Postpartum haemorrhage (pph)

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Postpartum haemorrhage

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Postpartum haemorrhage (pph)

  1. 1. Postpartum Haemorrhage (PPH)By Ezmeer Emiral
  2. 2. •Postpartum Haemorrhage (PPH) ClassificationPRIMARY PPH SECONDARY PPH• Loss of MORE than or • Loss of MORE than or EQUAL to 500mL blood EQUAL to 500mL blood from the genital tract from the genital tract within 24 hours of between 24 hours and delivery 12 weeks post delivery
  3. 3. •Aetiology 5 “T”s Tone Uterine atony Tissue Retained placenta and/or membranes Trauma Injury to vagina, perineum ad uterine tears at Caesarean section Thrombin Clotting disorder Traction Uterine inversion
  4. 4. •Causes 1.Uterine atony 2.Retained placenta 3.Genital tract laceration 4.Coagulopathy 5.Acute inversion of uterus
  5. 5. •Uterine Atony Uterus fails to contract following delivery of placenta.• Can be predict.• Predisposing conditions: • Multiparity(Fibrosis of uterine muscle) • Over distension of uterus(eg: Macrosomia,polyhydramnios) • Prolong labour (uterine inertia) • Fibroid • Placenta previa • Oxytocin induce labour
  6. 6. •Causes 1.Uterine atony 2.Retained placenta 3.Genital tract laceration 4.Coagulopathy 5.Acute inversion of uterus
  7. 7. •Retained Placenta Prevent a uterus from contracting efficiently• Causes:• Placenta separated but undelivered• Placenta partly or wholly attached• Placenta accreta
  8. 8. •Causes 1.Uterine atony 2.Retained placenta 3.Genital tract laceration 4.Coagulopathy 5.Acute inversion of uterus
  9. 9. •Genital Tract Lacerations Perineal or vaginal tears.• Causes:• Intsrumental delivery (Cervical tears)• Episiotomy can extend upwards• Uterine rupture
  10. 10. •Causes 1.Uterine atony 2.Retained placenta 3.Genital tract laceration 4.Coagulopathy 5.Acute inversion of uterus
  11. 11. •Clotting disorder• Causes:• Von Willebrands Disease, Platelet disorder• Placenta Abruptio-Retroplacental clot leads to consumptive coagulopathy• Unidentified dead fetus• Amniotic fluid embolus-amniotic fluid entering maternal circulation
  12. 12. •Causes 1.Uterine atony 2.Retained placenta 3.Genital tract laceration 4.Coagulopathy 5.Acute inversion of uterus
  13. 13. •Acute Inversion of Uterus Uterus is pulled ‘inside out’ and the fundus at the introitus.• Caused by traction on the umbilical cord before placenta has separated.• Associated factors:-Fundal placenta-Short cord-Morbidly adherent placenta Third Degree Uterine Inversion• Cardiovascular collapse & shock.
  14. 14. •Uterine Inversion Stages/Classification• First Degree (Incomplete)-inverted fundus reached the external os.• Second Degree (Complete)-whole body of the uterus is inverted and protrudes into the vagina• Third Degree – prolapse of inverted uterus, cervix and vagina outside the vulva
  15. 15. •Johnson’s Method • (A)The protruding fundus is grasped with fingers directed toward the posterior fornix. • (B, C) The uterus is returned to position by pushing it through the pelvis and into the abdomen with steady pressure towards the umbilicus. • Acute inversion of uterus- reduced manually or O’Sullivan (hydrostatic pressure) or surgery.
  16. 16. •Complications of PPH• Circulatory collapse shock, organ failure, stroke,death• Sheehan’s syndrome – damage to pituitary – pituitary necrosis• Puerperal anaemia• Fear of further pregnancies
  17. 17. •ManagementDiagnosis & management occur simultaneously• ABC,fluid resuscitation• Feel abdomen-uterus poorly contracted• Rub the fundus gently –see wether uterus contract and bleeding arrested• Set up IV line & IV infusion of 40 units of syntocinon/B.C*/ intramyometrial injection of ergometrine or PG• Send blood for group and cross matching Bimanual Compression*• Examine placenta to see if it is complete-If uncompleted, sent to OT for manual exploration• If complete-Examine vagina and cervix in lithotomy position for laceration
  18. 18. •Management• No laceration?-Examination under anaesthesia(allow further measures eg:uterine tamponade,radioloical occlusion)• Exploratory Laporotomy(iliac artery ligation,sutures) B lynch suture• Hysterectomy• B lynch -sutures are placed in double loop that surround the uterus & aim to squeeze whole uterus by tightening them Uterine Balloons
  19. 19. •Postpartum Haemorrhage (PPH) ClassificationPRIMARY PPH SECONDARY PPH• Loss of MORE than or • Loss of MORE than or EQUAL to 500mL blood EQUAL to 500mL blood from the genital tract from the genital tract within 24 hours of between 24 hours and delivery 12 weeks post delivery
  20. 20. •Secondary PPH Rare cause of massive bleeding. • It is usually the result of: • Retained product of conception Clinical Sign •Crampy abdominal pain • Uterine infection •Delayed uterine involution •Signs of infection Management •Broad spectrum antibiotic •Gentle evacuation of uterus
  21. 21. Thank You for Your AttentionQuestions?

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