A 34-year-old multiparous woman in labor develops sudden, severe postpartum hemorrhage unresponsive to uterine massage and oxytocin. Examination reveals a soft, boggy uterus. What is the next best step in management?
Administer uterotonic agents
A soft, boggy uterus after delivery and failure of massage and oxytocin point to continuing uterine atony.
The next step in the standard atonic PPH protocol is to give additional uterotonic agents such as methylergometrine, carboprost or misoprostol, which further contract the uterus.
Blood transfusion is used alongside for volume replacement but does not stop the bleeding, manual removal of placenta is for retained placenta, and surgery is reserved for failure of uterotonic therapy.
Hence, Administer uterotonic agents.
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Important Questions from Midwifery and Obstetrical Nursing
A 29-year-old woman presents with primary infertility and regular cycles. Her hysterosalpingography reveals bilateral tubal blockage. Which investigation should be prioritized next for management?
During infertility assessment, a female is diagnosed with Asherman's syndrome. What is the primary mechanism by which this condition causes infertility?
Which hormone fluctuation is primarily linked to premenstrual syndrome symptoms?
A 30-year-old pregnant woman with hyperemesis gravidarum is at risk for Wernicke's encephalopathy. Which vitamin supplement is essential in her treatment plan?
During assessment, a midwife observes a blood-tinged mucus discharge, known as the 'show,' in a pregnant woman. What is the significance of this finding?
