Aishah's postpartum haemorrhage
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1. A 32-year-old woman, gravida 3 para 2, presented at 40 weeks and 7 days for induction of labor for postdatism. She had a previous scar from a cesarean section in 2008 and was keen for a vaginal birth after cesarean (VBAC). 2. Upon examination, the placenta was found to be over the cervical os, indicating placenta previa. During labor, bleeding was noted from the placenta bed. An emergency cesarean section was performed for bleeding placenta previa. 3. The surgery found placenta previa type 2 posterior, with continued oozing from the placenta bed even after s
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This document discusses postpartum hemorrhage (PPH), defined as blood loss of 500 ml or more after childbirth. It outlines the main risk factors for PPH as the "four Ts" - tone (issues with the uterus), tissue (retained products of conception), trauma (lacerations), and thrombin (coagulation disorders). The document provides guidelines for preventing PPH through routine oxytocin administration after delivery and controlled cord traction. It also describes a stepwise approach for managing PPH, beginning with initial resuscitation and treatment of any atonic uterus or lacerations, and progressing to more invasive local control measures, surgery, or embolization if bleeding remains uncontrolled.
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Aishah's postpartum haemorrhage
- 1. POSTPARTUM HAEMORRHAGE BLEEDING PLACENTA PRAEVIA + BTL SITI AISHAH MOHD ZAMERI
- 2. PER ADMISSION 21/4/15; 32y.o/ Indian/ G3P2 @40w7d ANC: 1) 1 previous scar(2008) for breech delivery (untested)@ HSAH, patient keen for VBAC 2) Voluntary subfertility > 7 years 3) h/o UTI-completed abx E/A for IOL for postdatism -patient is keen for BTL, however, explained that BTL will be done only if patient went for EMLSCS. Counselled regarding LARC(Implanon) –pt say will d/w husband.
- 3. Latest scan (17/4/15) -S/C, FH+, placenta:AUS, AFI:20.6, EFW:3.66kg, parameters- to date Currently: no s/sx of labour FM good no fever/UTI/URTI sx Past obstetric hx: 1)2004/FT/VSD/3.25kg/male 2)2008/FT/LSCS for breech/2.75kg/male Past gynae hx: 13 (4-5 days) regular
- 4. Past med hx: uneventful Family hx: uneventful Allergy: seafood Social hx: housewife, H-lorry driver O/E- alert, conscious, pink Abdomen- soft, nontender, uterus@term, EFW:3.4-3.6kg CTG:reactive Plan: 1) for IOL as planned 2) V/S monitoring 3)Daily CTG 4) FKC
- 5. 1st prostin inserted 21/4/15- 10.00am Bishop score: 5/13 Dilatation (1), effacement:40%, station(2), consistency(medium), position(middle) prostin (1.5mg) inserted @ posterior fornix
- 6. 2nd prostin inserted 21/4/15- 1700pm Bishop score: 5/13 Dilatation (2), effacement:50%, station(2), consistency(medium), position(middle) prostin (1.5mg) inserted @ posterior fornix
- 7. L/R progress 22/4/15- t/o to labour room as BS this morning is 7/13, Os:3cm, MI, vertex, for ARM Currently, FM good, afebrile, irregular contraction, no LL, no UTI/ URTI sx. O/E- pink not tachypnoiec, V/S stable Per abdomen: S/C, soft, non tender, Uterus@ term, HPA:4/5, no scar tenderness VE: V/V-NAD, os:3cm, st:-2, MI, cx:40- 50% effaced. Plan: prop up pt, for MO to r/v, start
- 8. Review by MO 22/4/15; 12.55pm Informed by HO that checked upon ARM noted head was floating Upon VE noted: Os; 4cm Cx: soft (50% effaced) St:-3 (floating) + placenta bed over the os- PP type 2 +liquor mixed with blood CTG: reactive Case d/w Dr. Muna- for EMLSCS
- 9. INTRAOP 22/4/15; 1350- EMLSCS+BTL for bleeding placenta praevia. Findings: peritoneal cavity: no adhesions; engagement: cephalic, head not engaged; BTL done; placental site: PP type 2 posterior; Bleeding from placenta bed, secured with multiple suturing but still oozing from placenta bed. Dr. Kamal was called in Blood loss: 2000ml Intraop- transfused 2 pint WB + IV lasix 20mg stat Baby girl delivered, AS-4 @1min, 9@5min, BW:3.52kg
- 10. PROGRESS Post-op review: currently: comfortable, tolerable pain, no fever, no s/sx of anaemia. O/E- alert, conscious, not tachypnoeic. Per abdomen: soft, tender @ operation site, uterus well contracted@ 20w size, dressing not soaked. FBC & coag profile post op was taken and traced to be within normal value. (Hb:10.4) 24/4/15- Allow discharge