Understanding pph

1,653
-1

Published on

Published in: Health & Medicine, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,653
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Understanding pph

  1. 1. UNDERSTANDING POSTPARTUM HAEMORRHAGE Dr AHMAD MUZAMIR A.MUSTAFA O&G Department HOSPITAL ALOR SETAR 05/03/2004
  2. 2. A journey of a thousand miles begins with the first step
  3. 3. PROBLEM GIVING LECTURE AT THIS HOUR…
  4. 4. Introduction  Leading cause of maternal death – Malaysia and developing countries  30-40% of maternal deaths every year  Mostly in grandmultiparas, minority groups and immigrants, delivered at home by untrained birth attendants
  5. 5. Main Causes of Maternal Mortality In Malaysia 25 20 15 1995 1996 10 5 0 PPH HDP Em b Traum a Sepsis Unsp Source : CEMD 1995-1996
  6. 6. PPH - definition  Bleeding from the genital tract after delivery of the baby exceeding 500 mls or enough blood loss to cause hypotension and shock  PRIMARY – WITHIN 24 HOURS  SECONDARY – AFTER 24 HOURS (includes all cases of excessive or abnormal bleeding from the genital tract occuring after 24H of delivery up to 6 weeks postpartum
  7. 7. CAUSES  UTERINE ATONY  RETAINED PRODUCT OF CONCEPTION  INJURY OF THE GENITAL TRACT  COAGULATION DISORDER  UTERINE INVERSION/RUPTURE
  8. 8. PPH……. CAUSES (CEMD 1996) CAUSES NUMBERS PERCENTAGE RETAINED PLACENTA UTERINE ATONY 26 59.1 17 38.6 SECONDARY PPH 1 2.3 COAG.DEFECT 0 0 UTERINE RUPTURE UTERINE INVERSION CERVICAL LACERATION PELVIC HAEMATOMA 7 46.7 2 13.3 4 26.7 2 13.3
  9. 9. Uterine Atony Uterus fails to contract – vessels at the placental bed not obliterated – excessive bleeding
  10. 10. Uterine Atony  Risk factors:  Grandmultiparity  Overdistension of uterus – twin, polyhydramnios, macrosomic baby  Exhausted uterus - Prolonged labour, Instrumental delivery  Severe anaemia
  11. 11. Retained POC  Failure of contraction of uterus over where products are retained  Partial separation of placenta – bleeding from retroplacental space
  12. 12. Genital tract injury/ Obstetric Trauma Types of tear: Perineal tear Ruptured vulval varicosities Vaginal lacerations Cervical lacerations Uterine rupture
  13. 13. Uterine inversion  Inverted uterus – unable to contract – bleeding from placental bed
  14. 14. Coagulation disorder  1-2% of maternal death  Chronic – von Willebrand’s disease, idiopathic thrombocytopenia, patients on anticoagulant therapy  Acute – eclampsia, HELLP syndrome, Amniotic fluid embolism
  15. 15. EFFECTS OF PPH  Death  Anaemia, poor recovery from delivery, prone to infection  Complications from blood and blood products transfusion  Late complications – Sheehan’s syndrome (necrosis of pituitary gland) – failure of endocrine function, needs replacement Rx.
  16. 16. CONCLUSION        PPH LEADING CAUSE MATERNAL MORTALITY Access to blood and blood products at maternity centres RED ALERT SYSTEM PPH training manual Improving emergency obstetric care at health facilities All high risk women should be delivered in a hospital with appropriate facilities and personnel Obstetric flying squads in appropriate circumstances

×