a rapid evaluation of the general condition of the woman
including vital signs (pulse, blood pressure, respiration,
you suspect shock, immediately begin treatment. Even
if signs of shock are not present, keep shock in mind
as you evaluate the woman further because her status
may worsen rapidly. If shock develops, it is important to
begin treatment immediately.
for help if the woman is in shock, or is bleeding excessively.
a rapid IV infusion.
out if the woman is currently pregnant or has been recently
she is currently pregnant, find out the approximate
period of gestation
she is currently pregnant and less than 22 weeks,
consider abortion and ectopic pregnancy
– The risk of ectopic pregnancy is greater in any woman with anaemia, pelvic
inflammatory disease (PID), threatened abortion or unusual complaints about abdominal
pain; if you suspect an ectopic
pregnancy, perform bimanual examination gently because an early
ectopic pregnancy is easily ruptured
– Consider abortion in any woman of reproductive age who has a missed period
(delayed menstrual bleeding with more than a month having passed since her last
menstrual period) and has one or more
of the following: bleeding, cramping, partial expulsion of products of conception,
dilated cervix or smaller uterus than expected. If abortion is a possible diagnosis,
identify and treat any complications immediately.
she is currently pregnant and more than 22 weeks,
consider placenta previa, abruptio placentae and
uterine rupture; do not do a vaginal examination
at this stage
she has been recently delivered, consider postpartum
due to atonicity of the uterus first
– Massage the uterus to expel blood and blood clots; blood clots trapped
in the uterus will inhibit effective uterine contractions
– Give oxytocin 10 units IM
– Start an IV infusion and infuse IV fluids with 20 units oxytocin in the
– Catheterize the bladder.
to see if the placenta has been expelled and examine
the placenta to be certain it is complete.
– Examine the cervix, vagina and perineum for tears.