
  • Observation of bleeding and woman genital condition (vital signs, I/O chart, skin, consciousness) and laboratory test.
  • Referral and transfer.

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