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

    1. 1. POSTPARTUM HAEMORRHAGE<br />MOHD HANAFI BIN RAMLEE<br />MBBS IIIB<br />1<br />
    2. 2. PPH: DEFINITION<br />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.<br />-WHO-<br />ANTEPARTUM HAEMORRHAGE<br />24 hours<br />6 weeks<br />PRIMARY<br />SECONDARY<br />Conception<br />22 weeks<br />Foetal viability<br />POSTPARTUM HAEMORRHAGE<br />2/15<br />
    3. 3. PRIMARY PPH: AETIOLOGY<br />3/15<br />
    4. 4. SECONDARY PPH: AETIOLOGY<br />Retained products of conception<br />Infection<br />Breakdown of uterine wound<br />Chronic sub-involution of uterus<br />Thophoblastic disease (rare)<br />Endometrial cancer (rare)<br />4/15<br />
    5. 5. PPH: UTERINE ATONY<br />Most dangerous<br />Uterus although empty, fail to contract and control bleeding from the placental site following the delivery of the placenta.<br />PREDISPOSING FACTOR<br /><ul><li>Over distention of uterus (multiple pregnancy, polyhydromnious, macrosomia)
    6. 6. Retained product of conception
    7. 7. Prolonged labour
    8. 8. Oxytocin augmentation of labour
    9. 9. Grandmultiparity
    10. 10. Antepartumhaemorrhage
    11. 11. Uterine fibroid
    12. 12. General anesthetic drugs (halothane)
    13. 13. Precipitate delivery
    14. 14. Chorioamnionitis
    15. 15. Magnesium sulphate treatment of PIH
    16. 16. Anemia</li></ul>5/15<br />
    17. 17. PPH: RETAINED PLACENTA<br />Defined as failure of the placenta to be expelled within 30 minutes after delivery of the fetus.<br />2% of deliveries  continues bleeding<br />Causes:<br />Placenta separated but undelivered<br />Placenta partly or wholly attached<br />Placenta accreta<br />6/15<br />
    18. 18. PPH: GENITAL TRACT TRAUMA<br />Commonly follow an assisted delivery (forceps, ventouse)<br />Episiotomy can sometimes extends upwards and cause bleeding.<br />Uterine rupture at<br />previous caesarean section<br />previous myomectomy<br />7/15<br />
    19. 19. PPH: UTERINE INVERTION<br />Uterus pushed “inside out”, fundus at the introitus<br />A rare complication.<br />Commonly occur due to mismanagement of third stage of labour(controlled cord traction is applied when the uterus is not contract, or excessive fundalpressure)<br />Uterine atony and uterine anomalies.<br />First Degree- (Incomplete)-inverted fundus reached the external os. <br />Second Degree- (Complete)-whole body of the uterus is inverted and protudes into the vagina<br />Third Degree- prolapse of inverted uterus, cervix and vagina outside the vulva<br />Consequences<br />Severe shock - anuria and renal failure<br />Sepsis<br />Chronic inversion<br />Uterus strangulate and slough off<br />8/15<br />
    20. 20. MANAGEMENT: POSTPARTUM HAEMORRHAGE<br />MOHD HANAFI BIN RAMLEE<br />MBBS IIIB<br />9<br />
    21. 21. At ANE: INITIAL ASSESSMENT AND START BASIC TREATMENT<br />10/15<br />
    22. 22. ANE to OT: TEMPORIZING AND TRANSFER INTERVENTION<br />ANE to OT: DRUGS OF CHOICE<br />If not available or bleeding still continue from previous drugs<br />ANE to OT: TORRENTIAL BLEEDING<br />11/15<br />
    23. 23. OT: FINDING THE CAUSES<br />12/15<br />
    24. 24. OT: SURGICAL TECHNIQUES FOR PPH<br />13/15<br />
    25. 25. OT: B-LYNCH SUTURE<br />14/15<br />
    26. 26. SUMMARY<br />Hemorrhage is one of the four leading causes of maternal mortality.<br />The average blood loss from an uncomplicated vaginal delivery is 500 mL, and for cesarean delivery it averages 1,000 mL.<br />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.<br />Postpartum hemorrhage may be due to uterine atony (the most common cause), genital tract lacerations, retained products of conception, or defection coagulation.<br />Medical management pertains primarily to the treatment of uterine atony and/or associated coagulopathy.<br />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% (<br />Uterine packing should be used primarily as a temporizing method to allow time for adequate volume replacement prior to laparotomy.<br />Surgical techniques for the management of postpartum hemorrhage include uterine compression sutures, uterine artery ligation, internal iliac artery ligation, and hysterectomy<br />THANK YOU!!!<br />15/15<br />

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