Hello lovely members of this community I greet you all and I hope you all are having a great day already? I'm happy once again to bring you a very interesting topic today which is really one of it's kind and it's related to midwifery so it's for the benefit of everyone because either you are a woman or will become one soon or you have a wife, sibling, mother or even friend who is a female, it's very crucial for you to get this information and add it to your knowledge. So I encourage us all to stay focused and sail with me in this journey. So let's move.
The above topic of discussion today is actually in two parts which I would have loved to write separately, but due to my uncertain schedule, I have decided to marry the two in this article and I'm actually referring to postpartum hemorrhage (bleeding after childbirth) and then the non pneumatic anti shock garment. So I will start by explaining the concept of postpartum hemorrhage and how life threatening it could be to the individual (woman) after which I will then go ahead to talk about the the life saving device which serves as a first aid device in this situation.
FIRST AID KIT FOR EMERGENCY SITUATIONS
POSTPARTUM HEMORRHAGE
Postpartum hemorrhage just as the name goes,is a heavy bleeding that occurs after the process of childbirth and the amount of blood lost through this condition is usually up to 500mls and above that is why it is seen to be a threat to life if not prevented or if no prompt intervention is carried out.
Let's not forget that we also have bleeding which occurs during the period of pregnancy called antepartum hemorrhage and it's quite different from this particular type of bleeding.
This condition is known to be life threatening because all the organs of the human body require blood supply in order to enable them function effectively but because of the loss of blood through hemorrhage it puts them at great risk of damage as they are unable to get the required amount of blood supply for them to function effectively. Some of those organs includes the heart, the lungs, kidneys, brain and a lot of other organs.
TYPES OF POSTPARTUM HEMORRHAGE
Postpartum hemorrhage has two main types and these two types depends on the time of onset of the bleeding and they include:
PRIMARY POSTPARTUM HEMORRHAGE
This type of PPH commences within the first 24 hours of delivery of the baby. This type most times is discovered when the woman is still within the facility which some times makes it easy to be identified and arrested.
SECONDARY POSTPARTUM HEMORRHAGE
This type of bleeding usually commences after 24 hours upwards of child birth,and most times it occurs when the woman must have gone back home after delivery which makes it very deadly because by the time the woman must have been rushed to the facility for prompt attention, they must have lost great deal of blood and most times even die in the process. So this type can occur anytime within the 6weeks period of postpartum, the only difference is that it should be after the first 24hours.
CAUSES OF POSTPARTUM HEMORRHAGE
There are some conditions both during pregnancy and labour as well as after delivery that leads to bleeding and they are:
UTERINE ATONY: This simply has to do with the inability of the uterus to contract and from what I wrote about this in one of my previous articles, when the uterus contract, it helps to prevent bleeding so that is why in this case because the uterus is unable to contract very well after delivery,it now results to postpartum hemorrhage which is an obstetric emergency and requires prompt management.
LACERATION OF THE CERVIX, UTERUS OR PERINEUM: this could occur as a result of poor management of the second stage of labour, if the baby is macrosomic (big baby) or if the mother pushes the baby before time when the cervix is not fully dilated this laceration in turn will result to bleeding which is called postpartum hemorrhage because it's still within the period of post delivery.
This bleeding in this case, can be arrested through the application of sutures to the affected areas inorder to repair them or bring them back to there original state and the process of suturing them helps in constricting the blood vessels preventing further blood loss through them.
Least I forget, uterine rupture or laceration could occur as a result of over administration of uterotonic medications which could result to over or rapid contraction of the uterus which could result to bleeding and in some or most cases when it has gone out of controll, hysterectomy(removal of the uterus surgically) will be done to save the life of the woman.
RETAINED PRODUCTS OF CONCEPTION In this case, the products of conception being mentioned refers to the placenta and it's membrane. Usually, after the delivery of the baby which is in the second stage of labour, the placenta and every part of it is delivered during the 3rd stage of the labour process after which the midwife also ensures that nothing is remaining in the uterus that could trigger bleeding as a foreign body.
Inorder to make this clearer, these products of conception are usually accommodated in the uterus during the period of pregnancy and we know that pregnancy does not last for ever it has specific duration, and as soon as it ends after the baby is born, any other thing that is found in the uterus after this period is now a foreign body which could cause infection and bleeding that is why these products if not completely gotten rid of after delivery could lead to sepsis(infection) and hemorrhage postpartum.
POOR MANAGEMENT OF THE SECOND AND THIRD STAGE OF LABOUR
Poor management of the second and third stage of labour could lead to infection and postpartum hemorrhage.
This usually may occur from either not guarding the perineum during the process of conducting the delivery of the baby in the second stage of labour,not monitoring the progress of labour to note deviation or delays which could cause harm, over use or under use of uterotonic medications like oxytocin, misoprostol etc either to induce, augment labour or aid delivery of the placenta, lack of experience on the part of either the midwife carrying out the delivery or the doctor,could cause poor management of these labour process which in turn may result to PPH
These are some of the things that could cause bleeding after delivery which will now warrant emergency care to safe the life of the individual.
Least I forget, I will love to add that PPH Is not the only obstetrics hemorrhage that will require emergency care to save the life of the woman, antepartum hemorrhage (APH) which is bleeding that occurs during the period of pregnancy,also require prompt intervention to keep the woman safe.
These now brings me to the main topic of our discussion for today which is non pneumatic anti shock garment use in emergency situations.
NON-PNEUMATIC ANTI-SHOCK GARMENT
Non-pneumatic antishock garment which is also known by some people as compression jacket is a first aid device which is used for women during obstetric bleeding (any bleeding that occurs in women during pregnancy, delivery or after delivery) or obstetric shock which could ensure due to excessive loss of blood from the bleeding to save the life of the woman. This device usually when applied can sustain the woman for 48hrs period as a first aid untill Interventions are put in place to either find out the source of the bleeding or arrest the bleeding so as to keep the patient alive.
NON-PNEUMATIC ANTI-SHOCK GARMENT ALREADY ON A WOMAN
INDICATIONS
There are some conditions where non-pneumatic antishock garment is required and they include:
• Bleeding during pregnancy.
• Bleeding during childbirth.
• Bleeding after childbirth.
• Severe bleeding from any part of the lower extremities.
• Hypovolemic shock due to excessive blood loss.
DESCRIPTION
This first aid garment when applied looks like a trouser jacket and it is made up of 6 segments each segment positioned for a particular part of the lower extremity.
SEGMENT 1: is strapped on the ankles or above depending on how tall the person is.
SEGMENT 2: is strapped on the legs close to the first one.
SEGMENT 3: is strapped on the thighs.
SEGMENT 4: is strapped round the hip region.
SEGMENT 5: is placed over the belly button.
SEGMENT 6: is strapped over the segment 5.
These garment has an elastic property that is why it can easily be stretched. And it can be applied on women of different sizes and during application, the perennial area is meant to be accessible that is why it's made in such a manner that the area is not covered.
As a first aid device, it has the function of both arresting the bleeding as well as immobilizing the area in cases of fracture
PROCEDURE
The application of this device has a particular protocol or guidelines to be followed inorder to achieve the set aim of arresting the bleeding there by decreasing blood loss and preventing hypovolemic shock.
They include:
• The garment should be applied once there is bleeding with the pulse being more than 100bpm and blood pressure with a systolic(upper value)pressure of 80mmHg and less and in addition to these,signs of shock like cold clammy skin, paleness etc.
• The segments should be applied one after the other starting from the ankle (segment 1) and to the navel or belly button (segment 6).
• While the garment is on the patient, there should be intravenous fluid dripping so as to replace the lost fluids or better still blood transfusion to replenish the lost blood there by preventing hypovolemic shock in the individual.
• Regular monitoring of vital signs to know when it's stable enough for the device to be removed.
• The removal of the device should last for 1 hour, never to be less than that and by the 1hour, each segment removal should have a period of 15minutes of rest before the removal of the next segment during which the blood pressure and pulse are closely rechecked to ensure they don't fall back to less than a 100mmHg the total of the 15minutes for each segment is what gives rise to the 1hour. And each segment removal for both lower limbs should be done at the time before each brake.
• During the period of removal, if the blood pressure value drops at any point in time by 20,be it the blood pressure value or the pulse the whole device should be put back again from the beginning while the source of the Bleeding should be identified and tackled.
• The device is not to be removed except the source of the blood loss is identified and arrested.
MECHANISM
The mechanism of action of this device is quite simple first it helps in applying pressure to any part of the body where it is placed and by so doing, it stops bleeding from that area. In addition to that, due to the bleeding occuring from either the abdominal or perennial area, there tends to be accumulation of blood within the lower limbs depleting the amount that the heart, lungs and other vital organs should get normally.
In this case, the work of this first aid device is to push blood from the lower limbs to the heart and other vital organs there by normalizing the blood pressure and pulse as well as other vital signs saving the life of the woman. So that is simply how this devices works.
So I hope you can now understand why I said that this device is a life saver.
I think I have really given out the basic informations about this topic and so I will end the discussion at this juncture. Thanks a lot for your time and patience and I hope you where able to learn something from this post.
See you in my next post.
REFERENCES
• NASG
• PROTOCOL FOR APPLICATION AND REMOVAL OF NON-PNEUMATIC ANTI-SHOCK GARMENT