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POSTPARTUM HEMORRHAGE
Dr.Suresh Babu Chaduvula
Professor
Dept. of Obstetrics & Gynecology
College of Medicine, Abha, KKU, Saudi Arabia
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- 4 %
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
Third Stage hemorrhage: Bleeding occurs before the expulsion of
placenta Example- Placenta accreta,increta and
percreta & retained placenta True Postpartum hemorrhage: Occurs after the expulsion of placenta
Secondary or Delayed or Late Postpartum hemorrhage:
Bleeding occurs following delivery of the baby after 24 hours up to 6 weeks.
THE FOUR “T” TO REMEMBER
ToneTissueTrauma
Thrombin
PRIMARY POSTPARTUM HEMORRHAGE Causes: 1] Atonic 2] Traumaic 3] Mixed 4] Retained Placenta 4] Coagulopathy
PPH RISK FACTORS
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
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
PPH RISK FACTORS
PPH RISK FACTORS
TRAUMATIC PPH 1] Cervix – lacerations 2] Vaginal laceration 3] Perineum injury 4] Paraurethral injury 5] Uterine rupture
Retained Placenta Placenta accreta, increta and
percreta Succentuirate placenta.
PPH RISK FACTORS
Blood coagulation Disorders: Abruptio Placenta, Jaundice,
Thrombocytopenic purpura, HELLP syndrome
Combination of Atonic and Traumatic:
DIAGNOSIS Vaginal bleeding may be revealed or
concealed
Alteration in pulse, Blood pressure and Pulse pressure
Flabby uterus in atonic uterus
PPH
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.
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 preventative measures have failed.
MANAGEMENT OF PPH
MANAGEMENT OF PPH
MANAGEMENT OF PPH
DRUG THERAPY FOR PPH
MANAGEMENT OF PPH
MANAGEMENT OF PPH
THE B-LYNCH SUTURING
Description of technique
SUMMARY: REMEMBER 4 TS
Tone Tissue Trauma Thrombin
SUMMARY: REMEMBER 4 TS “TONE” Rule out Uterine
Atony
Palpate fundus. Massage uterus. Oxytocin Methergine Hemabate
SUMMARY: REMEMBER 4 TS “Tissue” R/O retained
placenta
Inspect placenta for missing cotyledons.
Explore uterus. Treat abnormal
implantation.
SUMMARY: REMEMBER 4 TS “TRAUMA” R/O cervical or
vaginal lacerations.
Obtain good exposure.
Inspect cervix and vagina.
Worry about slow bleeders.
Treat hematomas.
SUMMARY: REMEMBER 4 TS “THROMBIN” Replacement with
blood or Fresh frozen plasma or Platelet rich pasma.
THANK YOU