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Postpartum haemorrhage
 

Postpartum haemorrhage

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  • Uterine packing – balloon, tampone,Torpin packer.
  • By Professor Christopher B-LynchThe B-Lynch suture was first described in five women in 1997. In a review of the technique along with other uterine compression suture techniques, it has been reported that out of a 1,000 procedures performed, the failure rate was less than 1%. Very simply, the technique involves placing an absorbable suture in the lower uterine segment and then looping the suture over the fundus. The suture is then passed transversely through the lower uterine segment on the posterior surface of the uterus to the opposite side. The suture is then looped back over the uterine fundus (opposite side of the first loop) and then passed through the lower uterine segment on the anterior suture. Tying off the suture anteriorly results in vertical uterine compression

Postpartum haemorrhage Postpartum haemorrhage Presentation Transcript

  • POSTPARTUM HAEMORRHAGE
    MOHD HANAFI BIN RAMLEE
    MBBS IIIB
    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 HAEMORRHAGE
    24 hours
    6 weeks
    PRIMARY
    SECONDARY
    Conception
    22 weeks
    Foetal viability
    POSTPARTUM HAEMORRHAGE
    2/15
  • PRIMARY PPH: AETIOLOGY
    3/15
  • SECONDARY PPH: AETIOLOGY
    Retained products of conception
    Infection
    Breakdown of uterine wound
    Chronic sub-involution of uterus
    Thophoblastic disease (rare)
    Endometrial cancer (rare)
    4/15
  • 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
    • Antepartumhaemorrhage
    • Uterine fibroid
    • General anesthetic drugs (halothane)
    • Precipitate delivery
    • Chorioamnionitis
    • 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
    6/15
  • PPH: GENITAL TRACT TRAUMA
    Commonly follow an assisted delivery (forceps, ventouse)
    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 fundalpressure)
    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
    Consequences
    Severe shock - anuria and renal failure
    Sepsis
    Chronic inversion
    Uterus strangulate and slough off
    8/15
  • MANAGEMENT: POSTPARTUM HAEMORRHAGE
    MOHD HANAFI BIN RAMLEE
    MBBS IIIB
    9
  • At ANE: INITIAL ASSESSMENT AND START BASIC TREATMENT
    10/15
  • ANE to OT: TEMPORIZING AND TRANSFER INTERVENTION
    ANE to OT: DRUGS OF CHOICE
    If not available or bleeding still continue from previous drugs
    ANE to OT: TORRENTIAL BLEEDING
    11/15
  • OT: FINDING THE CAUSES
    12/15
  • OT: SURGICAL TECHNIQUES FOR PPH
    13/15
  • OT: B-LYNCH SUTURE
    14/15
  • 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% (
    Uterine packing should be used primarily as a temporizing method to allow time for adequate volume replacement prior to laparotomy.
    Surgical techniques for the management of postpartum hemorrhage include uterine compression sutures, uterine artery ligation, internal iliac artery ligation, and hysterectomy
    THANK YOU!!!
    15/15