Postpartum hemorrhage (PPH) is defined as blood loss exceeding 500 ml after vaginal delivery within 24 hours. It is a leading cause of maternal mortality, especially in resource-poor settings. Risk factors include polyhydramnios, macrosomia, prolonged labor, and previous surgery. Management involves resuscitation, assessing uterine contraction, exploring the uterus, and administering oxytocics for atony or performing manual removal of placental tissue. Prevention strategies include active management of the third stage of labor with oxytocics immediately after delivery and risk assessment during antenatal care.
2. Definition
A blood loss in excess of 500ml after a vaginal
delivery, occurring in the first 24 hrs post-
partum
3. Background
PPH is a leading cause of maternal mortality
in resource-poor settings
Uterine blood flow (UBF) at term is 500-700
ml/min
Approx. 85% of UBF goes to the placental
cotyledons
9. Use of oxytocics
Useful in uterine atony
Oxytocin – im 10units, follow iv infusion 20 U
in 1 L (max. 3L)
Ergometrine – im/iv 0.5 mg bolus. Can repeat
after 15 min, then q4hrs (max 5 doses). Not used
in hypertensive or heart disease
Prostaglandins
10. Prevention
Risk assessment not reliable in predicting PPH
Active management of the third stage of labour –
give oxytocic at the delivery of the anterior
shoulder
Antenatal care – women with normal Hb levels are
more likely to tolerate blood loss
- Thank you
11. References
1. Managing complications in pregnancy and Childbirth. WHO;
http://www.who.int/reproductive-
health/inpac/Symptoms/Vaginal_bleeding_after_S25_S34.html
2. Prevention and Management of Postpartum Haemorrhage. SOGC.
http://sogc.medical.org/SOGCnetsogc_docs/common/guide/pdfs/ps88
.pdf