Dr. Joshua Cherukuri B.Sc.,MBBS If any suggestions, contact : joshuachowdarycherukuri@gmail.com

1. DR. JOSHUA, CHERUKURI
14-JUL-2019
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2.  Cumulative blood loss ≥ 1000cc within 24 hours of
delivery (cesarean or vaginal).
or
 Blood loss that is partnered with associated signs &
symptoms of hypovolemia within 24 hours of delivery.
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3.  Estimated Blood loss is commonly half of the actual
blood loss.
 6% of volume decrease in post partum hematocrit is a
clinically significant blood loss with vaginal delivery.
 This decrease signifies > 1000ml loss in average-sized
women..
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4. Tone (Uterine Atony)
Trauma (Lacerations/Rupture)
Tissue (Retained Products)
Thrombin (Coagulopathy)
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5.  Over worked: Rapid Labor, Prolonged Labor
 Infected: Chorioamnionitis
 Relaxed: Mgso4, Halothane, B-Adrenergic agonists
 Overdistended:
Multiple pregnancy, Polyhydramnios, Macrosomia
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6. Clinical Findings:
 Soft & Doughy Uterus (above the umbilicus)
Management:
Bimanual Uternine Massage
Uterotonics: Oxytocin,Methergine,PGF2
alpha(hemabate)
Gentle cord traction
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10. RISK FACTORS:
Uncontrolled vaginal delivery
Traumatic vaginal delivery(Macrosomia)
Operative vaginal delivery( Forceps, Vaccum assisted)
CLINICAL FINDINGS:
Lacerations
Bleeding in presence of contracted uterus
MANAGEMENT:
Surgical repair
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11. RISK FACTORS
Accessory Lobe (very common)
Placenta Accreta (Rare)
CLINICAL FINDINGS
Missing Cotyledons in contacted uterus
MANAGEMENT
Manual removal Curettage under SONO
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14. RISK FACTORS
Abruption(common), Severe Pre –eclampsia (low
platelets and prolonged PTT) , Amniotic Fluid
embolus(unusual),
Demise(prolonged retention of dead fetus)
CLINICAL FINDINGS:
Genaralised oozing, Petechiae in presence of contracted
uterus
MANAGEMENT:
Remove POC, ICU, Blood products as needed like fresh
frozen plasma, plateletes etc
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15. Uterus not palpable, Inverted Uterus
Risk factors
Myometrial Weakness(most common)
Previous history of Uterine inversion
Clinical Findings
Beefy bleeding mass, Cannot palpate uterus
Management
Vaginal fornices , IV oxytocin
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19. MANAGEMENT :
Ligation of Uterine Vessels(ovarian artery and uterine
artery), Internal iliac artery.
 some times need to do hystercetomy
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20. RISK FACTORS
Post partum hemorrhage
Leading to Anterior Pituitary Insuffucency causes 1st
symptom loss of a trophic harmone “prolactin”.
First symptom : Lactation Failure
Hormones: subsequently the harmones which we
follow depending on severity is >FSH/LH > If
complete Infarction, then TSH/ACTH.
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