What is primary pph? How will you manage a case of primary pph of writes down the preliminary management of pph.

Q.2. What is primary pph? How will you manage a case of primary pph of writes down the preliminary management of pph.
Primary pph – primary pph is blood loss from the birth canal of 500 ml of more with  in 24 hours of delivery.
Manage a case of primary pph
For manage a case of primary pph diagnosis and treatment are needed.
Diagnosis
Symptoms:
Bleeding per vagina within 24 hours of delivery of foetus.
Signs:
i. Sings of haemorrhage and shock
ii. Per abdominal examination-uterus is soft and flaccid. Height is at higher level-uterus. contracted.
iii. Per vaginal examination:
Bleeding either copious of slow oozing of inter-mittent gushes occurs.
Placenta delivered, not delivery of partially delivered.
Management of PPH:-
A. General management
1. Immediate hospitalization and isolation.
2. Rapid assesment of the mother condition.
3. Set up an intravenous channel.
4. Sending of blood for grouping, cross matching and screening.
5. Blood tranfusion is arranged.
6. Inj oxytocin 20 units in glucose drip is run or Inj-methergin 2 amp or given in drip tube,
7. The patient is keep quite with the foot end of the bed raised.
B Specific treatment:
The specific causes of primary pph should be detected and treatment of according
1. If placenta is delivered and uterus is feel soft and relaxed and bleeding is continue.
Inj Ergomentrine should be given for maintain the contraction.
2. If any trauma is present in the perineum vagina or cervix detected by speculum is repaired under G/A. vestibular haemorrhage is controlled by deep catgut stich.
3. If bleeding continuous from empty uterus bimanual compresion of the uterus is done while the patient is still under anesthesia.
4. If all treatment are failed Hysterectomy should be done. It is especially indicated in rupture uterus.