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Obstetric Haemorrhage . ZAHIDA QURESHI 10 TH JANUARY 2013. Definitions . Obstetric Haemorrhage APH –Bleeding from the genital tract from 22-24 weeks upto delivery PPH-bleeding after delivery of the baby 500mls after vaginal delivery and 1000 following c/section

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Obstetric Haemorrhage


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    1. Obstetric Haemorrhage ZAHIDA QURESHI 10TH JANUARY 2013

    2. Definitions • Obstetric Haemorrhage • APH –Bleeding from the genital tract from 22-24 weeks upto delivery • PPH-bleeding after delivery of the baby • 500mls after vaginal delivery and 1000 following c/section • Primary –within 24 hours • Secondary -upto 6 weeks

    3. Causes of Late Pregnancy Bleeding • Placenta Previa • Abruption • Ruptured vasa previa • Uterine scar disruption • Cervical polyp • Bloody show • Cervicitis or cervical ectropion • Vaginal trauma • Cervical cancer Life-Threatening

    4. Placenta Previa Low-Lying Marginal Complete

    5. WHO analysis of causes of maternal death: a systematic reviewLancet 367: 1066-1074, 2006

    6. Time from onset of complication to death • PPH 2 h • APH 12 h • Ruptured uterus 1 d • Eclampsia 2 d • Obstructed labour 3 d • Sepsis 6 d

    7. APH • Contribution to premature delivery, • Prediction and prevention • Use of steroids • Tocolytics to delay delivery • Time and mode of delivery

    8. Etiology of Postpartum haemorrhage Tone - uterine atony (70%) Tissue - retained tissue/clots(20%) Trauma - laceration, rupture, inversion (10%) Thrombopathy– coagulopathy (1%)

    9. Emergency Trolley Emergency protocols Endotracheal tube Laryngoscope Essential drugs Crystalloids, giving sets, haemacel

    10. THE GOLDEN HOUR • As more time elapses between the point of severe shock and the start of resuscitation, the percentage of surviving patients decreases • The “Golden Hour” is the time in which resuscitation must begin to achieve maximum survival

    11. USE OF OXYTOCIC DRUGS

    12. PROCEDURES

    13. Non-Pneumatic Anti Shock Garments • Criteria for Removal: Hgb 7.5 and Vital Signs Stable x 2 hours • START AT ANKLES • Wait 15 minutes between removing each segment, • Check Vital Signs • Do not continue REMOVAL if • BP decreases by 20 mm HG OR • Pulse increase by 20 BPM

    14. B-LYNCH PROCEDURE

    15. Research • Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial Lancet 2012; 379: 1721–27 • The WOMAN trial is a pragmatic, randomized, double‐blind, placebo‐controlled trial in women with a clinical diagnosis of PPH to determine the effect of tranexamic acid on death, hysterectomy, surgical intervention, blood transfusion and non‐fatal vascular occlusive events. • Ongoing 4 sites in Kenya, Globally 5000 women of 15,000 recited to end in Dec 2014 • Balloon Condom Tamponade