3. Definition
SUBJECTIVE, any amount of blood loss affecting general condition
Clinical findings in PPH (degrees of shock)
NOTE: women may become compromised with small amount of blood loss
as in
Gestational HTN e proteinuria
Anemic or dehydrated, small stature
Compensation Mild Moderate Severe
Blood loss 500-1000 ml
10-15%
1000-1500
15-25%
1500-2000
25-35%
2000-3000
35-45%
SBP change None Slight fall
(80-100 mmHg)
Marked fall
(70-80 mmHg)
Profound fall
(50-70 mmHg)
S&S Palpitations
Dizziness
Tachycardia
Weakness
Sweating
Tachycardia
Restlessness
Pallor
Oliguria
Collapse
Air hunger
Anuria
4. Risk factors (4 T)
Tone
Over distension of uterus
•Polyhydraminos
•Twin
Uterine ms exhaustion
•Prolonged labor
•High parity
Intra-amniotic infection
•Prolonged ROM
•Fever
Tissue
Retained products
Retained blood clots
•Atonic uterus
Abnormal placenta
•Succenturiata
Trauma
Laceration of cervix,
vagina, perineum
Extensions, Lacerations at
Cs
Uterine rupture
Thrombin
Pre-existing (hemophilia)
Therapeutic anti-
coagulant
Acquired in preg
•ITP
•DIC
5. Atonic vs Traumatic PPH
Atonic Traumatic
Bleeding Gushes of dark clotted blood Continuous & bright red
Uterus larger, boggy, deficient contractions Small, hard, well contracted
Uterine compression Gushes or clots comes out No effect
Exploration of genital
tract
Bleeding is coming through cervical canal
& no lacerations detected
Bleeding coming from laceration in
genital tract
6. Prevention
1. Routine, prophylactic OXYTOCIN after delivery of shoulder either:
1. 10 units IM & 5 units IV push OR
2. 10 – 20 units / liter IV drip at 100-150 cc/hr
2. 3rd stage care:
1. Early cord clamping
2. Controlled cord traction with uterine palpation & inspection of placenta &
lower genital tract
