Selasa, 19 Januari 2016

Minggu, 17 Januari 2016: Arrêter l'Hémorragie

Yesterday, I got patient with post-partum hemorrhage. She gave birth with the helping from her family. Her husband called me 2 hours after delivery. When I and my team arrived to patient's house, the condition of her was so bad. Her face was pale, nearly cyanotic, her breathing was fast, and she was lethargic, almost lost of consciousness. Her pulse was fast, exceed 100 beats per minute. Also her blood pressure was low, it's just 40 mmHg. The blood spilled from her birth canal like water. The first thought that strucked me was this patient would die any minute. Without delay, we put double IV line and gave her 2 litres saline fluid to resuscitate her vital sign. Fortunately, the contraction of her uterus was good enough. I was pretty sure if the bleeding wasn't caused by contraction problem. Because if it was the culprit, all I could do just pray. We've ran out of oxytocin, medication to improve the uterus contraction, since last month. Probably the bleeding was caused by tissue or traumatic problem. Usualy, there were 4 culprits in postpartum hemmorhage namely tonus, tissue, trauma, and thrombocyte or coagulation factor. I asked her family if they still stored the placenta. They said they've buried it. I told them to dig it up. I wanted to see if all cotiledons and membrane of placenta were complete. Luckily, they were. When I was looking in the birth canal, I saw the portio of uterus has been ruptured due trauma of labour. Blood flow from the ruptured portio. After explored the birth canal to make sure there was no another torn, we made a tampon to stop the bleeding. Because we didn't have any vassopressor to raise blood pressure, I was relying on fluid replacement, bleeding stoppage with tampon, and dexamethasone injection. After 1 hour, the condition of patient was getting better. The blood pressure raised to 110/70 mmHg, pulse diminished under 100 beats per minute, respiration rate normalized, and patient became alert. Maybe I'll refer this patient if the ruptured portio still bleeding and big enough to compromise reproductive function of patient. The interim priority for this patient is life saving.
Until today, this patient is getting better.

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