Clinical Practice Guidelines on Abnormal Uterine BleedingFull description
iugrFull description
kematian janin dalam kandungan di atas 20 mingguFull description
Clinical Practice Guidelines on Abnormal Uterine Bleeding
Prolaps uteriFull description
Cancer is a disease in which abnormal cells divide without control and are able to invade other tissues. Uterine cancer is the most common cancer occurring in reproductive system of women. Uterine cancer begins when healthy cells in the uterus change
Cancer is a disease in which abnormal cells divide without control and are able to invade other tissues. Uterine cancer is the most common cancer occurring in reproductive system of women. Uterine cancer begins when healthy cells in the uterus change
asuhan keperawatan IUFDFull description
Uterine fibroids are a major cause of morbidity in women of reproductive age. Hence it is important to evaluate the occurrence of fibroid. An observational retrospective study was carried out in Obstetric and Gynecology Department over a period of 2
Uterine Atony Uterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage. Clinically, 75 -80% of of postpartum hemorrhages are due to uterine atony. Uterine atony failure of the myometrium to contract after delivery of the placenta; associated with excessive bleeding from the placental implan tation site. Before Delivery
If you are at risk for uterine ut erine atony, your doctor or nurse should make the following preparations in case excessive bleeding occurs during or after delivery: • •
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at least one large intravenous line should be established% medication to induce contractions of the uterus--oxytocin (Pitocin), methylergonovine (Methergine), and or prostaglandins--should be on hand, and appropriate nursing and anesthesia personnel should be available.
In addition, the blood bank should be notified of the possible need for a blood transfusion for certain high risk patients. After Delivery
Uterine atony is diagnosed after delivery when there is excessive bleeding and a large, relaxed uterus. The doctor first rules out other potential causes of the bleeding (tears in the vagina or cervix and fragments of the placenta remaining in the uterus); these problems should be resolved if they are present. If the bleeding continues, the uterus may be stimulated to contract with use of massage and intravenous oxytocin. Many studies show this technique reduces postpartum hemorrhage and the need for blood transfusions. If heavy bleeding from atony occu rs despite the use of oxytocin after delivery, then two additional medications may be used to help control hemorrhage: •
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Methylergonovine, a strong vasoconstrictor derived from ergot, is injected into a muscle. it is not given to patients with preeclampsia or a history of high blood pressure because it can cause high blood pressure. Prostaglandin F-2-alpha (Hemabate) is injected under the skin and also directly into the uterus. Frequent side effects include diarrhea and vomiting. It can cause caus e bronchial constriction and is usually avoided in patients with asthma. Emergency surgery should be performed if atony persists despite these measures to control the bleeding. This may be accomplished by tying off the blood vessels that supply the uterus. If successful, this procedure should not affect future pregnancies. In a more involved procedure, the doctor uses x-rays to guide a small catheter through blood
vessels in the mother6s leg and into the blood vessels supplying the uterus. These blood vessels are then injected with gelatin sponge particles or spring coils to obstruct blood flow to the uterus. Although successful control of hemorrhage has been reported with this technique, the equipment necessary to perform it may not be available in most emergency situations. If bleeding persists in spite of all conservative measures to control it, a hysterectomy (removal of the uterus) may be necessary. Medical Treatment
1. Intervenously fluids administered to increase fluid and blood volume. 2. Oxytocin administration. 3. Methergine/prostin may be administered to stimulate uterine contractions when oxytocin is ineffective. 4. blood transfusion if the patient’s hematocrit drops too low and/or if she is symptomatic. Nursing Interventions
1. 2. 3. 4.
Palpate the fundus frequently to determine continued muscle tone. Massage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle). Monitor patient’s vital signs every 85 minutes until stable. Prevent bladder distention. Bladder distention displaces the uterus and prevents effective uterine contractions.
Nursing Diagnosis
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De f i c i e n t f l u i d v o l u m e r e l a t e d t o p o s t p a r t u m h e m o r r h a g e Acute pain related to uterine cramping and perineal experienced Risk for ineffective tissue perfusion related to h emmorhage
