A 27-year-old woman, gravida 1, para 1, experiences brisk vaginal bleeding immediately following an uncomplicated vaginal delivery of a 4100-g (9-lb) neonate. The placenta delivers intact 5 minutes later. On physical examination, her blood pressure is 100/60 mm Hg and pulse is 110/min. The uterus is soft, boggy, and palpated above the umbilicus. Arrange the following management steps in the correct sequential order from initial first-line intervention to definitive treatment for this patient's complication.
- 1Perform bimanual uterine massage and ensure adequate intravenous access
- 2Administer additional uterotonic medications (e.g., methylergonovine, carboprost)
- 3Place an intrauterine balloon tamponade
- 4Proceed with surgical intervention (e.g., uterine compression sutures or hysterectomy)
Cevap
The correct sequence for managing postpartum hemorrhage due to uterine atony is: 1) Bimanual uterine massage, 2) Uterotonic medications, 3) Intrauterine balloon tamponade, and 4) Surgical intervention.
The standard protocol for managing primary postpartum hemorrhage due to uterine atony follows a stepwise escalation from least invasive to most invasive. The sequence begins with physical manipulation (bimanual massage) and resuscitation, followed by medical management with uterotonics. If bleeding persists, intrauterine balloon tamponade provides mechanical compression. Finally, surgical interventions are utilized when all other measures fail.
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Anahtar Kavram
Stepwise escalation in the management of postpartum hemorrhage (uterine atony)