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Post partum hemorrhage LB

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A brief clinical and pathophysiological overview of PPH.

Published in: Health & Medicine
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Post partum hemorrhage LB

  1. 1. POST-PARTUM HEMORRHAGE Leul Biruk MD 014/15
  2. 2. Outline ■ Introduction : Definition and basic overview ■ Normal physiology post-partum ■ Sx and Dx ■ Etiology : “The 4T’s” ■ Risk Factors ■ General Management ■ Most common causes ■ References
  3. 3. Definition ■ A significant amount of blood loss post-partum (after delivery) that presents with symptoms or signs of low blood volume. ■ >500 ml with vaginal delivery or >1000 ml with a C-section (subj.) ■ > 10% decrease in hemoglobin or hematocrit (obj.)
  4. 4. Overview
  5. 5. Normal physiology post-partum
  6. 6. Sx ■ Heavy vaginal bleeding ■ Hypovolemia Hypovolemic shock  Dizzy  Lightheaded  confused Dx ■ Mostly limited to PE initially  Palpate the uterus • Increased size • Reduced muscle tone
  7. 7. Detection of Blood loss ■ 10%-15% loss (500 mL): no signs/symptoms ■ 20 %: tachycardia, tachypnea, delayed capillary refill, orthostatic changes, narrowed pulse pressure (due to elevated diastolic pressure from vasoconstriction to maintain systolic pressure) ■ 30% +: tachycardia/tachypnea worsen, overt hypotension ■ 40%-50%: profound blood loss: oliguria, shock, coma, and death
  8. 8. Etiology ■ The fourT’s:  Tone  Trauma  Tissue  Thromobosis
  9. 9. Oxytocin Methylergonovine Misoprostol
  10. 10. Risk Factors ■ Prolonged labor ■ Augmented labor ■ Rapid labor ■ Hx of prior hemorrhage ■ Episiotomy ■ Preeclampsia ■ Over distended uterus (macrosomia, multiple gestation, polyhydramnios) ■ Operative delivery ■ Ethnicity (Asian, Hispanic)
  11. 11. Most common causes: ■ Uterine atony (80%) ■ Retained placenta ■ Genital tract trauma (e.g., laceration) ■ Coagulation disorder ■ Hematoma ■ Uterine inversion ■ Uterine rupture
  12. 12. General management ■ Management facilitated if high-risk patients identified and preparations made occur prior to bleeding ■ Before delivery i. Baseline hematocrit ii. Blood type and screen (cross match for high risk) iii. IV access iv. Baseline coagulation tests and platelets if indicated v. Assessment of risk factors
  13. 13. ■ Delivery room i. Excess umbilical cord traction avoided ii. Judicious use of forceps/vacuum iii. Inspection of placenta for complete removal iv.Active management of 3rd stage v.Visualization of cervix/vagina vi. Removal of clots from uterus/vagina prior to transfer to recovery
  14. 14. ■ After delivery i. Observation of patient for excessive bleeding ii. Frequent palpation/massage of uterus iii.Vital signs frequently monitored
  15. 15. References ■ Danforth'sObstetrics and Gynecology 10th ■ Step-up to obstetrics and gynecology / [edited by] FrankW. Ling, Russell R. Snyder, SandraAnn Carson,Wesley C. Fowler. — 1st edition ■ Postpartum hemorrhage - Reproductive system physiology - NCLEX-RN - Khan Academy ■ Osmosis.org : Postpartum hemorrhage - causes, symptoms, treatment, pathology
  16. 16. Thank you for listening…… ……and your welcome!

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