Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Neglected Tropical Diseases NTDs are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mids have led to ambitious new control and elimination targets set for by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the "neglected" status of applied social science research on NTDs.

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Run it fast if hypovolaemia has not yet been corrected. Blood transfusion may be needed if haemorrhage is severe. If the pethidine and diazepam are not available, use another appropriate analgesic, if available, and continue gently with the manual removal of the placenta as it is a life saving procedure.

Procedure1Provide emotional support to the woman throughout. Help the woman lie on her back with knees bent. If she is unable to void urine, catheterize and empty the bladder.

A full bladder can prevent the delivery of the placenta. Administer analgesic. Wash and scrub your hands and arms well.

Clean around the vagina and the perineal area with an antiseptic solution. Put on short sterile gloves first.

Part the labia and clean the vestibule, i. Then, on the hand that will be inserted into the vagina, put on a long sterile glove on top of the short one.

This will prevent the introduction of bacteria from the arm. If no long glove is available, use a second short glove, cut off the part for the fingers and use the rest to lengthen the first glove 7. Hold the umbilical cord with a clamp and pull cord gently until it is taut and parallel with the floor. Introduce the other, long-gloved hand into the vagina with the fingers and thumb straight but close together and follow the cord, using a gentle rotation movement to go through the cervical os into the uterine cavity Figure 9.

Follow the cord until you find the placenta. Once you have put your hand into the uterus, do not bring your hand out until you have separated the placenta and are bringing it out of the uterus. Do not go in and out of the uterus as this increases the risk of infection. Let go of the cord with your external hand and grasp the fundus of the uterus through the abdomen. This supports the uterus and provides counter traction during the manual removal to prevent inversion of the uterus.

Figure 9. Reach the placenta and find its edge. Slip the fingers of your hand between the edge of the placenta and the uterine wall. With your palm facing the placenta and fingers held tightly together, use a sideways slicing movement to gently detach the placenta.

Go all around the placental bed until all the placenta is detached from the uterine wall. When all of the placenta is separated and in the palm of your hand, Figure 9. Do not pull on just a piece of placenta for it may tear from the rest of the placenta. The membranes will follow the delivered placenta.

Pull them out slowly and carefully as they might tear off and be left in the uterus giving rise to haemorrhage or infection. Continue to provide counter-traction to the uterus with the other hand to prevent uterine inversion. Insert your hand again to palpate the uterine cavity for any remaining placental tissue.

Add oxytocin 20 IU to 1 litre of IV fluid either Ringers lactate or normal saline and give by intravenous infusion. Give rapidly if bleeding. Have an assistant massage the uterus to encourage contraction. If there is continued heavy bleeding, give ergometrine 0. Examine the removed placenta and check for completeness Figure 9. Check for tears in the birth canal and repair, as required.

Problems in the removal of the placenta. If the placenta does not separate from the uterine wall by gentle lateral movements of the finger tips at the line of cleavage, suspect placenta accreta and refer the woman to a higher level health facility for laparotomy and possible sub-total hysterectomy. No bleeding will occur from the uterine wall if the placenta is attached, only from areas where the placenta has separated If the placenta is retained due to a constriction ring, or if hours or days have passed since the birth of the baby, it may not be possible to get the whole hand into the uterus.

Remove the placenta in fragments using two fingers, ovum forceps or a wide, blunt curette. Referral for exploration of the uterus under anaesthetic may be requi. Log masuk Ayo Mulai. Download for free Report this document.

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Makalah Isi

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Makalah Perdarahan Post Partum

Elisa Lestari PO. Ria Deskaranti PO. The failure of the uterus associated with placental or fragment of the placenta, uterus disturbed, or lobes succenturiate torn blood vessels in the membranes. The material retained act as a physical block against a strong uterine contraction needed to constrict the placental vessels atrelaksasi. However, in many cases, dysfunctional contraction postpartum retained placenta is the main reason.

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