SAQ 266 – Obstetrics – emergency delivery and postpartum haemorrhage

Question 1. emergency delivery and postpartum haemorrhage.

a. Stages of labour

• First stage: regular uterine contractions to full cervical dilatation.
• Second stage: full cervical dilatation to delivery of the baby.
• Third stage: delivery of the baby to delivery of the placenta.

b. Immediate newborn care

• Dry the newborn.
• Maintain warmth using a heated cot or warm environment.
• Stimulate and confirm effective breathing or crying.
• Swaddle the newborn.
• Provide skin-to-skin contact or give the newborn to the mother.

c. Mother while placenta remains in situ

• Check that there is no second baby.
• Administer oxytocin 10 units IM or IV.
• Use controlled cord traction and inspect the placenta once delivered.
• Massage the uterus after placental delivery.
• Observe vaginal blood loss and identify or treat genital-tract trauma.

d. Postpartum haemorrhage management

• Apply direct pressure to visible bleeding and treat tears.
• Massage the uterus, perform bimanual compression, and insert an indwelling urinary catheter.
• Commence an oxytocin infusion, for example 40 units in 1 L normal saline.
• Activate major haemorrhage management, obtain two large-bore IV lines, and give early blood products or fluid.
• Pack the uterus or vagina if required and notify theatre, obstetrics, and anaesthetics early.