Professional Documents
Culture Documents
Seminar On Complication of 3rd Stage PPH
Seminar On Complication of 3rd Stage PPH
Seminar
on
rd
COMPLICATION OF 3
stage of labour
Early postpartum hemorrhage: Its occur just after the delivery of baby or
with in 24 hour of delivery.
Late postpartum hemorrhage: Most frequently occurs 1-2 weeks after
delivery but may occur up to 6 weeks of postpartum.
INCIDENCE:
Vaginal delivery is associated with a 3.9% incidence of postpartum
hemorrhage. Cesarean delivery is associated with a 6.4% incidence of postpartum
hemorrhage. Delayed postpartum hemorrhage occurs in 1-2% of patients.
ETIOLOGY:
Early postpartum hemorrhage
May result from
Uterine atony
Retained products of conception
Uterine rupture
Uterine inversion
Placenta accreta
Placental hypertrophy
Lower genital tract lacerations
Coagulopathy
Bleeding Disorder
Late postpartum hemorrhage
Retained products of conception
Infection
Subinvolution of placental site
Uterine atony and lower genital tract lacerations are the most common causes of
postpartum hemorrhage.
Factors Predisposing to Uterine Atony Include
Over distension of the uterus secondary to multiple gestations, polyhydramnios,
macrosomia, rapid or prolonged labor, grand multiparity, oxytocin administration,
intra-amniotic infection, and use of uterine-relaxing agents such as terbutaline,
magnesium sulfate, halogenated anesthetics, or nitroglycerin.
In uterine atony, lack of closure of the spiral arteries and venous sinuses coupled
with the increased blood flow to the pregnant uterus causes excessive bleeding.
Active management of the third stage of labor with administration of uterotonics
before the placenta is delivered (oxytocin still being the agent of choice), early
clamping and cutting of the umbilical cord, and traction on the umbilical cord have
proven to reduce blood loss and decrease the rate of postpartum hemorrhage.
DIAGNOSIS:
The onset of postpartum hemorrhage is acute, intervention is immediate, and
resolution is generally within minutes; consequently, laboratory studies or imaging
in the management of the immediate course of this process has little role.
However, it is important to check a patient's
CBC count
Prothrombin time/activated partial thromboplastin time (PT/aPTT) to
exclude resulting anemia or coagulopathy, which may require further
treatment.
TREATMENT
Initial therapy includes
Uterine packing is now considered safe and effective therapy for the treatment
of postpartum hemorrhage. Use prophylactic antibiotics and concomitant
oxytocin with this technique. The timing of removal of the packing is
controversial, but most physicians favour 24-36 hours. This treatment is
successful in half of patients. If unsuccessful, it still provides time in which the
patient can be stabilized before other surgical techniques are employed.
Complications are rare (6-7%) and include fever, infection, and nontarget
embolization.
The B-Lynch suture technique:A suture is passed through the anterior uterine
wall in the lower uterine segment approximately 3 cm medial to the lateral edge
of the uterus.
The suture is wrapped over the fundus 34 cm medial to the cornual and
inserted into the posterior uterine wall again in the lower uterine segment
approximately 3 cm medial to the lateral edge of the uterus and brought out 3
cm medial to the other edge of the uterus.
The suture is wrapped over the fundus and directed into and out of the anterior
uterine wall parallel to the previous anterior sutures. The uterus is compressed
in an accordion like fashion and the suture is tied across the lower uterine
segment.
The B-Lynch suture technique and other compression suture techniques are
operative approaches to postpartum hemorrhage that have proven to preserve
fertility.
Fig: Hysterectomy
NURSING MANAGEMENT
NURSING DIAGNOSIS
INTERVENTIONS:
Fever
Foul smelling discharge containing large tissue residue
Persistent bleeding
Severe cramps and contractions
Delay in milk production
DIAGNOSIS OF RETAINED PLACENTA:
A careful examination
In a few cases, doctor may not diagnose the missing part of the placenta.
But, when you begin to experience the symptoms after delivery, it signals
the retention.
Ultrasound scan to check for retained placental fragments in the womb.
If the placental tissue is left in the uterus, it cannot contract properly, and the
blood vessels continue to bleed.
1. Manual removal of placenta: Insert a catheter to empty the bladder, and give
you intravenous antibiotics to prevent any infection. You will also get a local
anesthesia, either spinal or epidural. The practitioner will then place her hand
inside the uterus to remove the placenta. You will require more intravenous
drugs after the manual placental removal for the uterus to contract .
Today we have discussed about the third stage of labour, and complication of third
stage of labour that is ; Post partum haemorrhage and Retained Placenta in detail
with Definition, cause, risk factors symptoms and treatment of the PPH and
Retained placenta and its nursing management also. This topic help us in our
clinical posting and during practical examination.
BIBLIOGRAPHY:
Journal-obgyn-india.com
http://www.journal-obgyn-india.com/
www.wikipedia.com
www.pubmed.com
www.scribd.com
www.healthline.com