1)Join HO teaching with fellow ONG HOs and a professor at ONG department.
Topic: POST PARTUM HAEMORRHAGE [PPH]
Important points taken about PPH;
a)As HO, must identify the patients that have high risk to develop PPH after labor and must anticipate :
-Grand multipara
-MAcrosomia
-advanced maternal ages
-Twins pregnancy
-maternal obesity
-polyhdramnios
b) Precipitate labor in patient drinking air selusuh, ubat selusuh (minyak kelapa dara, bunga kembang semangkuk, bunga manjakani)
-if the os 2cm but contraction like 7cm, must ask the patient if she takes air selusuh.
c) cases of prolonged labor such as,
-operative VD trauma as forcep
-Hx postpartum Hge
-retained placenta/membrane
-pt previous cs
-pregnancy with fibroid
-pt with coagulation (DIC)
-prolonged administration of pitocin
d) Treatment of PPH:
-uterine massage (first plan)
-snytometrin (oxytocin)
-if fail give hemabate up to 8cc
-balloning as Bakry ballon (must ask sister because usually nurse kept this in her room because quite expensive)
-Foley's cathether ( 3 way cathether red color)
-B lynch suture done by MO or registrar
-ligation of artery (rare and dangerous) because tortous int. iliac vein.
-hysterectomy (last choice)
e) In manual removal of placenta, if clot more than 500ml, call MO and call for help.
*if 300ml only dont call MO yet.
**1 kidney dish 150ml
**1 blue sheet : 500ml
f) Pitocin sometimes in bolus (not unit cc) because in PPH want good contraction then maintain by drop.
!!!TAKE NOTE!!! ----> 14 days MIA, automatic will be expelled without any reasons. But can apply back apply in MMC & SPA within 2 years.
2) Enter dengue at emergency department to see how clerking the dengue cases and review.
Example clerking dengue cases page 1
page 2
page 4
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