2. Postpartum haemorrhage refers to any amount of
bleeding from or into the genital tract following
birth of the baby upto the end of puerperium .
3. ⦁ Primary postpartum hemorrhage is the
hemorrhage occurring during the third stage of
labor and within 24 hours of delivery.
⦁ Secondary postopartum hemorrhage is
hemorrhage occurring after 24hours of
delivery and within 6weeks of delivery.
4. Primary postpartum hemorrhage are:
⦁ Atonic uterus
⦁ Trauma
⦁ Mixed ( combination of both atonic and trauma)
⦁ Retained product of conception
⦁ Uterine rupture
⦁ Uterine inversion
⦁ Blood coagulopathy
5. Secondary postpartum haemorrhage include:
⦁ Retained bits of membranes.
⦁ Infection
⦁ Cervico-vaginal laceration
⦁ Endometritis
⦁ invasive placenta
⦁ Secondary hemorrhage from caesarean section
⦁ Other rare causes – chorion epithelioma, carcinoma
cervix, placental polyp and fibroid polyp
6. ⦁ Prolonged third stage of labor
⦁ Multiple delivery
⦁ Episiotomy
⦁ Fetal macrosomia
⦁ History of postpartum hemorrhage.
⦁ Grandmultiparity
⦁ Placenta previa
⦁ Placental abruption
⦁ Pregnancy induced hypertension
⦁ Infection
7. ⦁ Massive blood loss
⦁ Passing large clots
⦁ Dizziness
⦁ Fatigue.
⦁ Decreased blood pressure.
⦁ Increased heart rate
⦁ Swelling and pain in tissues in the vaginal and
perineal area
9. ⦁ Slow delivery of the baby.
⦁ Spontaneous separation and delivery of placenta
during caesarean section.
⦁ Active management of third stage of labor.
⦁ Examination of placenta.
⦁ Induced or accelerated labor by oxytocin.
⦁ Exploration of utero-vaginal canal.
⦁ To observe the patient for about two hours after
delivery.
10. ⦁ Rub up the uterus to stimulate contraction and
retraction.
⦁ Administer ergometrine IM or Syntometrine IM
⦁ Expel the placenta with the next uterine
contraction by fundal pressure or controlled cord
traction.
⦁ Empty the urinary bladder by catheterization.
11. Tone
⦁ Uterine massage
⦁ Uterotonic agents - Uterotonic agents include
oxytocin, ergot alkaloids, and prostaglandins.
12. Trauma
⦁ Lacerations and hematomas- resulting from
birth trauma can cause significant blood loss
⦁ Uterine Rupture - Symptomatic uterine
rupture requires surgical repair of the defect
or hysterectomy.
⦁ Uterine inversion- is rare.
13. Classic signs of placental separation include a small gush
of blood with lengthening of the umbilical cord and a
slight rise of the uterus in the pelvis.
14. Thrombin
Coagulation disorders, a rare cause of post-
partum hemorrhage. Most coagulopathies are
identified before delivery, allowing for
advance planning preventing postpartum
hemorrhage.
