PREVENTION AND MANAGEMENT

OF

POSTPARTUM
HAEMORRHAGE
(PPH)
CME
VENUE: ANTENATAL HALL, MATERNITY
DATE: 26/07/2017
PRESENTER: CESARINE KONGA, REGISTERED MIDWIFE.
 OBJECTIVES
What is Postpartum Haemorrhage?
Types of postpartum haemorrhage?
What are the causes of postpartum
haemorrhage?
How to manage postpartum haemorrhage?
How to prevent postpartum haemorrhage?
 Definition
o Blood loss after delivery of >500mls (vaginal delivery), >1,000mls
(abdominal delivery), ANY blood loss sufficient enough to cause
haemodynamic instability.
o Occurs in up to 18% of births, ¼ of all deaths worldwide, top 4 in
o developed countries due to; Hypo-volemic shock, Disseminated
Intravascular Coagulation (DIC), Renal failure, Hepatic failure,
Acute Respiratory Distress Syndrome (ARDS).
o Is most common maternal morbidity in developed countries
although risk factors and preventive strategies are clearly
documented
 Types of PPH

A. PRIMARY PPH - blood loss of 500ml or more

within 24hours of delivery.

B.SECONDARY PPH - blood loss of 500ml or more

between 24 hours and 6 weeks after birth.
C.MASSIVE PPH - PPH with blood loss in excess of
1,500ml
*Rate of blood loss is also essential
 RISK FACTORS

 First pregnancy  Augmented labor

 High Multiparity  Rapid labor
 Maternal obesity  Prolonged first of labor
 Large baby  Prolonged third stage of labor
 Previous PPH  Episiotomy
 Multiple pregnancy  Operative delivery
 Hydramnios  Chorioamnonitis
 Antepartum hemorrhage  Use of uterine relaxing agents
 Preeclampsia
What are the causes of postpartum hemorrhage?
4Ts

4 T’s
TONE TISSUE

THROMBI TRAUM
N A
 Causes
Tone Tissue
 Previous PPH  Retained placenta/
 Prolonged labour
 membrane/clot
 Age > 40 years
 Big baby
 Multiple pregnancy
 Placenta praevia
 Obesity
 Asian ethnicity
 Causes cont…
Thrombin Trauma
Abruption Caesarean section
PET (emergency > elective)
Pyrexia Perineal trauma
Intrauterine death
Operative delivery
Amniotic fluid embolism
Vaginal and cervical tears
Uterine rupture

DIC
Management of Primary PPH

Has the placenta been

delivered and is it complete?

Is the uterus well-contracted?

Is the bleeding due to trauma?

 Management of Primary PPH
PLACENTA RETAINED Management of the 3rd stage
 Rub up  Check the fundus? 2nd baby!!

 Call for help  Oxytocic agent - Ergometrine

 Oxytocic  Signs of separation - show, the cord

lengthens,fundus rises, suprapubic test
 Resuscitate +ve
 Take blood: CBC, crossmatch,  Ensure the uterus is contracted
coagulation study  Controlled cord traction / Brandt Andrews
 Controlled cord traction / Brandt  Observations - regular checks for 1 hour
Andrews  Check the placenta
 Manual removal
 Mgt of Primary PPH cont…
PLACENTA OUT
 Rub up the uterus
 Call for help!!
 Oxytocin –Ergometrine-IM
 Resuscitation
 Blood for CBC, cross match, coagulation
study
 Inspect the placenta? Complete
 Check the perineum vagina and cervix
 If bleeding continues – EUA
Uterine rupture
 Neglected obstruction
 Previous classical caesarean section
 Traumatic external e.g. MVA
 Iatrogenic: forceps, ventouse
 Repair or hysterectomy
 Uterine packing / Balloon tamponade
 Ligation of uterine or internal iliac
 artery
 Hysterectomy
Management of Secondary PPH

Retained products of conception- Removal

Intrauterine infection- Give Antibiotics
Do Exploration.
Prevention of postpartum haemorrhage
 Health education during antenatal care. teach the woman to eat balance diet
 Active management of the 3rd stage include ,
 Administering oxytocin soon after the delivery of the anterior shoulder.
 Use cord controlled traction to delivery the placenta
 Usually- early cord clamping
 Give misoprostol tablet orally or rectal
 Check tear and repair
 Repair episiotomy if you done
 Use partograph to monitor the labour pain.
 Uterine inversion occur due to mismanagement of 3 rd stage of labour, use active
management of the third stage of labour may reduce the incidence of uterine inversion.
 Treat infection earlier during pregnant.
Thank
you!