The document provides an overview of postpartum hemorrhage (PPH) including its definition, risk factors, causes, prevention, and management. It discusses predicting patients at risk, preparing for potential hemorrhage, and treating PPH through evaluating tone, tissue, trauma, and thrombin (the 4 Ts). Uterine atony is identified as the leading cause, accounting for 80% of PPH cases. Early use of uterotonic medications and fluid resuscitation are emphasized as essential in management.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
Blood loss of >/ 500 ml within 24 hours of vaginal birth or 1000 ml after caesarean section or any blood loss sufficient to compromise haemodynamic instability
MINOR PPH- 500- 1000ml blood loss
MAJOR PPH- > 1000ml Blood loss
MASSIVE PPH- >2000ml Blood loss
A presentation on Medically Indicated Deliveries Before 39 weeks.
Includes updated information from ACOG.
Medically indicated late-preterm and early-term deliveries. Committee Opinion No. 560. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:908–10.
A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. Focus of this proposal include gestational diabetes, maternal obesity, postpartum weight loss, and as well as patient engagement / health literacy
This lecture was originally given as a Prezi presentation at the Women & Infant's OB Conference for Dekalb Medical Center on March 7th, 2011. A full copy of the prezi can be found here: http://prezi.com/wrpz-mgq-nio/hypertensive-emergencies-in-obstetrics/
A brief presentation on some of the factors thought to be related to severe nausea and vomiting during pregnancy (Hyperemesis Gravidarum) with ways to treat this condition.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
14. THE STEPS TO PPH: P OST P ARTUM H EMORRHAGE: P REDICT H ANDLE P REPARE
15. THE STEPS TO PPH: P OST P ARTUM H EMORRHAGE: P REDICT H ANDLE P REPARE Identify patients at risk Use a multi-disciplinary Approach Optimize clinical management
21. Risk Factors for Postpartum Hemorrhage What Should we do with a list like this? Prior postpartum hemorrhage Advanced maternal age Multifetal gestations Prolonged labor Polyhydramnios Instrumental delivery Fetal demise Placental abruption Anticoagulation therapy Multiparity Fibroids Prolonged use of oxytocin Macrosomia Cesarean delivery Placenta previa and accreta Chorioamnionitis General anesthesia
22. Clinically Important Risk Factors for Postpartum Hemorrhage Prior postpartum hemorrhage Abnormal placentation Operative delivery
23. Risk Factors for Postpartum Hemorrhage under Clinical Control Prolonged labor Instrumental delivery Anticoagulation therapy Prolonged use of oxytocin Cesarean delivery General anesthesia
25. 80% OF CASES OF POSTPARTUM HEMORRHAGE ARE DUE TO UTERINE ATONY (a less busy slide)
26. What about DIC? Coagulopathy is a relatively uncommon cause of primary PPH Coagulopathy most commonly occurs when another cause of PPH already has produced significant blood loss.
27. RDFS RDFS is retained dead fetus syndrome Well described in most obstetrics texts Clinically manifested at about 6 weeks after fetal death Rarely seen in modern obstetrics.
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29. 80% OF CASES OF POSTPARTUM HEMORRHAGE ARE DUE TO UTERINE ATONY (Did I mention that…)
30. Question: What causes uterine atony and is there anything we can do to prevent uterine atony induced postpartum hemorrhage?
33. Upper Genital Tract Trauma Most often is the result of uterine rupture Bleeding from direct uterine injury during cesarean Injury of associated vascular structures (uterine, artery or broad ligament varicosities) during cesarean
34. Lower Genital Tract Trauma May occur spontaneously or result from episiotomy, obstetric maneuvers, or operative instrumented deliveries. Involve perineum, cervix and vagina.
39. “ Perhaps the most important aspect in the management of PPH is the attitude of the attendant in charge. It is critical to maintain equanimity in what can be a chaotic and stressful environment ” . Yinka Oyelese, MD, Obstet Gynecol Clin N Am 34 (2007) 421–441
40. Analysis Paralysis An excessive number of well-meaning individuals increases the ambient noise, adds to confusion, and opens the door to communication errors. Yinka Oyelese, MD, Obstet Gynecol Clin N Am 34 (2007) 421–441
46. Identify possible post partum hemorrhage. Simultaneous evaluation and treatment. Remember ABCs. Use O2 4L/min. If bleeding does not readily resolve, call for help. Start two 16g or 18g IVs. Initial Assessment
47. Initial Steps for PPH Bimanual compression Manual exploration of the uterus Empty the bladder Administer uterotonic agents Examine lower genital tract for lacerations.
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52. Medical Treatment of Postpartum Hemorrhage Medications that cause uterine contractions Medications that promote coagulation
53. METHERGINE “ Speedy” OXYTOCIN “ The Champ” Cytotec Inexpensive (?) Effective Medications for Uterine Atony
59. - Balanced * ( 0.9% NaCl, lactated Ringers -Hypertonic (3.5,5, 7.5% NaCl) -Hypotonic (0.45% NaCl) * Same electrolyte concentration as the extracellular compartnt -Albumin (5%, 25%) -Dextran, glucose polymers (40, 70) -Hydroxyethyl starch (Hespan ) Crystalloid Colloid Blood/Blood Products Fluid Management of Postpartum Hemorrhage
60. Acute Postpartum Blood Loss PROBLEMS : Loss of circulatory Volume Loss of O 2 carrying capacity Restore volume 1 - Crystalloid 2 - Colloid SaO 2 O 2 carrying capacity Supplemental O 2 Transfusion
62. Managing blood loss by hemorrhage classification Class Blood Loss Volume Deficit Spx Rx I < 1000 cc 15% Orthostatic tachycardia Crystalloid II 1001-1500 15-25% Incr. HR, orthostasis, mental Decr cap refill Crystalloid, III 1501-2500 25-40% Incr HR, RR Decr BP, Oliguria Crystalloid Colloid, RBCs IV > 2500 > 40% Obtunded Oliguria/anuria CV collapse RBC, Crystalloid, Colloid
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64. Acute isovolemic hemodilution Withdraw 2-4 u. of Blood Replace the volume with crystalloid Lower the pre-op Hct Replace the blood at end of surgery Acute hypervolemic hemodilution Admin 1500-2000cc Crystalloid Hemodilution (Lowers pre-op Hct) Ways to optimize hemodynamic status
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67. Oxytocin 10U in 20cc of NS placed in clamped umbilical vein. If this fails, get OB assistance. Check Hct, type & cross 2-4 u. Two large bore IVs. Anesthesia and OR support. Removal of Abnormal Placenta
79. Sometimes found incidentally. During routine exam of uterus. Small dehiscence, less than 2cm. Not bleeding. Not painful. Can be followed expectantly. Uterine Rupture
80. Vaginal bleeding. Abdominal tenderness. Maternal tachycardia. Abnormal fetal heart rate tracing. Cessation of uterine contractions. Uterine Rupture before delivery
81. May be found on routine exam. Hypotension more than expected with apparent blood loss. Increased abdominal girth. Uterine Rupture after delivery
86. The 4 “Ts” Recalled “ THROMBIN” Check labs if suspicious.
Editor's Notes
Annual rates of postpartum hemorrhage caused by atony, by mode of delivery, and by induction status (United States, 1994–2006)Callaghan. Trends in postpartum hemorrhage. Am J Obstet Gynecol 2010.