REDUCING POSTPARTUM HEMORRHAGE AND ECLAMPSIA
Despite the presence of a skilled attendant and proper management, about 3-4 % of women will still experience postpartum blood loss more than 1000 ml during the third stage of labor. Over all, every year on average, 130 000 women bleed to death while giving birth. In about 90 % of cases the cause is uterine atony, or failure of the uterus to contract properly after childbirth.
If bleeding is profuse, treatment with hormone oxytocin 0, 5 ml [5 units] in an I.V. [Intra Venous] infusion. If oxytocin is not available, another option of treatment is prostaglandin misoprostol [generic, Cytotec]. Oral: 100 and 200 microgram tablets, 3-4 times daily.
Preventing postpartum hemorrhage [The writer experiences]:
Prevent of uterine atony [weaken contraction of uterus].The writer experiences was giving neuromuscular and tropic vitamins such as tablet neurodex which contains vitamins B1 100 mg, B6 200 mg and B12 250 microgram, once daily for the last trimester of pregnancy. The effect of these vitamins are: good strength of smooth muscle of uterus, good excitability of autonomic nervous system supplied the uterus; and the uterus is sensitive to oxytocin in parturition and strong contraction of uterus on the second and on the third stage of labor; eventually prevent hemorrhage.
The other drugs prevent the bleeding on postpartum hemorrhage are: vitamin C 500 mg per oral daily, vitamin K 5 mg per oral daily and calcium lactate 500 mg per oral daily, respectively once daily for the last month of pregnancy. The purpose of giving these drugs are better clotting of blood on post partum period and finally prevent bleeding or hemorrhage.
PRE-ECLAMPSIA AND ECLAMPSIA.
Pre-eclampsia is a disorder of pregnancy affecting several body systems, including the brain, liver and kidney. The symptoms and signs are characterized by hypertension, protein in urine and generalize edema. The manifestations develop from the 24th week of pregnancy through the second week of delivery. Severe , persistent, generalized headache, vertigo, malaise and nervous irritability are prominent symptoms which are due in part to cerebral edema. Epigastrium pain, nausea, and liver tenderness are the result of congestion, thrombosis of the periportal system. Ninety-five % of cases occur after the 32nd week, and 75 % of these patients are primigravidas.
About one in 200 patients with the pre-eclampsia develops eclampsia, which is marked by convulsions or coma and be fatal without treatment. Together, pre-eclampsia and eclampsia affect about 10 % of all pregnancies and account for about 12 % of all maternal deaths.
Treatment of pre-eclampsia:
1. Hospital care. Give sedatives and anticonvulsants e.g. Phenobarbital 60 mg orally 3 times daily. Magnesium sulfate [an excellent anticonvulsant] may be given I.V., 20 ml of 10 % aqueous solution injected slowly, and repeated hourly to prevent or control seizures.
2. Diuretics: Chlorothiazide [Diuril], 250-500 mg orally daily or Hidro-Diuril 25-50 mg per oral daily, or Furosemide [Lasix] 40 mg per oral twice daily may be given to promote diuresis and reduce blood pressure.
3. Antihypertensive drugs: Captopril 25 mg tablet per oral 3 times daily or Amlodipine [Norvasc] 5 mg – 10 mg tablet once daily.
Treatment of eclampsia:
General care. Hospitalize the patient in a single, darken, quiet room, at absolute bed rest with side rail for protection during convulsions, and provide special nurses the clock. Allow no visitors. Do not disturb the patient for unnecessary procedures.
Diet and fluids: If the patient is convulsing, give nothing by mouth. Measure and record fluid intake and output for each 24-hours period.
Anticonvulsant Magnesium sulfate, 10 ml of a 25 % solution I.V. when the patient enters the hospital and then one injection after each convulsion. It may combine with Sodium Phenobarbital 250-500 mg I. M. every 6-8 hours.
Delivery: Because severe hypertensive disease, renal disease, and toxemia of pregnancy are usually aggravated by continuing pregnancy, the most direct method of treatment of any of these disorders is termination of pregnancy. Control eclampsia before attempting induction of labor or delivery. Induce labor , preferably by amniotomy alone, when the patient’s condition permits. Use oxytocin to stimulate labor if necessary.
Vaginal delivery is preferred. If the patient is not at term, is not inducible, if she is bleeding, or if there is a question of disproportion, cesarean section may be necessary.