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Postpartum haemorrhage (PPH) is excessive bleeding from the genital tract after childbirth. It is an important obstetric emergency and a major cause of maternal morbidity and mortality. Primary PPH is traditionally defined as blood loss of 500 mL or more within 24 hours after vaginal birth or 1000 mL or more after caesarean birth. Severe PPH can rapidly lead to hypovolaemic shock, anaemia, coagulation abnormalities, organ failure and death. The major causes are uterine atony, retained placental tissue, genital tract trauma and coagulation disorders. Effective nursing management requires early recognition, rapid assessment, immediate intervention, continuous monitoring and appropriate referral. The nurse should identify women who are at increased risk of PPH during antenatal, intranatal and postnatal periods. Risk factors include previous PPH, multiple pregnancy, polyhydramnios, prolonged or very rapid labour, induction or augmentation of labour, prolonged use of oxytocin, placenta previa or accreta, retained placenta, large baby, operative delivery, uterine fibroids, severe anaemia and coagulation disorders. Antenatal assessment should include identification of risk factors, haemoglobin estimation and correction of anaemia. Women should receive adequate nutrition, iron and folic acid supplementation and appropriate treatment of infections and other medical conditions. During labour, the nurse should maintain accurate records of maternal vital signs, uterine contractions, fluid intake and output and progress of labour. Unnecessary prolonged labour and inappropriate use of uterotonic drugs should be avoided. The nurse should ensure that intravenous access is available when indicated and that emergency equipment, uterotonic medicines, intravenous ___ _____ _______ _________ _________.
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