POSTPARTUM HEMORRHAGE

Maria Fatima C. Padre

MID2Y2-1

PPH: DEFINITION
PPH is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 Hours. -WHO-

ANTEPARTUM HEMORRHAGE

24 hours Conception 22 weeks Fetal viability

PRIMARY SECONDARY

6 weeks

POSTPARTUM HEMORRHAGE

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PRIMARY PPH: AETIOLOGY

TONE [Abnormality Of Uterine Contraction]
Over distended uterus Uterine muscle exhaustion / Uterine Atony [90%] Intra amniotic infection Functional/anatomic distortion of the uterus

TISSUE [Retained Product Of Conception]

Retained products Abnormal placenta

Placenta Praevia /Abruptio Placenta

Blood clots and cotyledon

4T S AETIOLOGY OF PRIMARY PPH

TRAUMA [At Genital Tract] Cervix, vagina , perineum laceration
Caesarean section laceration Uterine rupture

THROMBIN [Abnormality Of Coagulation]

Coagulopathy
therapeutic

Uterine inversion

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SECONDARY PPH: AETIOLOGY 1. 2. 3. 4. 5. Retained products of conception Infection Breakdown of uterine wound Throphoblastic disease (rare) Endometrial cancer (rare)
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PPH: UTERINE ATONY

Most dangerous Uterus although empty, fail to contract and control bleeding from the placental site following the delivery of the placenta.
PREDISPOSING FACTOR Over distention of uterus (multiple pregnancy, polyhydromnious, macrosomia) Retained product of conception Prolonged labour Oxytocin augmentation of labour Grandmultiparity Antepartum hemorrhage General anesthetic drugs (halothane) Magnesium sulphate treatment of PIH Anemia 5/15

PPH: RETAINED PLACENTA

Defined as failure of the placenta to be expelled within 30 minutes after delivery of the fetus. 2% of deliveries continues bleeding Causes: Placenta separated but undelivered Placenta partly or wholly attached Placenta accreta

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PPH: GENITAL TRACT TRAUMA

Commonly follow an assisted delivery (forceps) Episiotomy can sometimes extends upwards and cause bleeding. Uterine rupture at previous caesarean section previous myomectomy
7/15

PPH: UTERINE INVERTION

Uterus pushed inside out, fundus at the introitus A rare complication. Commonly occur due to mismanagement of third stage of labour (controlled cord traction is applied when the uterus is not contract, or excessive fundal pressure) Uterine atony and uterine anomalies.

First Degree- (Incomplete)-inverted fundus reached the external os. Second Degree- (Complete)-whole body of the uterus is inverted and protudes into the vagina Third Degree- prolapse of inverted uterus, cervix and vagina outside the vulva Severe shock - anuria and renal failure Sepsis Chronic inversion Uterus strangulate and slough off

Consequences

8/15

MANAGEMENT: POSTPARTUM HEMORRHAGE

Maria Fatima C. Padre
MID2Y2-1

At ANE: INITIAL ASSESSMENT AND START BASIC TREATMENT

Call for help Monitor Vital Sign Catheterize bladder and monitor urine output

Assess Airway, Breathing, Circulation [ABC]

Start fluid replacement with IV crystalloid

Assess need for blood transfusion

Provide Supplementary Oxygen

Lab test Obtain an intravenous line

FBC, Coagulation Blood Group Cross Match

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SUMMARY
Hemorrhage is one of the four leading causes of maternal mortality. The average blood loss from an uncomplicated vaginal delivery is 500 mL, and for cesarean delivery it averages 1,000 mL. Although there is no universally accepted definition for postpartum hemorrhage, it would seem reasonable to define postpartum hemorrhage as blood loss that produces signs and symptoms of hemodynamic instability. Postpartum hemorrhage may be due to uterine atony (the most common cause), genital tract lacerations, retained products of conception, or defection coagulation. Medical management pertains primarily to the treatment of uterine atony and/or associated coagulopathy. Blood volume replacement should begin with crystalloid followed by packed red blood cells to maintain a urine output of 25 to 30 mL or more per hour and the hematocrit at or near 30%

THANK YOU!!!
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