An ever increasing number of couples worldwide are finding it difficult having children;it appears that more couples are becoming infertile or is it just a case of increasing awareness about an age old problem?;different authorities hold different views on this,however what is certain is that for those in whom having children appears near impossible,the frustration,heartache and despair constitute a daily nightmare from which they would dearly love to wake up.
Why in Europe and other more developed parts of the world,the option of adoption comes easily,in Africa and especially Nigeria,this is hardly thought of,as being able to bear one's own children is so highly priced that it ranks above all else in marriage.Speaking in the same context,most Nigerians are poor while the available options for medical mangement of infertility are quite expensive,thus restricting access to these treatment options to the rich few;so internal strife,unhappiness and utter despondency characterize most homes where infertility thrives.
Knowledge is power,this is a fact;infertility is not a woman's problem,it is everybody's problem since both men and women contribute to it and infact it seems as if men's contribution to infertility is rising even though the classic Nigerian man would never agree to being responsible for his wife's inability to conceive.
Since prevention is always better than cure,we should all be conscious of the factors involved in infertility causation and as much as possible avoid them or reduce them to a minimum,these factors would be the subject of my next post.
For questions and clarifications,send me a mail:doctorzini@yahoo.com or call 08067516613.
Sunday, July 18, 2010
Sunday, June 20, 2010
Saturday, June 19, 2010
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Online monetary issues
Online business:blogs,referrers,clicks,surveys etc;there are a thousand and one views on this subject,expressing different opinions on the same subject.However to be quite honest,it just does not ring true that these online financial inclined activities are as easy as some make it out to be,infact i know for a fact that it can be extremely frustrating and discouraging.
Your determination and resilience as well as your ability to learn and quickly too are vital factors in determining how far you go.
If you desire to have an online payment system which is free to create and operate,just click on the link above.
See you in my next post,your comments and suggestions are highly welcome.
Your determination and resilience as well as your ability to learn and quickly too are vital factors in determining how far you go.
If you desire to have an online payment system which is free to create and operate,just click on the link above.
See you in my next post,your comments and suggestions are highly welcome.
Wednesday, June 16, 2010
Monday, June 14, 2010
PROTOCOL FOR MANAGEMENT OF POST – PARTUM HAEMORRHAGE.
INTRODUCTION
Post – partum haemorrhage is one of the commonest causes of maternal deaths globally, consequently, securing the post - partum period has been recognized as the key to all efforts aimed at reducing the burden of maternal mortality especially in developing countries where inadequacy of skilled birth attendants at delivery and poor health status of women combine frequently to increase the risk of morbidity and mortality from delivery.
Definition
Traditionally, Post – partum haemorrhage (PPH) said to occur if a patient loses 500ml or more of blood from the birth canal after complete delivery of the baby.
If this occurs within 24Hours of delivery, it is termed primary PPH and if it occurs after 24Hours but within 6weeks of delivery, it is termed secondary Post – Partum haemorrhage (20 PPH)
However, any bleeding from the genital tract after delivery, that compromises the patient’s clinical state after delivery, is significant, irrespective of quantity. This is influenced by the patient’s clinical state before delivery. This rider to the definition of PPH (especially 10 PPH) is particularly important in patients with anaemia and sickle cell disease and those with contracted blood volume as in pre-eclampsia and dehydration.
Management of PPH
Post-partum haemorrhage is an important obstetric emergency and demands prompt diagnosis and treatment.
Estimation of blood loss
It is often difficult to accurately quantify blood loss at delivery. Most midwives / accoucheurs rely on their experiences to make estimates and under-estimation is often the rule than the exception. Practitioners should beware of this fact, and where there is doubt, rely more on the clinical features exhibited by each patient as useful indicators of the volume of blood loss as at the time of assessment.
STEPS IN THE MANAGEMENT OF PPH
Due to the emergency nature of post-partum haemorrhage and the fact that its cause is best determined by exclusion, it is useful to adopt a flow chart approach for its management.
This has the advantage of a step-ladder process that integrates investigation, treatment and monitoring of the patient, with minimal loss of time. And this is very crucial in the management of PPH.
VITAL STEPS / ACTIONS
Successful management of a patient with PPH stands on a tripod of 3 basic actions.
1. Identify patient with PPH.
2. Resuscitate patient.
3. Determine the cause of PPH and treat the cause.
Step 1
Identify patient with PPH by using the above defined criteria or the following clinical features
Profuse bleeding per vaginam
Pallor.
Rapid and thready pulse.
Low blood pressure.
Uterus may or may not be well contracted.
Step 2
Upon suspicion of excessive bleeding in a patient, in the third stage of labour, it is advocated that the uterine cornua be massaged in order to stimulate an efficient contraction.
Step 3
The urinary bladder should be emptied by voiding or catheterization.
Step 4
An intravenous access should be established quickly and administration of intravenous fluids commenced.
Step 5
Ergometrine 0.5mg should be given intravenously or same dose repeated if this has been given at delivery. This should be followed by intravenous administration of high concentration Oxytocin infution constituted by adding 40 international units of oxytocin to 500ml of normal saline. This should be given, preferably, through a second intravenous access secured with a wide bore I.V. cannula or connected via a Y- connection to the first I.V. line.
Step 6
Further bleeding will necessitate a blood cross-match, verification of the patient’s clotting profile and commencement of blood transfusion when blood is available.
Step 7
At this stage, if the placenta has not been delivered, controlled cord traction should be performing to do so, failing which a manual removal should be instituted under general anaesthesia. Accumulated evidence now suggests that injection of 0.9% saline solution plus oxytocin into the umbilical vein of a retained placenta is a more effective, safer and simpler means of treatment than the manual removal.
Step 8
Where the placenta has been previously delivered, it should be carefully inspected for completeness. In the event on an uncertainty of the completeness of the placenta, an ultrasound scan may be perform to detect residual placenta tissue, which will necessitate a uterine evacuation.
Step 9
Persistence of bleeding will require the attention of an obstetrician who is expected to examine for and repair any genital tract laceration.
Step 10
The persistence of bleeding at this stage should be managed with a bimanual compression of the uterus while oxygen is administered and prosuidandin F2α is injected into the uterine fundus.
Step 11
The suspicion of rupture of the uterus will indicate a laparotomy.
Step 12
The clotting profile should he repeated at this stage, in the absence of a coagulopathy a laparotomy should he performed, at which ligation of the ascending branches of the uterine arteries or the hypogustric artery or a hysterectomy may he performed.
Step 13
If disseminated intravascular coagulation is confirmed, a haematologist will have to be involved and the transfusion of fresh frozen plasma or cryoprecipitate and fibrinogen should be given.
Flow Chart For The Management Of Post – Partum Haemorrhage.
PPH
• Intravenous Access / fluid / oxytocics
• Cross match blood / clotting profile
• Head low position
• Oxygen by mask
• Crystalloids / Colloids
• Blood Transfusion
Uterus not well contracted Uterus well contracted
Uterus Atony Retained Placenta Examine placenta
More oxytocics C.C.T. / Manual Removal Complete Incomplete/uncertain
Examine for Genital tract trauma USS
Absent Present ERPC
Repeat clotting profile, USS Repair
Coagulation failure Normal coagulation
Fresh frozen plasma or cryoprecipitate Suspect uterine Rupture
Laparotomy
Atony Rupture
Intramyometrial Ligation of ascending BIIAL B-lynch Hysterectomy Repair
Oxytocics, PGF2 Uterine Artery suture
Prevention of Primary Post-Partum haemorrhage
The adage, prevention is better than cure, finds ready application in post-partum haemorrhage. The institution of preventive measures on patients who are prone to developing this disorder has been one of the major achievements of modern midwifery. It draws its strength from patient’s attendance to prenatal care where risks of post-partum haemorrhage are from the past and present obstetric history and the characteristics of the current pregnancy. These considerations include high parity, previous haemorrhage, existing anaemia, multiple gestation, polyhydramnios, and placenta praevia.
The At Risk Group
The prevention process starts with risk identification and proceeds to patient counseling, blood group determination, correction of anaemia before on set of labour, and patient’s assessment at 36 weeks of gestation to determine the best mode of delivery. The process continues in labour with its supervision being made by a skilled attendant (doctor, midwife or muse), early presentation in labour, request for a blood cross-match, and an intravenous infusion in the first stage of labour. An adherence 10 partographic ideal in the care of the first stage of labour serves to prevent prolonged labour, a predisposing factor to post-partum haemorrhage. The use of episiolomy or resort to instrumental delivery should be only when indicated.
Prophylactic Management of Post-Partum Haemorrhage
Recent analysis of accumulated evidences suggests that active management of third stage of labour is superior to “expectant management” in terms of blood loss, post-partum haemorrhage and other serious complications of the third stage and is recommended for use for all women expecting to deliver in a maternity hospital. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, curly cord clamping and controlled cord traction of the umbilical cord. Syntometrine (combination of syntocinon and Ergometrine) is the most preferred oxytocic for this purpose because it has been shown to be associated with reduced risk of post-partum haemorrhage when compared to oxytocin use alone. Syntometrine is also associated with side effect of vomiting and hypertension, which accompany Ergometrine use. Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. A thorough inspection of the placenta and membranes usually held under running water, SS very valuable for the earliest diagnosis of retained placenta! tissue. Prompt and skillful repair if episiotomies are always protective against post-partum haemorrhage. The strict observance of maternal rest in the fourth stage of labour, coupled with close monitoring of her vital signs and sanitary pad count during the period is reassuring and proraotive of early detection of a haemorrhage. Another preventive measure against post-partum i haemorrhage is the continuation of syntocinon infusion throughout the fourth static of labour.
Post – partum haemorrhage is one of the commonest causes of maternal deaths globally, consequently, securing the post - partum period has been recognized as the key to all efforts aimed at reducing the burden of maternal mortality especially in developing countries where inadequacy of skilled birth attendants at delivery and poor health status of women combine frequently to increase the risk of morbidity and mortality from delivery.
Definition
Traditionally, Post – partum haemorrhage (PPH) said to occur if a patient loses 500ml or more of blood from the birth canal after complete delivery of the baby.
If this occurs within 24Hours of delivery, it is termed primary PPH and if it occurs after 24Hours but within 6weeks of delivery, it is termed secondary Post – Partum haemorrhage (20 PPH)
However, any bleeding from the genital tract after delivery, that compromises the patient’s clinical state after delivery, is significant, irrespective of quantity. This is influenced by the patient’s clinical state before delivery. This rider to the definition of PPH (especially 10 PPH) is particularly important in patients with anaemia and sickle cell disease and those with contracted blood volume as in pre-eclampsia and dehydration.
Management of PPH
Post-partum haemorrhage is an important obstetric emergency and demands prompt diagnosis and treatment.
Estimation of blood loss
It is often difficult to accurately quantify blood loss at delivery. Most midwives / accoucheurs rely on their experiences to make estimates and under-estimation is often the rule than the exception. Practitioners should beware of this fact, and where there is doubt, rely more on the clinical features exhibited by each patient as useful indicators of the volume of blood loss as at the time of assessment.
STEPS IN THE MANAGEMENT OF PPH
Due to the emergency nature of post-partum haemorrhage and the fact that its cause is best determined by exclusion, it is useful to adopt a flow chart approach for its management.
This has the advantage of a step-ladder process that integrates investigation, treatment and monitoring of the patient, with minimal loss of time. And this is very crucial in the management of PPH.
VITAL STEPS / ACTIONS
Successful management of a patient with PPH stands on a tripod of 3 basic actions.
1. Identify patient with PPH.
2. Resuscitate patient.
3. Determine the cause of PPH and treat the cause.
Step 1
Identify patient with PPH by using the above defined criteria or the following clinical features
Profuse bleeding per vaginam
Pallor.
Rapid and thready pulse.
Low blood pressure.
Uterus may or may not be well contracted.
Step 2
Upon suspicion of excessive bleeding in a patient, in the third stage of labour, it is advocated that the uterine cornua be massaged in order to stimulate an efficient contraction.
Step 3
The urinary bladder should be emptied by voiding or catheterization.
Step 4
An intravenous access should be established quickly and administration of intravenous fluids commenced.
Step 5
Ergometrine 0.5mg should be given intravenously or same dose repeated if this has been given at delivery. This should be followed by intravenous administration of high concentration Oxytocin infution constituted by adding 40 international units of oxytocin to 500ml of normal saline. This should be given, preferably, through a second intravenous access secured with a wide bore I.V. cannula or connected via a Y- connection to the first I.V. line.
Step 6
Further bleeding will necessitate a blood cross-match, verification of the patient’s clotting profile and commencement of blood transfusion when blood is available.
Step 7
At this stage, if the placenta has not been delivered, controlled cord traction should be performing to do so, failing which a manual removal should be instituted under general anaesthesia. Accumulated evidence now suggests that injection of 0.9% saline solution plus oxytocin into the umbilical vein of a retained placenta is a more effective, safer and simpler means of treatment than the manual removal.
Step 8
Where the placenta has been previously delivered, it should be carefully inspected for completeness. In the event on an uncertainty of the completeness of the placenta, an ultrasound scan may be perform to detect residual placenta tissue, which will necessitate a uterine evacuation.
Step 9
Persistence of bleeding will require the attention of an obstetrician who is expected to examine for and repair any genital tract laceration.
Step 10
The persistence of bleeding at this stage should be managed with a bimanual compression of the uterus while oxygen is administered and prosuidandin F2α is injected into the uterine fundus.
Step 11
The suspicion of rupture of the uterus will indicate a laparotomy.
Step 12
The clotting profile should he repeated at this stage, in the absence of a coagulopathy a laparotomy should he performed, at which ligation of the ascending branches of the uterine arteries or the hypogustric artery or a hysterectomy may he performed.
Step 13
If disseminated intravascular coagulation is confirmed, a haematologist will have to be involved and the transfusion of fresh frozen plasma or cryoprecipitate and fibrinogen should be given.
Flow Chart For The Management Of Post – Partum Haemorrhage.
PPH
• Intravenous Access / fluid / oxytocics
• Cross match blood / clotting profile
• Head low position
• Oxygen by mask
• Crystalloids / Colloids
• Blood Transfusion
Uterus not well contracted Uterus well contracted
Uterus Atony Retained Placenta Examine placenta
More oxytocics C.C.T. / Manual Removal Complete Incomplete/uncertain
Examine for Genital tract trauma USS
Absent Present ERPC
Repeat clotting profile, USS Repair
Coagulation failure Normal coagulation
Fresh frozen plasma or cryoprecipitate Suspect uterine Rupture
Laparotomy
Atony Rupture
Intramyometrial Ligation of ascending BIIAL B-lynch Hysterectomy Repair
Oxytocics, PGF2 Uterine Artery suture
Prevention of Primary Post-Partum haemorrhage
The adage, prevention is better than cure, finds ready application in post-partum haemorrhage. The institution of preventive measures on patients who are prone to developing this disorder has been one of the major achievements of modern midwifery. It draws its strength from patient’s attendance to prenatal care where risks of post-partum haemorrhage are from the past and present obstetric history and the characteristics of the current pregnancy. These considerations include high parity, previous haemorrhage, existing anaemia, multiple gestation, polyhydramnios, and placenta praevia.
The At Risk Group
The prevention process starts with risk identification and proceeds to patient counseling, blood group determination, correction of anaemia before on set of labour, and patient’s assessment at 36 weeks of gestation to determine the best mode of delivery. The process continues in labour with its supervision being made by a skilled attendant (doctor, midwife or muse), early presentation in labour, request for a blood cross-match, and an intravenous infusion in the first stage of labour. An adherence 10 partographic ideal in the care of the first stage of labour serves to prevent prolonged labour, a predisposing factor to post-partum haemorrhage. The use of episiolomy or resort to instrumental delivery should be only when indicated.
Prophylactic Management of Post-Partum Haemorrhage
Recent analysis of accumulated evidences suggests that active management of third stage of labour is superior to “expectant management” in terms of blood loss, post-partum haemorrhage and other serious complications of the third stage and is recommended for use for all women expecting to deliver in a maternity hospital. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, curly cord clamping and controlled cord traction of the umbilical cord. Syntometrine (combination of syntocinon and Ergometrine) is the most preferred oxytocic for this purpose because it has been shown to be associated with reduced risk of post-partum haemorrhage when compared to oxytocin use alone. Syntometrine is also associated with side effect of vomiting and hypertension, which accompany Ergometrine use. Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. A thorough inspection of the placenta and membranes usually held under running water, SS very valuable for the earliest diagnosis of retained placenta! tissue. Prompt and skillful repair if episiotomies are always protective against post-partum haemorrhage. The strict observance of maternal rest in the fourth stage of labour, coupled with close monitoring of her vital signs and sanitary pad count during the period is reassuring and proraotive of early detection of a haemorrhage. Another preventive measure against post-partum i haemorrhage is the continuation of syntocinon infusion throughout the fourth static of labour.
PROTOCOL FOR MANAGEMENT OF POST – PARTUM HAEMORRHAGE.
INTRODUCTION
Post – partum haemorrhage is one of the commonest causes of maternal deaths globally, consequently, securing the post - partum period has been recognized as the key to all efforts aimed at reducing the burden of maternal mortality especially in developing countries where inadequacy of skilled birth attendants at delivery and poor health status of women combine frequently to increase the risk of morbidity and mortality from delivery.
Definition
Traditionally, Post – partum haemorrhage (PPH) said to occur if a patient loses 500ml or more of blood from the birth canal after complete delivery of the baby.
If this occurs within 24Hours of delivery, it is termed primary PPH and if it occurs after 24Hours but within 6weeks of delivery, it is termed secondary Post – Partum haemorrhage (20 PPH)
However, any bleeding from the genital tract after delivery, that compromises the patient’s clinical state after delivery, is significant, irrespective of quantity. This is influenced by the patient’s clinical state before delivery. This rider to the definition of PPH (especially 10 PPH) is particularly important in patients with anaemia and sickle cell disease and those with contracted blood volume as in pre-eclampsia and dehydration.
Management of PPH
Post-partum haemorrhage is an important obstetric emergency and demands prompt diagnosis and treatment.
Estimation of blood loss
It is often difficult to accurately quantify blood loss at delivery. Most midwives / accoucheurs rely on their experiences to make estimates and under-estimation is often the rule than the exception. Practitioners should beware of this fact, and where there is doubt, rely more on the clinical features exhibited by each patient as useful indicators of the volume of blood loss as at the time of assessment.
STEPS IN THE MANAGEMENT OF PPH
Due to the emergency nature of post-partum haemorrhage and the fact that its cause is best determined by exclusion, it is useful to adopt a flow chart approach for its management.
This has the advantage of a step-ladder process that integrates investigation, treatment and monitoring of the patient, with minimal loss of time. And this is very crucial in the management of PPH.
VITAL STEPS / ACTIONS
Successful management of a patient with PPH stands on a tripod of 3 basic actions.
1. Identify patient with PPH.
2. Resuscitate patient.
3. Determine the cause of PPH and treat the cause.
Step 1
Identify patient with PPH by using the above defined criteria or the following clinical features
Profuse bleeding per vaginam
Pallor.
Rapid and thready pulse.
Low blood pressure.
Uterus may or may not be well contracted.
Step 2
Upon suspicion of excessive bleeding in a patient, in the third stage of labour, it is advocated that the uterine cornua be massaged in order to stimulate an efficient contraction.
Step 3
The urinary bladder should be emptied by voiding or catheterization.
Step 4
An intravenous access should be established quickly and administration of intravenous fluids commenced.
Step 5
Ergometrine 0.5mg should be given intravenously or same dose repeated if this has been given at delivery. This should be followed by intravenous administration of high concentration Oxytocin infution constituted by adding 40 international units of oxytocin to 500ml of normal saline. This should be given, preferably, through a second intravenous access secured with a wide bore I.V. cannula or connected via a Y- connection to the first I.V. line.
Step 6
Further bleeding will necessitate a blood cross-match, verification of the patient’s clotting profile and commencement of blood transfusion when blood is available.
Step 7
At this stage, if the placenta has not been delivered, controlled cord traction should be performing to do so, failing which a manual removal should be instituted under general anaesthesia. Accumulated evidence now suggests that injection of 0.9% saline solution plus oxytocin into the umbilical vein of a retained placenta is a more effective, safer and simpler means of treatment than the manual removal.
Step 8
Where the placenta has been previously delivered, it should be carefully inspected for completeness. In the event on an uncertainty of the completeness of the placenta, an ultrasound scan may be perform to detect residual placenta tissue, which will necessitate a uterine evacuation.
Step 9
Persistence of bleeding will require the attention of an obstetrician who is expected to examine for and repair any genital tract laceration.
Step 10
The persistence of bleeding at this stage should be managed with a bimanual compression of the uterus while oxygen is administered and prosuidandin F2α is injected into the uterine fundus.
Step 11
The suspicion of rupture of the uterus will indicate a laparotomy.
Step 12
The clotting profile should he repeated at this stage, in the absence of a coagulopathy a laparotomy should he performed, at which ligation of the ascending branches of the uterine arteries or the hypogustric artery or a hysterectomy may he performed.
Step 13
If disseminated intravascular coagulation is confirmed, a haematologist will have to be involved and the transfusion of fresh frozen plasma or cryoprecipitate and fibrinogen should be given.
Flow Chart For The Management Of Post – Partum Haemorrhage.
PPH
• Intravenous Access / fluid / oxytocics
• Cross match blood / clotting profile
• Head low position
• Oxygen by mask
• Crystalloids / Colloids
• Blood Transfusion
Uterus not well contracted Uterus well contracted
Uterus Atony Retained Placenta Examine placenta
More oxytocics C.C.T. / Manual Removal Complete Incomplete/uncertain
Examine for Genital tract trauma USS
Absent Present ERPC
Repeat clotting profile, USS Repair
Coagulation failure Normal coagulation
Fresh frozen plasma or cryoprecipitate Suspect uterine Rupture
Laparotomy
Atony Rupture
Intramyometrial Ligation of ascending BIIAL B-lynch Hysterectomy Repair
Oxytocics, PGF2 Uterine Artery suture
Prevention of Primary Post-Partum haemorrhage
The adage, prevention is better than cure, finds ready application in post-partum haemorrhage. The institution of preventive measures on patients who are prone to developing this disorder has been one of the major achievements of modern midwifery. It draws its strength from patient’s attendance to prenatal care where risks of post-partum haemorrhage are from the past and present obstetric history and the characteristics of the current pregnancy. These considerations include high parity, previous haemorrhage, existing anaemia, multiple gestation, polyhydramnios, and placenta praevia.
The At Risk Group
The prevention process starts with risk identification and proceeds to patient counseling, blood group determination, correction of anaemia before on set of labour, and patient’s assessment at 36 weeks of gestation to determine the best mode of delivery. The process continues in labour with its supervision being made by a skilled attendant (doctor, midwife or muse), early presentation in labour, request for a blood cross-match, and an intravenous infusion in the first stage of labour. An adherence 10 partographic ideal in the care of the first stage of labour serves to prevent prolonged labour, a predisposing factor to post-partum haemorrhage. The use of episiolomy or resort to instrumental delivery should be only when indicated.
Prophylactic Management of Post-Partum Haemorrhage
Recent analysis of accumulated evidences suggests that active management of third stage of labour is superior to “expectant management” in terms of blood loss, post-partum haemorrhage and other serious complications of the third stage and is recommended for use for all women expecting to deliver in a maternity hospital. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, curly cord clamping and controlled cord traction of the umbilical cord. Syntometrine (combination of syntocinon and Ergometrine) is the most preferred oxytocic for this purpose because it has been shown to be associated with reduced risk of post-partum haemorrhage when compared to oxytocin use alone. Syntometrine is also associated with side effect of vomiting and hypertension, which accompany Ergometrine use. Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. A thorough inspection of the placenta and membranes usually held under running water, SS very valuable for the earliest diagnosis of retained placenta! tissue. Prompt and skillful repair if episiotomies are always protective against post-partum haemorrhage. The strict observance of maternal rest in the fourth stage of labour, coupled with close monitoring of her vital signs and sanitary pad count during the period is reassuring and proraotive of early detection of a haemorrhage. Another preventive measure against post-partum i haemorrhage is the continuation of syntocinon infusion throughout the fourth static of labour.
Post – partum haemorrhage is one of the commonest causes of maternal deaths globally, consequently, securing the post - partum period has been recognized as the key to all efforts aimed at reducing the burden of maternal mortality especially in developing countries where inadequacy of skilled birth attendants at delivery and poor health status of women combine frequently to increase the risk of morbidity and mortality from delivery.
Definition
Traditionally, Post – partum haemorrhage (PPH) said to occur if a patient loses 500ml or more of blood from the birth canal after complete delivery of the baby.
If this occurs within 24Hours of delivery, it is termed primary PPH and if it occurs after 24Hours but within 6weeks of delivery, it is termed secondary Post – Partum haemorrhage (20 PPH)
However, any bleeding from the genital tract after delivery, that compromises the patient’s clinical state after delivery, is significant, irrespective of quantity. This is influenced by the patient’s clinical state before delivery. This rider to the definition of PPH (especially 10 PPH) is particularly important in patients with anaemia and sickle cell disease and those with contracted blood volume as in pre-eclampsia and dehydration.
Management of PPH
Post-partum haemorrhage is an important obstetric emergency and demands prompt diagnosis and treatment.
Estimation of blood loss
It is often difficult to accurately quantify blood loss at delivery. Most midwives / accoucheurs rely on their experiences to make estimates and under-estimation is often the rule than the exception. Practitioners should beware of this fact, and where there is doubt, rely more on the clinical features exhibited by each patient as useful indicators of the volume of blood loss as at the time of assessment.
STEPS IN THE MANAGEMENT OF PPH
Due to the emergency nature of post-partum haemorrhage and the fact that its cause is best determined by exclusion, it is useful to adopt a flow chart approach for its management.
This has the advantage of a step-ladder process that integrates investigation, treatment and monitoring of the patient, with minimal loss of time. And this is very crucial in the management of PPH.
VITAL STEPS / ACTIONS
Successful management of a patient with PPH stands on a tripod of 3 basic actions.
1. Identify patient with PPH.
2. Resuscitate patient.
3. Determine the cause of PPH and treat the cause.
Step 1
Identify patient with PPH by using the above defined criteria or the following clinical features
Profuse bleeding per vaginam
Pallor.
Rapid and thready pulse.
Low blood pressure.
Uterus may or may not be well contracted.
Step 2
Upon suspicion of excessive bleeding in a patient, in the third stage of labour, it is advocated that the uterine cornua be massaged in order to stimulate an efficient contraction.
Step 3
The urinary bladder should be emptied by voiding or catheterization.
Step 4
An intravenous access should be established quickly and administration of intravenous fluids commenced.
Step 5
Ergometrine 0.5mg should be given intravenously or same dose repeated if this has been given at delivery. This should be followed by intravenous administration of high concentration Oxytocin infution constituted by adding 40 international units of oxytocin to 500ml of normal saline. This should be given, preferably, through a second intravenous access secured with a wide bore I.V. cannula or connected via a Y- connection to the first I.V. line.
Step 6
Further bleeding will necessitate a blood cross-match, verification of the patient’s clotting profile and commencement of blood transfusion when blood is available.
Step 7
At this stage, if the placenta has not been delivered, controlled cord traction should be performing to do so, failing which a manual removal should be instituted under general anaesthesia. Accumulated evidence now suggests that injection of 0.9% saline solution plus oxytocin into the umbilical vein of a retained placenta is a more effective, safer and simpler means of treatment than the manual removal.
Step 8
Where the placenta has been previously delivered, it should be carefully inspected for completeness. In the event on an uncertainty of the completeness of the placenta, an ultrasound scan may be perform to detect residual placenta tissue, which will necessitate a uterine evacuation.
Step 9
Persistence of bleeding will require the attention of an obstetrician who is expected to examine for and repair any genital tract laceration.
Step 10
The persistence of bleeding at this stage should be managed with a bimanual compression of the uterus while oxygen is administered and prosuidandin F2α is injected into the uterine fundus.
Step 11
The suspicion of rupture of the uterus will indicate a laparotomy.
Step 12
The clotting profile should he repeated at this stage, in the absence of a coagulopathy a laparotomy should he performed, at which ligation of the ascending branches of the uterine arteries or the hypogustric artery or a hysterectomy may he performed.
Step 13
If disseminated intravascular coagulation is confirmed, a haematologist will have to be involved and the transfusion of fresh frozen plasma or cryoprecipitate and fibrinogen should be given.
Flow Chart For The Management Of Post – Partum Haemorrhage.
PPH
• Intravenous Access / fluid / oxytocics
• Cross match blood / clotting profile
• Head low position
• Oxygen by mask
• Crystalloids / Colloids
• Blood Transfusion
Uterus not well contracted Uterus well contracted
Uterus Atony Retained Placenta Examine placenta
More oxytocics C.C.T. / Manual Removal Complete Incomplete/uncertain
Examine for Genital tract trauma USS
Absent Present ERPC
Repeat clotting profile, USS Repair
Coagulation failure Normal coagulation
Fresh frozen plasma or cryoprecipitate Suspect uterine Rupture
Laparotomy
Atony Rupture
Intramyometrial Ligation of ascending BIIAL B-lynch Hysterectomy Repair
Oxytocics, PGF2 Uterine Artery suture
Prevention of Primary Post-Partum haemorrhage
The adage, prevention is better than cure, finds ready application in post-partum haemorrhage. The institution of preventive measures on patients who are prone to developing this disorder has been one of the major achievements of modern midwifery. It draws its strength from patient’s attendance to prenatal care where risks of post-partum haemorrhage are from the past and present obstetric history and the characteristics of the current pregnancy. These considerations include high parity, previous haemorrhage, existing anaemia, multiple gestation, polyhydramnios, and placenta praevia.
The At Risk Group
The prevention process starts with risk identification and proceeds to patient counseling, blood group determination, correction of anaemia before on set of labour, and patient’s assessment at 36 weeks of gestation to determine the best mode of delivery. The process continues in labour with its supervision being made by a skilled attendant (doctor, midwife or muse), early presentation in labour, request for a blood cross-match, and an intravenous infusion in the first stage of labour. An adherence 10 partographic ideal in the care of the first stage of labour serves to prevent prolonged labour, a predisposing factor to post-partum haemorrhage. The use of episiolomy or resort to instrumental delivery should be only when indicated.
Prophylactic Management of Post-Partum Haemorrhage
Recent analysis of accumulated evidences suggests that active management of third stage of labour is superior to “expectant management” in terms of blood loss, post-partum haemorrhage and other serious complications of the third stage and is recommended for use for all women expecting to deliver in a maternity hospital. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, curly cord clamping and controlled cord traction of the umbilical cord. Syntometrine (combination of syntocinon and Ergometrine) is the most preferred oxytocic for this purpose because it has been shown to be associated with reduced risk of post-partum haemorrhage when compared to oxytocin use alone. Syntometrine is also associated with side effect of vomiting and hypertension, which accompany Ergometrine use. Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. A thorough inspection of the placenta and membranes usually held under running water, SS very valuable for the earliest diagnosis of retained placenta! tissue. Prompt and skillful repair if episiotomies are always protective against post-partum haemorrhage. The strict observance of maternal rest in the fourth stage of labour, coupled with close monitoring of her vital signs and sanitary pad count during the period is reassuring and proraotive of early detection of a haemorrhage. Another preventive measure against post-partum i haemorrhage is the continuation of syntocinon infusion throughout the fourth static of labour.
Multiple pregnancy management protocol
Introduction:
The presence of two or more foetuses co-existing in a pregnant uterus.The commonest variety is twin pregnancy;triplets,quadruplets and higher order multiple pregnancies are rare.
The incidence of multiple pregnancies has increased recently;maternal and perinatal morbidity and mortality rates are higher than for singleton pregnancies
A. Problems
Maternal
1. Exaggerated early morning sickness
2. Miscarriages
3. Anaemia
4. Preterm labour
5. APH
6. UTI
7. Pregnancy induced hypertension
8. Previous PPH
Foetal
1. High still birth rate
2. chromosomal anomalies
3. prematurity
4. hypoxia
5. trauma
6. Cord accidents
7. urogenital anomalies
8. Abnormal lie&presentation
DIAGNOSIS
Early diagnosis to prevent complication
Clinical diagnosis possible in about 75% of cases
High index of suspicion[our environment where high twin rates occur]
Diagnostic indices:
1. Uterus larger than date by 4wks[4cm]
2. Excessive maternal weight gain
3. Exaggerated pregnancy symptoms/signs[threatened abortion,APH,DIC if one foetus dies,pre-eclampsia/eclampsia,excessive anaemia,glycosuria,OGTT anomalies]
4. Polyhydramnios
5. Family history of twinning
6. History of assisted reproduction
7. Elevated MSAFP
8. Ballotment of more than one foetus
9. Multiple small parts
10. Recording of different heart rates simultaneously using electronic foetal monitoring that are asynchronous with maternal pulse with each varying about 8beats/minute
11. Palpation of one or more foetuses in the fundus after delivery of one infant
Ultrasound diagnosis is preferred and highly accurate from early pregnancy,monitor growth of foetuses,detect anomalies
The incidence of undiagnosed twins before labour with ultrasound is less than 10% in developed countries
Differential diagnosis
1. Inaccurate date
2. Polyhydramnios from single pregnancy
3. Molar pregnancy
4. Fibroid,ovarian tumour
5. Distended bladder or full rectum
6. Complicated twins-conjoined twins
Reducing complications of multiple pregnancy
1. Early diagnosis
2. Enhanced antenatal care:iron,folic acid,vitamin supplements,high protein diet[no evidence for routine hospitalization,no evidence for prophylactic cerclage improving outcome]
3. Frequent follow-up visits-sonographic measurement of cervical length with emergency cerclage offered by 24wks if short cervix or funnel shaped membranes noted
4. Early and prompt treatment of vaginal infections,pre-eclampsia and eclamsia
5. Tocolytic drugs for 48hrs to allow for steroid effect to be realised.Terbutaline[maternal hypotension];indomethacine contraindicated after 32wks due to premature closure of the ductus arteriosus
6. APH:delay delivery till at least 34wks as much as possible
LABOUR AND DELIVERY
Prerequisite :
adequate assistance:personnel[paediatricians,senior obstetric resident,midwives,anaesthesiologist]
On admission:
Evaluation to include:
physical exam-mother’s CVS,Respiratory
obstetric:presentation of each foetus especially the leading twin.Sonographic aid desirable for this and estimate of foetal weight
routine,continuous electronic foetal monitoring
IV line is mandatory
Induction of labour is controversial[decision by consultant]
Hb,group and crossmatch 2pints of blood
Indication for C/S
1. Foetal compromise,locked twins,cord prolapsed
2. Placenta praevia
3. Triplets and higher order
4. Previous C/S
5. Other complications of pregnancy e.g. pre-eclampsia,DM etc
Categories of twin delivery
Twin 1 VxA-VxB:vaginal birth,exception if any other complication
Twin-VxA-non VxB:vaginal birth of first twin+external version of second twin.If this fails,then C/S
Twin-non vertexA-TwinB:primary C/S
Prompt clamping of cord at delivery of first twin to prevent ex-sanguination of second twin
After delivery of first twin,
-conduct a vaginal examination to note presentation of second twin,presence of second sac and absence or presence of cord presentation or prolapse
-do external version to convert breech to vertex and guide same into pelvic inlet
-rupture membrane of second sac if no cord presentation
-Time of delivery between twin A and B for optimum foetal wellbeing remains controversial[30minutes used to be suggested]
Augment labour if return of contraction is delayed beyond 10minutes of delivery of first twin
-Locked twins:twin A is breech and twin B vertex;both heads impacted in the pelvis
-liberal use of oxytocics for 2hrs after delivery of second twin and placentae,fundal massage to prevent PPH
-Neonatologist care of infant especially if low birth weight baby,preterm delivery etc.
Examine placenta(e) for zygosity
The presence of two or more foetuses co-existing in a pregnant uterus.The commonest variety is twin pregnancy;triplets,quadruplets and higher order multiple pregnancies are rare.
The incidence of multiple pregnancies has increased recently;maternal and perinatal morbidity and mortality rates are higher than for singleton pregnancies
A. Problems
Maternal
1. Exaggerated early morning sickness
2. Miscarriages
3. Anaemia
4. Preterm labour
5. APH
6. UTI
7. Pregnancy induced hypertension
8. Previous PPH
Foetal
1. High still birth rate
2. chromosomal anomalies
3. prematurity
4. hypoxia
5. trauma
6. Cord accidents
7. urogenital anomalies
8. Abnormal lie&presentation
DIAGNOSIS
Early diagnosis to prevent complication
Clinical diagnosis possible in about 75% of cases
High index of suspicion[our environment where high twin rates occur]
Diagnostic indices:
1. Uterus larger than date by 4wks[4cm]
2. Excessive maternal weight gain
3. Exaggerated pregnancy symptoms/signs[threatened abortion,APH,DIC if one foetus dies,pre-eclampsia/eclampsia,excessive anaemia,glycosuria,OGTT anomalies]
4. Polyhydramnios
5. Family history of twinning
6. History of assisted reproduction
7. Elevated MSAFP
8. Ballotment of more than one foetus
9. Multiple small parts
10. Recording of different heart rates simultaneously using electronic foetal monitoring that are asynchronous with maternal pulse with each varying about 8beats/minute
11. Palpation of one or more foetuses in the fundus after delivery of one infant
Ultrasound diagnosis is preferred and highly accurate from early pregnancy,monitor growth of foetuses,detect anomalies
The incidence of undiagnosed twins before labour with ultrasound is less than 10% in developed countries
Differential diagnosis
1. Inaccurate date
2. Polyhydramnios from single pregnancy
3. Molar pregnancy
4. Fibroid,ovarian tumour
5. Distended bladder or full rectum
6. Complicated twins-conjoined twins
Reducing complications of multiple pregnancy
1. Early diagnosis
2. Enhanced antenatal care:iron,folic acid,vitamin supplements,high protein diet[no evidence for routine hospitalization,no evidence for prophylactic cerclage improving outcome]
3. Frequent follow-up visits-sonographic measurement of cervical length with emergency cerclage offered by 24wks if short cervix or funnel shaped membranes noted
4. Early and prompt treatment of vaginal infections,pre-eclampsia and eclamsia
5. Tocolytic drugs for 48hrs to allow for steroid effect to be realised.Terbutaline[maternal hypotension];indomethacine contraindicated after 32wks due to premature closure of the ductus arteriosus
6. APH:delay delivery till at least 34wks as much as possible
LABOUR AND DELIVERY
Prerequisite :
adequate assistance:personnel[paediatricians,senior obstetric resident,midwives,anaesthesiologist]
On admission:
Evaluation to include:
physical exam-mother’s CVS,Respiratory
obstetric:presentation of each foetus especially the leading twin.Sonographic aid desirable for this and estimate of foetal weight
routine,continuous electronic foetal monitoring
IV line is mandatory
Induction of labour is controversial[decision by consultant]
Hb,group and crossmatch 2pints of blood
Indication for C/S
1. Foetal compromise,locked twins,cord prolapsed
2. Placenta praevia
3. Triplets and higher order
4. Previous C/S
5. Other complications of pregnancy e.g. pre-eclampsia,DM etc
Categories of twin delivery
Twin 1 VxA-VxB:vaginal birth,exception if any other complication
Twin-VxA-non VxB:vaginal birth of first twin+external version of second twin.If this fails,then C/S
Twin-non vertexA-TwinB:primary C/S
Prompt clamping of cord at delivery of first twin to prevent ex-sanguination of second twin
After delivery of first twin,
-conduct a vaginal examination to note presentation of second twin,presence of second sac and absence or presence of cord presentation or prolapse
-do external version to convert breech to vertex and guide same into pelvic inlet
-rupture membrane of second sac if no cord presentation
-Time of delivery between twin A and B for optimum foetal wellbeing remains controversial[30minutes used to be suggested]
Augment labour if return of contraction is delayed beyond 10minutes of delivery of first twin
-Locked twins:twin A is breech and twin B vertex;both heads impacted in the pelvis
-liberal use of oxytocics for 2hrs after delivery of second twin and placentae,fundal massage to prevent PPH
-Neonatologist care of infant especially if low birth weight baby,preterm delivery etc.
Examine placenta(e) for zygosity
Protocol for Management of preterm labour
Introduction
The onset of spontaneous labour between 28 and 37weeks of pregnancy.It occurs in between 7-12% of pregnancies but more frequently between 28-34weeks.
The condition is significant because of its contribution to high perinatal morbidity and mortality being second only to congenital foetal abnormalities,the maternal morbidity and the increased costs of taking care of the preterm neonates in intensive neonatal units.
Diagnosis:
Presence of two or more of:
1. Regular uterine contractions of more than 2 in 10minutes by palpation or tocometer
2. Effacement and dilatation of cervix-atleast 2cm dilatation and reasonable degree of effacement
3. Passage of bloody mucus vaginal discharge
Assessment:
I. Accurate assessment of gestational age[LMP,previous scan date]
II. Foetal weight&heart rate estimation by ultrasound if feasible
III. Foetal presentation[to exclude abnormal lie&position]
IV. General maternal condition:-palor,Bp,heart,chest etc
V. Laboratory :
-FBC,differential;MP
-Urine-mcs,urinalysis
-Scan-foetal lie,position,presentation,placenta location,cervical length
-Speculum vaginal examination-bacterial culture&to exclude cord prolapse if foetal membranes have ruptured,and by sighting determine effacement and cervical os dilatation;also to obtain cervical mucus swab for fibronectin assay.
Avoid digital vaginal examination unless immediate delivery is inevitable.
Haematologic work-up for haemorrhaging cases.
Treatment of symptomatic preterm labour in singleton pregnancy:
i. Admit for bed rest
ii. Site IV line
iii. Treat for malaria
Further treatment depends on:
a. Estimated gestational age
b. Foetal weight
c. +/- other complications e.g. PPROM
Two options available:
A. Expectant(observation)
B. Intervention-immediate delivery
A. Expectant treatment
Usually for gestational ages 28-34wks and uncomplicated preterm labours.
Consideration is given to:
i. Bed rest,hydration
ii. corticosteroids mandatory
-betamethasone 12mg IM every 24hours X 2doses[drug of choice]
-dexamethasone 6mg 12hrly X 4doses
Multiple administration of steroids after the initial 48hrs is unnecessary and may even be harmful
iii. Tocolytics:suppress uterine contractions if bed rest and infusions fail to do so;aim is to suppress uterine contractions for 48hrs to allow steroid administration only.
Choice of tocolytic depends on availability,affordability,adverse effects.
Objective of tocolysis-to gain some time to enable corticosteroids improve neonatal outcome.
Maintenance tocolysis has doubtful effect,so not recommended.
RCOG recommends:
Atosibane or nifedipine as 1st line drug(tocolytic)
Atosibane is an oxytocin antagonist,not easily available but expensive
Other tocolytic groups are:
i. Progesterone(17α-hydroxyprogesterone caproate)
ii. Betamimetics e.g. Ritodrine,Salbutamol,Terbutaline
iii. Magnesium sulphate
iv. Prostaglandin synthetase inhibitors e.g. indomethacine
Contraindications to tocolysis in Preterm labour.
a) Foetal:
-death,distress,chorioamniotitis
-estimated foetal weight≥2500gm
-Erythroblastosis foetalis
-severe IUGR
b) Maternal:
-severe hypertension
-pulmonary or cardiac disease
-advanced cervical dilatation beyond 4cm
-maternal haemorrhage e.g. abruption,placenta praevia,DIC
iv. Antibiotics[prophylactic/therapeutic]
B.Interventions[conduct of preterm labour/vaginal delivery]
Guidelines
1. desirable that intensive care neonatal unit be present and made functional,otherwise in-utero transfer is recommended.
2. Presence of skilled midwives,senior resident and consultant obstetric/paediatric staff
3. Reduction of doses of sedatives/narcotic analgesia or None at all
4. Epidural analgesia useful
5. Generous episiotomy is necessary
6. Delay clamping of cord for about 60seconds with baby held below placental bed
7. Avoid precipitate delivery of the head
8. Obstetrics outlet forceps may be used with no force applied
9. Vacuum extraction is contraindicated
10. Paediatrician to resuscitate preterm neonate and manage at intensive care unit
Indications for C/S in preterm labour
1. Preterm breech with estimated foetal weight 1.5-2.0kg
2. Severe pre-eclampsia/eclampsia
3. Major degree placenta praevia
4. Foetal distress
At C/S,a low vertical incision may be choice if lower uterine segment is not formed.
The onset of spontaneous labour between 28 and 37weeks of pregnancy.It occurs in between 7-12% of pregnancies but more frequently between 28-34weeks.
The condition is significant because of its contribution to high perinatal morbidity and mortality being second only to congenital foetal abnormalities,the maternal morbidity and the increased costs of taking care of the preterm neonates in intensive neonatal units.
Diagnosis:
Presence of two or more of:
1. Regular uterine contractions of more than 2 in 10minutes by palpation or tocometer
2. Effacement and dilatation of cervix-atleast 2cm dilatation and reasonable degree of effacement
3. Passage of bloody mucus vaginal discharge
Assessment:
I. Accurate assessment of gestational age[LMP,previous scan date]
II. Foetal weight&heart rate estimation by ultrasound if feasible
III. Foetal presentation[to exclude abnormal lie&position]
IV. General maternal condition:-palor,Bp,heart,chest etc
V. Laboratory :
-FBC,differential;MP
-Urine-mcs,urinalysis
-Scan-foetal lie,position,presentation,placenta location,cervical length
-Speculum vaginal examination-bacterial culture&to exclude cord prolapse if foetal membranes have ruptured,and by sighting determine effacement and cervical os dilatation;also to obtain cervical mucus swab for fibronectin assay.
Avoid digital vaginal examination unless immediate delivery is inevitable.
Haematologic work-up for haemorrhaging cases.
Treatment of symptomatic preterm labour in singleton pregnancy:
i. Admit for bed rest
ii. Site IV line
iii. Treat for malaria
Further treatment depends on:
a. Estimated gestational age
b. Foetal weight
c. +/- other complications e.g. PPROM
Two options available:
A. Expectant(observation)
B. Intervention-immediate delivery
A. Expectant treatment
Usually for gestational ages 28-34wks and uncomplicated preterm labours.
Consideration is given to:
i. Bed rest,hydration
ii. corticosteroids mandatory
-betamethasone 12mg IM every 24hours X 2doses[drug of choice]
-dexamethasone 6mg 12hrly X 4doses
Multiple administration of steroids after the initial 48hrs is unnecessary and may even be harmful
iii. Tocolytics:suppress uterine contractions if bed rest and infusions fail to do so;aim is to suppress uterine contractions for 48hrs to allow steroid administration only.
Choice of tocolytic depends on availability,affordability,adverse effects.
Objective of tocolysis-to gain some time to enable corticosteroids improve neonatal outcome.
Maintenance tocolysis has doubtful effect,so not recommended.
RCOG recommends:
Atosibane or nifedipine as 1st line drug(tocolytic)
Atosibane is an oxytocin antagonist,not easily available but expensive
Other tocolytic groups are:
i. Progesterone(17α-hydroxyprogesterone caproate)
ii. Betamimetics e.g. Ritodrine,Salbutamol,Terbutaline
iii. Magnesium sulphate
iv. Prostaglandin synthetase inhibitors e.g. indomethacine
Contraindications to tocolysis in Preterm labour.
a) Foetal:
-death,distress,chorioamniotitis
-estimated foetal weight≥2500gm
-Erythroblastosis foetalis
-severe IUGR
b) Maternal:
-severe hypertension
-pulmonary or cardiac disease
-advanced cervical dilatation beyond 4cm
-maternal haemorrhage e.g. abruption,placenta praevia,DIC
iv. Antibiotics[prophylactic/therapeutic]
B.Interventions[conduct of preterm labour/vaginal delivery]
Guidelines
1. desirable that intensive care neonatal unit be present and made functional,otherwise in-utero transfer is recommended.
2. Presence of skilled midwives,senior resident and consultant obstetric/paediatric staff
3. Reduction of doses of sedatives/narcotic analgesia or None at all
4. Epidural analgesia useful
5. Generous episiotomy is necessary
6. Delay clamping of cord for about 60seconds with baby held below placental bed
7. Avoid precipitate delivery of the head
8. Obstetrics outlet forceps may be used with no force applied
9. Vacuum extraction is contraindicated
10. Paediatrician to resuscitate preterm neonate and manage at intensive care unit
Indications for C/S in preterm labour
1. Preterm breech with estimated foetal weight 1.5-2.0kg
2. Severe pre-eclampsia/eclampsia
3. Major degree placenta praevia
4. Foetal distress
At C/S,a low vertical incision may be choice if lower uterine segment is not formed.
First Aid kit
Main Parts of a First Aid Kit
What One Should Put in Their First Aid Kit
These Main Parts of a First Aid Kit
Each house needs to have a basic First Aid Kit available. With the correct supplies, almost any medical emergency that is minor can be handled by you. Additionally, your First Aid Kit may be able to help you stay in control of the situation until medical workers show up in the event of a major medical emergency.
So what does a First Aid Kit contain?
Be sure to have these supplies:
Bandages: Various sizes of band-aids should be included. One will want everything from the small finger bandages up to the big square type bandages.
Medical tape: Created to be used on your skin, this medical tape is ideal for attaching gauze bandages to your skin. Also, it works as you have to tape together a fast finger splint.
Medical scissors: The tips are usually rounded to ensure they can be used to cut bandages close to the skin without worrying about piercing the skin. They will be required to cut bandages or medical tape to sizes that are appropriate.
Alcohol wipes: These can be purchased wrapped individually. You could use them to clean and sterilize wounds, scrapes as well as scratches.
Antibiotic ointment: It is usually available from a tube, but some medical supply stores might offer them also in an single packet form. Prior to the application of the bandage, the wounds are kept free from germs by the ointment.
Rubber gloves: Safety never hurts. At least one or two pairs are required for a First Aid Kit in the event that you need to come in contact with bodily fluids.
Tweezers: A quality pair of tweezers may be used to take out thorns or splinters. Purchase a pair of metal instead of plastic if at all possible.
Sterile cotton pads: They are usually wrapped individually. They’re good for wound cleaning.
Pain relievers: So you have the right pain reliever on hand, keep an assortment in your kit, like aspirin, acetaminophen and ibuprofen.
Instant cold pack: These can be purchased in any drugstore or pharmacy. These plastic packages instantly become a makeshift cold pack for injuries or sprains when you hit them with your fingers or apply pressure on them with your palm.
First Aid manual: Even if you have had proper instruction, you need to keep a manual in your kit, in case a person without instruction needs to use it as well.
These are the very basics that should be in each and every First Aid Kit you own. Burn cream, a flashlight and batteries, a CPR mask, safety pins, syringe, assorted small splints, Ace bandage, charcoal for poisonings, bug bite treatment, blanket and thermometer are other extras you may consider including.
Clearly mark a box, bag or container “First Aid,” and store your supplies inside. Your home and every vehicle you use should have a well-stocked First Aid Kit.
What One Should Put in Their First Aid Kit
These Main Parts of a First Aid Kit
Each house needs to have a basic First Aid Kit available. With the correct supplies, almost any medical emergency that is minor can be handled by you. Additionally, your First Aid Kit may be able to help you stay in control of the situation until medical workers show up in the event of a major medical emergency.
So what does a First Aid Kit contain?
Be sure to have these supplies:
Bandages: Various sizes of band-aids should be included. One will want everything from the small finger bandages up to the big square type bandages.
Medical tape: Created to be used on your skin, this medical tape is ideal for attaching gauze bandages to your skin. Also, it works as you have to tape together a fast finger splint.
Medical scissors: The tips are usually rounded to ensure they can be used to cut bandages close to the skin without worrying about piercing the skin. They will be required to cut bandages or medical tape to sizes that are appropriate.
Alcohol wipes: These can be purchased wrapped individually. You could use them to clean and sterilize wounds, scrapes as well as scratches.
Antibiotic ointment: It is usually available from a tube, but some medical supply stores might offer them also in an single packet form. Prior to the application of the bandage, the wounds are kept free from germs by the ointment.
Rubber gloves: Safety never hurts. At least one or two pairs are required for a First Aid Kit in the event that you need to come in contact with bodily fluids.
Tweezers: A quality pair of tweezers may be used to take out thorns or splinters. Purchase a pair of metal instead of plastic if at all possible.
Sterile cotton pads: They are usually wrapped individually. They’re good for wound cleaning.
Pain relievers: So you have the right pain reliever on hand, keep an assortment in your kit, like aspirin, acetaminophen and ibuprofen.
Instant cold pack: These can be purchased in any drugstore or pharmacy. These plastic packages instantly become a makeshift cold pack for injuries or sprains when you hit them with your fingers or apply pressure on them with your palm.
First Aid manual: Even if you have had proper instruction, you need to keep a manual in your kit, in case a person without instruction needs to use it as well.
These are the very basics that should be in each and every First Aid Kit you own. Burn cream, a flashlight and batteries, a CPR mask, safety pins, syringe, assorted small splints, Ace bandage, charcoal for poisonings, bug bite treatment, blanket and thermometer are other extras you may consider including.
Clearly mark a box, bag or container “First Aid,” and store your supplies inside. Your home and every vehicle you use should have a well-stocked First Aid Kit.
Sunday, February 14, 2010
Welcome!
I am Mudiaga Zini,a medical doctor licensed to practice in Nigeria.I discovered that there is much ignorance among Nigerians in the area of health and of course Nigerians do not like going to see the doctor,so i've decided to bring the doctor to Nigerians.
Welcome to my blog,post your health related questions and they will be answered as soon as possible.
Thank you,
Dr. Zini.
Welcome to my blog,post your health related questions and they will be answered as soon as possible.
Thank you,
Dr. Zini.
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