1. Mrs. kook age 42 years: para 4+0 is admitted to the postnatal ward. One hour later following a term spontaneous vertex delivery to a normal neonate she is noted to have developed excessive per vaginal bleeding. The doctor attending made a diagnosis of post- partum hemorrhage a) Describe the most likely course of bleeding and the specific management of Mrs. Kook till the bleeding stops. (16 marks) b) State four complications which Mrs Kook is likely to get (4 marks) 2. Baby Pre was born at 30 weeks with a birth weight of 1350gms and an APGAR score of 3/1 minutes, 9/5 minutes. The baby is stable and is consequently admitted in the Newborn unit (NBU) for further management; a) State eight (8)characteristics of a preterm Newborn (8 marks) b) Discuss the management of baby Pre for the last 48 hours (12 marks)

1. a) The most likely course of bleeding in Mrs. Kook's case is primary postpartum hemorrhage, which is excessive bleeding that occurs within the first 24 hours after delivery. The specific management of Mrs. Kook until the bleeding stops would involve the following steps:<br /><br />- Assess the patient's vital signs, including blood pressure, heart rate, and respiratory rate.<br />- Administer oxygen to maintain adequate oxygenation.<br />- Administer uterotonic drugs, such as oxytocin, to help the uterus contract and reduce bleeding.<br />- Perform uterine massage to stimulate uterine contractions.<br />- If bleeding continues, consider surgical intervention such as uterine artery ligation or hysterectomy.<br /><br />b) Four complications that Mrs. Kook is likely to get include:<br /><br />1. Anemia: Excessive bleeding can lead to a significant loss of blood, resulting in anemia.<br />2. Hypovolemic shock: Severe blood loss can cause a decrease in blood volume, leading to hypovolemic shock.<br />3. Coagulation disorders: Prolonged bleeding can disrupt the normal clotting mechanism, leading to coagulation disorders.<br />4. Infection: Postpartum hemorrhage increases the risk of infection, particularly if surgical intervention is required.<br /><br />2. a) Eight characteristics of a preterm newborn include:<br /><br />1. Low birth weight: Preterm babies are often born with a low birth weight, which can increase the risk of complications.<br />2. Underdeveloped organs: Preterm babies may have underdeveloped organs, such as the lungs, brain, and digestive system.<br />3. Thin, transparent skin: The skin of preterm babies is often thin and transparent, making it easier to assess the underlying tissues.<br />4. Poor temperature regulation: Preterm babies have difficulty maintaining their body temperature, making them more susceptible to hypothermia.<br />5. Irregular breathing patterns: Preterm babies may have irregular breathing patterns, which can be a sign of respiratory distress.<br />6. Poor sucking and swallowing reflexes: Preterm babies may have underdeveloped sucking and swallowing reflexes, which can affect their ability to feed.<br />7. Increased risk of infections: Preterm babies have an increased risk of infections due to their immature immune system.<br />8. Increased risk of developmental delays: Preterm babies are at a higher risk of experiencing developmental delays, particularly in areas such as cognitive and motor skills.<br /><br />b) The management of baby Pre for the last 48 hours would involve the following steps:<br /><br />1. Continuous monitoring of vital signs, including heart rate, respiratory rate, and oxygen saturation.<br />2. Providing warmth and maintaining body temperature to prevent hypothermia.<br />3. Administering medications as needed, such as antibiotics for infection prevention and treatment.<br />4. Providing nutrition, either through breastfeeding or formula feeding, to support growth and development.<br />5. Monitoring for signs of respiratory distress, such as increased work of breathing or decreased oxygen saturation.<br />6. Administering corticosteroids to promote lung maturity and reduce the risk of respiratory distress syndrome.<br />7. Providing pain management as needed, using appropriate methods such as sucrose or acetaminophen.<br />8. Collaborating with a multidisciplinary team, including neonatologists, nurses, and respiratory therapists, to provide comprehensive care for baby Pre.