1 / 34

Postpartum Hemorrhage

Postpartum Hemorrhage. Dr.Suresh Babu Chaduvula Professor Dept. of Obstetrics & Gynecology College of Medicine, Abha , KKU, Saudi Arabia. POSTPARTUM HEMORRHAGE [ PPH ]. Definition:

bacaj
Download Presentation

Postpartum Hemorrhage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Postpartum Hemorrhage Dr.SureshBabuChaduvula Professor Dept. of Obstetrics & Gynecology College of Medicine, Abha, KKU, Saudi Arabia

  2. POSTPARTUM HEMORRHAGE [ PPH ] • Definition: • More than 500 ml of blood loss following normal vaginal delivery of the fetus or 1000ml following Cesarean section. • Clinically the amount of blood loss from or into the genital tract which will adversely affect the general condition of the patient • Hemorrhage leading to fall in hematocrit by 10 %. • Incidence – 1 %

  3. TYPES • 1] Primary 2] Secondary • Primary – bleeding occurs following delivery of the baby up to 24 hours • Primary is two types: • A] Third Stage hemorrhage • B] True Post Partum hemorrhage

  4. Third Stage hemorrhage: • Bleeding occurs before the expulsion of placenta • Example- Placenta accreta, retained placenta • True Postpartum hemorrhage: • Occurs after the expulsion of placenta

  5. Secondary or Delayed or Late Postpartum hemorrhage: • Bleeding occurs following delivery of the baby after 24 hours up to 6 weeks.

  6. Primary Postpartum Hemorrhage • Causes: • 1] Atonic • 2] Traumaic • 3] Mixed • 4] Coagulopathy

  7. Atonic PPH • Contributes for 80 % of PPH • Commonest cause of PPH • Cause – Faulty retraction of the uterus • Etiology: • 1] Grand Multipara • 2] Over- distension of uterus – Multiple pregnancy, Hydramnios, big baby • 3] Anemia

  8. 4] Prolonged Labor • 5] Anaesthesia – Halothane. Ether, • Cyclopropane • 6] Uterine fibroid • 7] Precipitate labor • 8] Malformations of uterus – septate uterus, bicornuate uterus • 9] Ante partum hemorrhage • 10] Initiation & augmentation of delivery with oxytocin

  9. Traumatic PPH • 1] Cervix – lacerations • 2] Vaginal laceration • 3] Perineum injury • 4] Paraurethral injury • 5] Uterine rupture

  10. Combination of Atonic and Traumatic: • Blood coagulation Disorders: • Abruptio Placenta, Jaundice, Thrombocytopenic purpura, HELLP syndrome

  11. The Four “T” to remember Tone Tissue Trauma Thrombin

  12. PPH Risk Factors

  13. PPH Risk Factors

  14. PPH Risk Factors

  15. PPH Risk Factors

  16. DIAGNOSIS • Vaginal bleeding may be revealed or concealed • Alteration in pulse, Blood pressure and Pulse pressure • Flabby uterus in atonic uterus

  17. PPH

  18. PREVENTION OF PPH • UTEROTONIC DRUGS • Routine oxytocic administration in the third stage of labour can reduce the risk of PPH by more than 40% • The routine prophylaxis with oxytocics results in a reduced need to use these drugs therapeutically • Management of the third stage of labour should therefore include the administration of oxytocin after the delivery of the anterior shoulder.

  19. MANAGEMENT OF PPH • Early recognition of PPH is a very important factor in management. • An established plan of action for the management of PPH is of great value when the preventive measures have failed.

  20. MANAGEMENT OF PPH

  21. MANAGEMENT OF PPH

  22. DRUG THERAPY FOR PPH

  23. MANAGEMENT OF PPH

  24. MANAGEMENT OF PPH

  25. MANAGEMENT OF PPH

  26. The B-Lynch Suturing Description of technique

  27. Summary: Remember 4 Ts • Tone • Tissue • Trauma • Thrombin

  28. Summary: remember 4 Ts • “TONE” • Rule out Uterine Atony • Palpate fundus. • Massage uterus. • Oxytocin • Methergine

  29. Summary: remember 4 Ts • “Tissue” • R/O retained placenta • Inspect placenta for missing cotyledons. • Explore uterus. • Treat abnormal implantation.

  30. Summary: remember 4 Ts • “TRAUMA” • R/O cervical or vaginal lacerations. • Obtain good exposure. • Inspect cervix and vagina. • Worry about slow bleeders. • Treat hematomas.

  31. Summary: remember 4 Ts • “THROMBIN” • Replacement with blood or Fresh frozen plasma or Platelet rich plasma.

  32. THANK YOU

More Related