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Post-partum haemorrhage

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An overview of post-partum haemorrhage

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Post-partum haemorrhage

  1. 1. Post Partum Haemorrhage Dhammike Silva Senior Lecturer Faculty of Medicine USJP
  2. 2.  Primary  Loss of 500ml of blood within 24hrs after delivery  Major PPH >1000ml  Secondary  Blood loss greater than expected 24hrs to 12 weeks Definition
  3. 3.  Developed countries 5%  Sri Lankan  2014 Maternal mortality 113 (MMR 33.7)  PPH 11  2015 Maternal mortality 112 (MMR 32.03)  PPH 10  Morbidity & near misses are much more higher than mortalities Incidence Family Health Bureau Sri Lanka
  4. 4.  TOO LITTLE….... TOO LATE…... Blood transfusion in PPH
  5. 5.  Antenatal diagnosis  Oral iron  Parental iron  Active management of third stage Reducing Risk of BT
  6. 6.  CONSENT  SAMPLES FOR CROSS MATCHING  ABO, Rh D and KELL  CMV SERONEGATIVE RED CELL AND PLATELETS – UNIVERSAL LEUCOCYTE DEPLETION  GROUP O ,Rh D NEGATIVE ,KELL NEGATIVE
  7. 7.  PROPERATIVE/PREDELIVERY AUTOLOGOUS BLOOD DEPOSIT  INTRAOPERATIVE CELL SALVAGE MINIMISING USE OF BANKED BLOOD
  8. 8.  PROTOCOL  SKILLS AND DRILLS  MECHANICAL STRATEGIES MANAGEMENT
  9. 9. WHEN ? O , Rh D NEGATIVE WHAT COMPONENTS ?
  10. 10. Ideally same group but others possible 12-15 ml / kg Maintain PT and APTT Regular FBC, and coagulation screen during PPH Cryoprecipitate – standard dose of two 5 unit pools then according to Fibrinogen ( aim at levels > 1.5 g/l ) Fibrinogen 2.9 g / l ( normal 3.5 – 6.5 in pregnancy) Viral transmission FFP and CRYOPRECIPITATE
  11. 11.  Aim  Transfusion trigger  Ideally Group compatible  ABO Non identical possible – HLA matched  Anti D Platelets
  12. 12.  Initiates blood coagulation  Arterial thrombosis  No RCT’S in PPH  Incidence of Thrombotic complications 2.5 % Recombinant factor VII a
  13. 13.  THROMBOELASTOGRAPHY ( TEG)  ROTATION THROMBOELASTOMETRY ( ROTEM)  VALIDATED TRANSFUSION ALGORITHM PROTOCOL  QUALITY ASSURANCE MEASURES  NO RCT’s NEAR PATIENT TESTING
  14. 14.  No place still Fibrinogen concentrate
  15. 15.  Tranexamic Acid  Misoprostol Antifibrinolytics and Misoprostol
  16. 16. Aetiology
  17. 17. B Lynch
  18. 18. Airway, breathing, O2 10-15L/min, RR Consciousness Reassurance 14G cannula, Blood 20ml FBC Coag, cross match Hartmann 2L Colloids 1.5L Blood, FFP, Platelets, Cryoprecipitate Monitoring Oxytocin bolus infusion Ergometrine bolus PGF2 alpha IM/ direct Tranexemic acid/ Factor VII Foley catheter Misoprostol 1000mg Tone, Trauma, Retained products Uterine massage Communication
  19. 19. Thank you.....

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