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Case (83)

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Dr.Habiib:
Aisha is 29 year old, married for 12 years,  gravid 5 and para 6, with 6 living offspring, the youngest are twin recent delivery two days ago, in prolonged labor took 18 hours. The delivery was at home in far village, where there is no hospital or medical services. She presented to hospital with moderate vaginal bleeding after delivery with two days duration.

Examination:
A. General examination: the patient is:
        - Pallor in color.
        - Rapid weak pulse.
        - Low blood pressure.
        - Subnormal temperature.
        - Oliguria.
B. Abdominal examination:
    - The fundal level of the uterus is higher than the expected level after delivery.
    -  The uterus is soft in consistence.
    - The uterus is atonic, there is no contraction.

Discussion:

1. What is the first step to manage this patient?
2.  How to manage this patient, step by step in details?
3. If this patient is not dealing with proper map of management, what is the risk that will face?
4. What are the commonest causes of maternal mortality in developing countries?
5. What is role of community medicine and public health to decrease these common problems in our community?


This is emergency life saving, so be carefull.

Sharon:
Firstly , HEAD LOW to Maintain BP , IV Fluid Resuscitation (Crystalloids + Colloids), BT x 2-4 depending on hemogram , IV Antibiotics , USG to r/o abdominal cause of PPH , Encourage Breast feeding to minimise vaginal bleeding , IV Inj. Tranexamic acid 1 gm sos , hematinics sos .

Sharon:
The commonest cause of post partum mortality is PPH (Post Partum Hemorrhage) . The said pt. will face severe hypovolaemic shock threatening to coma if not dealt with swiftly and efficiently.

Sharon:
Proper contraception methods and early diagnosis with proper management of prolonged labour at grass root level will surely curb the problem of high maternal mortality in developing countries.

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