MANAGEMENT OF POST PARTUM HEAMORRHAGE BY YOLAM KAMEME (MZIMBA SOUTH DISTRICT HOSPITAL) RONALD CHAGOMA (RUMPHI DISTRICT HOSPITAL) EMMANUEL NYIRENDA (NKHOTAKOTA DISTRICT HOSPITAL)

Objectives Learners should be able to 1.define post partum haemorrhage 2.Do aortic compression 3.Assemble necessary equipment for condom tamponade 4.Able to perform condom tamponade procedure

Introduction Postpartum Hemorrhage is bleeding of 500 mls and above from the genital tract after delivery of baby up to 6 weeks postpartum Cause 80% of maternal death world wide In Malawi it contribute to 10% of maternal deaths. Ref: Malawi reproductive health, Integrated maternal and neonatal health care manual, 2009.

Ct.. Postpartum haemorrhage can be controlled by simple and low cost techniques These techniques could be 1.Abdominal aortic compression 2.Condom tamponade These can be used after other measures like uterine massage and oxytocin have failed

Compression of the aorta The procedure involves compression of the abdominal aorta at the level of umbilicus, between the abdominal wall and the vertebral column while the other hand is feeling for the femoral pulse. It doesn’t require any equipment, just you and your two hands.

procedure 1.Locate the femoral artery in right groin 2.Compress the aorta at the level of the umbilicus with a closed fist 3.Confirm disappearance of the femoral artery pulse 4.Continue to apply pressure and continue to monitor femoral artery purse, bearing in mind that this does not solve the route cause and might go to the next stage.

Condom tamponade This is the procedure where you insert iv drip with a tubing into a sterile condom and tie it securely with a suture and inserted into a cervix of bleeding uterus.

Required equipment 1.Pair of sterile gloves 2.Sims SPECULAM 3.Male condom 4.Giving set 5.Scissors 6.Suture 7.Sponge holding Forceps

procedure 1.Put on sterile gloves 2.Prepare the iv drip set set, introduce the upper part into an iv bottle 3.Insert the tubing into the sterile condome, tie it securely with the suture 4.Locate the cervix and insert the condom and tubing through the cervix into the uterus 5.Open the drip and infuse the condom so that it expands against the bleeding wall of the uterus 6.Once stabilised, transport the patient to EMOC for observation and father treatment.

ct This procedure stops bleeding and prevents unnecessary deaths But it is done as a temporally measure.

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