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Postpartum hemorrhage and Its Management
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Postpartum hemorrhage and Its Management

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  • 1. Dr.Suresh Babu Chaduvula Professor Dept. of Obstetrics & Gynecology College of Medicine, Abha, KKU, Saudi Arabia
  • 2.  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 %
  • 3.  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
  • 4.  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
  • 5.  Secondary or Delayed or Late Postpartum hemorrhage:  Bleeding occurs following delivery of the baby after 24 hours up to 6 weeks.
  • 6. Tone Tissue Trauma Thrombin
  • 7.  Causes:  1] Atonic  2] Traumaic  3] Mixed  4] Retained Placenta  4] Coagulopathy
  • 8.  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
  • 9.  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
  • 10.  1] Cervix – lacerations  2] Vaginal laceration  3] Perineum injury  4] Paraurethral injury  5] Uterine rupture Retained Placenta Placenta accreta, increta and percreta Succentuirate placenta.
  • 11. Blood coagulation Disorders:  Abruptio Placenta, Jaundice, Thrombocytopenic purpura, HELLP syndrome  Combination of Atonic and Traumatic:
  • 12.  Vaginal bleeding may be revealed or concealed  Alteration in pulse, Blood pressure and Pulse pressure  Flabby uterus in atonic uterus
  • 13.  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.
  • 14.  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.
  • 15. Description of technique
  • 16.  Tone  Tissue  Trauma  Thrombin
  • 17.  “TONE”  Rule out Uterine Atony  Palpate fundus.  Massage uterus.  Oxytocin  Methergine  Hemabate
  • 18.  “Tissue”  Inspect placenta for missing cotyledons.  R/O retained placenta  Explore uterus.  Treat abnormal implantation.
  • 19.  “TRAUMA”  R/O cervical or vaginal lacerations.  Obtain good exposure.  Inspect cervix and vagina.  Worry about slow bleeders.  Treat hematomas.
  • 20.  “THROMBIN”  Replacement with blood or Fresh frozen plasma or Platelet rich pasma.
  • 21. THANK YOU