Managing Complications in Pregnancy and Childbirth: - IAWG

Vaginal bleeding after childbirthS-27- OR mebendazole 500 mg by mouth once or 100 mg twotimes per day for 3 days;- OR levamisole 2.5 mg/kg body weight by mouth oncedaily for 3 days;- OR pyrantel 10 mg/kg body weight by mouth once dailyfor 3 days.- If hookworm is highly endemic (prevalence of 50% or more),repeat the anthelmintic treatment 12 weeks after the first dose.DIAGNOSISTABLE S-7Diagnosis of vaginal bleeding after childbirthPresenting Symptom andOther Symptoms and SignsTypically PresentSymptoms and SignsSometimes PresentProbable Diagnosis• Immediate PPH a• Uterus soft and notcontracted• Immediate PPH a• Placenta not delivered within30 minutes after delivery• Portion of maternal surfaceof placenta missing or tornmembranes with vessels• Uterine fundus not felt onabdominal palpation• Slight or intense pain• Bleeding occurs more than 24hours after delivery• Uterus softer and larger thanexpected for elapsed timesince delivery• Shock• Complete placenta• Uterus contracted• Immediate PPH a• Uterus contracted• Immediate PPH a• Uterus contracted• Inverted uterusapparent at vulva• Immediate PPH b• Bleeding is variable(light or heavy,continuous or irregular)and foul-smelling• AnaemiaAtonic uterus, pageS-28Tears of cervix,vagina or perineum,page S-31Retained placenta,page S-31Retained placentalfragments, page S-32Inverted uterus, pageS-33Delayed PPH, pageS-33