c. Make sure the newborn's umbilical cord is not bleeding. The smallest amount
of bleeding may be serious for premature infants.
d. Give oxygen to the baby. DO NOT blow oxygen in a stream directly over the
baby's face. The oxygen flow should be low--less than four liters per minute.
e. Ensure that the infant is not contaminated. Premature infants are very
susceptible to infection. Wear a surgical gown and mask. Also, keep people (except for
your assistant, if you have one) away from the infant.
Section V. COMPLICATIONS OF LABOR AND DELIVERY
2-22. ANTEPARTUM HEMORRHAGE
a. Definition/Causes. Antepartum hemorrhage is the patient hemorrhaging
before delivery. Three major causes of this condition are placenta abruptio, placenta
previa, and uterine rupture.
(1) Placenta abruptio. In this condition, the placenta separates from the wall
of the uterus. The separation usually occurs during the last two months of pregnancy.
When the placenta separates from the uterine wall, placenta blood vessels rupture, and
spontaneous bleeding starts. The mother may go into shock and the fetus may not
have enough oxygen. Signs of this condition include abdominal pain and rapid onset of
labor. The uterus becomes rigid. Transport the mother immediately to a hospital and
treat for shock.
(2) Placenta previa. The presenting part is the placenta. Since the placenta
has many blood vessels, a massive hemorrhage may occur.
(3) Uterine rupture. A uterine rupture is a tearing of a part of the uterus.
The patient has sudden, severe abdominal pain and a rigid abdomen. Bleeding may
not be apparent externally, but the patient can have profound shock from internal
DO NOT attempt to examine the patient internally, regardless of the
cause of antepartum hemorrhage.
b. Management of Antepartum Hemorrhage. Manage as follows.
Place the patient flat on a stretcher, lying on her side.
Administer oxygen to the patient.