DefinitionA blood loss in excess of 500ml after a vaginal delivery, occurring in the first 24 hrs post- partum
Background PPH is a leading cause of maternal mortality  in resource-poor settings Uterine blood flow (UBF) at term is 5...
Aetiology Uterine atony - common Obstetric lacerations Retained placental tissue Inverted uterus Ruptured uterus Def...
Risk Factors   Polyhydramnios, multiple gestation, macrosomia   Prolonged labour, grandmultiparity   Fibroid, placenta ...
Management All available personnel should be mobilized.  Inform Obstetrician/anaeshetist. Resuscitate: iv access, O2 by ...
Management contd… Atony – massage, compress, oxytocics Placental causes – remove manually or do a  gentle curretage (if ...
Controlling bleeding Uterine exploration Bimanual compression &massage Abdominal aorta compression Curretage Oxytocic...
Use of oxytocicsUseful in uterine atony     Oxytocin – im 10units, follow iv infusion 20 U      in 1 L (max. 3L)     Erg...
Prevention Risk assessment not reliable in predicting PPH Active management of the third stage of labour –  give oxytoci...
References1.   Managing complications in pregnancy and Childbirth. WHO;     http://www.who.int/reproductive-     health/in...
Primary Postpartum Haemorrhage
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Primary Postpartum Haemorrhage

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Primary Postpartum Haemorrhage

  1. 1. DefinitionA blood loss in excess of 500ml after a vaginal delivery, occurring in the first 24 hrs post- partum
  2. 2. 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
  3. 3. Aetiology Uterine atony - common Obstetric lacerations Retained placental tissue Inverted uterus Ruptured uterus Defective coagulation
  4. 4. Risk Factors Polyhydramnios, multiple gestation, macrosomia Prolonged labour, grandmultiparity Fibroid, placenta praevia Previous surgery Precipitous or instrumental delivery Pregnancy induced hypertension Bleeding diasthesis, liver disease
  5. 5. Management All available personnel should be mobilized. Inform Obstetrician/anaeshetist. Resuscitate: iv access, O2 by mask, monitor vital signs, catheterize assess uterine contraction; explore uterus & LGT; expel & observe blood clots FBC, clotting profile, Group & Xmatch
  6. 6. Management contd… Atony – massage, compress, oxytocics Placental causes – remove manually or do a gentle curretage (if not morbidly adherent) Obstetric trauma – repair lacerations, correct inversion (under analgesia); identify rupture Reverse Coag. Defect – desmopressin, replace factors…
  7. 7. Controlling bleeding Uterine exploration Bimanual compression &massage Abdominal aorta compression Curretage Oxytocics Operative management
  8. 8. Use of oxytocicsUseful 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
  9. 9. 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
  10. 10. References1. Managing complications in pregnancy and Childbirth. WHO; http://www.who.int/reproductive- health/inpac/Symptoms/Vaginal_bleeding_after_S25_S34.html2. Prevention and Management of Postpartum Haemorrhage. SOGC. http://sogc.medical.org/SOGCnetsogc_docs/common/guide/pdfs/ps88 .pdf

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