Postpartum hemorrhage (PPH) is defined as blood loss greater than 500 ml following vaginal delivery or 1000 ml after cesarean delivery. Risk factors include prior history of PPH, anemia, uterine anomalies, and prolonged labor. Risk reduction measures include active management of the third stage of labor, use of uterotonics, and treatment of anemia. Management of PPH involves resuscitation, monitoring for vital signs and investigations, and arresting the bleeding through uterine massage, administration of uterotonics, repairing lacerations, and treating underlying causes such as atony, retained placenta, or inversion. Surgical interventions like compression sutures or hysterectomy may be needed in severe

1. Post Partum
Hemorrhage
Presenter: Se To Ka Wai & Ng Pei Song
Supervisor: Dr Afif

2. Definition
PPH
> 500 ml following
vaginal delivery
> 1000 ml after
abdominal delivery
Any blood loss
sufficient enough to
cause
haemodynamically
instability
Primary (within the fist
24 hours after delivery)
Secondary (after 24
hours till 6 weeks post-
delivery)

3. Risk Factors

6. Risk Reduction Measures
(Antenatal)

7. Risk Reduction Measures
(Intrapartum)

8. Risk Reduction Measures
(Post Partum)

9. Management of PPH
• Resuscitation
• Monitoring and investigation
• Arresting the bleeding

10. Resuscitation
• High flow facial O2 at 15L/min
• Protect airway if level of consciousness impaired
• 2 large bore branula
• IV fluid, blood & blood products, drugs
• CBD with strict I/O chart

11. Drugs
• Uterotonic drugs
• IV tranexamic acid
• Vasopressors or inotropic drugs

12. Monitoring and investigations
• Monitoring
– Vital signs (BP, PR, RR, Temp, PS, SpO2)
– Fluid balance
• Investigations
– FBC, BUSE, Coag profile, ABG, GXM

13. Arresting the bleeding
• Uterine massage
• Ensure placenta and membrane complete
• Uterotonic drugs
• Find causes and treat the underlying
causes

14. Uterine atony
• First line drugs
– IV Oxytocin 40IU
– IM Syntometrine
– IM Carboprost 250mcg over 15minutes
– Rectal misoprostol 800-1000mcg
– Rectal Gemeprost 1mg
• Other measures
– Bimanual compression and/or aortic compression
– Bakri balloon
– Laparotomy – uterine compression suture, pelvic devascularisation,
hysterectomy

15. Bimanual compression

16. Bakri balloon

17. Uterine compression sutures

18. Retained placenta
• Manual removal of placenta
• Monitor vitals & blood loss every
15minutes while awaiting OT call

19. Manual removal of placenta

20. Genital tract trauma
• Repair of any tear or lacerations
• Ideally done in OT with good lighting and
prophylactic antibiotics
• Examine for hematoma

21. Hematoma
• Infralevator hematoma
– <5cm – conservative (analgesia +
antibiotic)
– >5cm – surgical intervention under
anesthesia, I&D, identify and ligating
bleeding vessels
• Supralevator hematoma
– If stable, size remains same – conservative
– If unstable, size increasing – surgical
intervention

22. Uterine inversion
• Manual replacement
• Hydrostatic replacement
– O’Sullivan’s technique
• Surgical replacement
– Huntington’s procedure
– Haultain’s procedure

23. Uterine rupture
• Resuscitation
• Laparotomy and repair
• Hysterectomy if beyond repair, unable to
secure hemostasis

24. THANK YOU