The document discusses complications that can occur during the third stage of labor and their management. It covers postpartum hemorrhage, inversion of the uterus, and retained placenta. For postpartum hemorrhage, the main causes are uterine atony, trauma, and coagulation disorders. Prevention focuses on proper care during all stages of labor and delivery. Management includes uterine massage, uterotonic drugs, exploration and suturing for trauma. For retained placenta, manual removal under anesthesia is usually required. Inversion of the uterus is a life-threatening emergency treated by manually repositioning the uterus and providing supportive care.
This document provides guidelines for managing postpartum haemorrhage. It outlines steps to take including calling for help, evaluating vital signs, establishing an IV line, administering oxygen, checking if the placenta has been delivered, massaging the uterus, giving medications like oxytocin and misoprostol, and providing nursing care such as monitoring blood loss. It further describes performing bimanual compression of the uterus if bleeding continues, which involves emptying the bladder, inserting a gloved hand into the vagina to apply pressure on the uterus while the other hand applies counter pressure on the abdomen.
This document discusses complications of the third stage of labor, specifically postpartum hemorrhage. It defines postpartum hemorrhage, classifies it by severity and timing, and identifies the main causes as being an atonic uterus, trauma, retained placental tissues, and coagulation disorders. The management of postpartum hemorrhage is described in stages from immediate resuscitation through bimanual compression, uterine tamponade, surgery such as ligation of arteries, and hysterectomy if needed. Specific approaches are provided for addressing atonic, traumatic, or coagulation-related causes of bleeding.
The third stage of labor, which involves delivery of the placenta, is the most crucial stage for the mother's health. A major complication is postpartum hemorrhage (PPH), excessive bleeding after childbirth. PPH can be primary (within 24 hours) or secondary (24+ hours later). The main causes of primary PPH are uterine atony (95%), retained tissue, trauma, and coagulopathy. Treatment involves controlling bleeding through uterine massage, medications, and in severe cases, surgery. While clinical examination and ultrasound are used for diagnosis, homeopathy may also help prevent PPH complications.
Management of true postpartum hemorrageIshta Thakur
This document discusses the management of true postpartum hemorrhage (PPH). It begins by defining true PPH as bleeding following the delivery of the placenta. It then outlines the principles of management which include communication, resuscitation, monitoring, and arresting bleeding. Next, it describes the immediate measures taken such as IV fluids and medications. It discusses monitoring vitals and outputs. The actual management involves addressing atonic, traumatic, retained tissues, or coagulation causes. Specific treatment steps are provided for managing atonic uterus and other causes if bleeding continues. Surgical methods like compression sutures and arterial ligation are described. Secondary PPH causes and treatments are also summarized.
The document discusses the third stage of labor and postpartum hemorrhage. It describes the stages of labor including the third stage which involves placental separation and expulsion. The events of the third stage and mechanisms of placental separation are explained. Active management of the third stage is recommended to prevent postpartum hemorrhage. The etiology, diagnosis, and management of primary postpartum hemorrhage are outlined. Prevention focuses on risk assessment and active management of labor and delivery. True postpartum hemorrhage is managed through resuscitation, arresting bleeding, and involvement of senior staff.
This document provides information on third stage complications of labour including secondary postpartum hemorrhage, retained placenta, morbidly adherent placenta, inversion of the uterus, and amniotic fluid embolism. It discusses the causes, risk factors, diagnosis, and management of these complications. Key points covered include the definition of retained placenta, grades of morbidly adherent placenta, risk factors for placenta accreta, and manual and hydrostatic methods for managing an inverted uterus.
The third stage of labor is the period from when the baby is delivered until the placenta is delivered, which usually occurs within a few minutes. There are two types of management for the third stage: active management, which involves administering uterotonics after birth, and physiological management. Postpartum hemorrhage and retained placenta are risks during this stage. Primary PPH occurs within 24 hours of delivery with blood loss of 500-1000ml, while secondary PPH occurs between 24 hours to 12 weeks postpartum. Causes of PPH include uterine atony, retained tissue, trauma, and coagulopathies. Prevention involves uterotonics and active management, while treatment involves uterine massage, medications,
This document provides guidelines for managing postpartum haemorrhage. It outlines steps to take including calling for help, evaluating vital signs, establishing an IV line, administering oxygen, checking if the placenta has been delivered, massaging the uterus, giving medications like oxytocin and misoprostol, and providing nursing care such as monitoring blood loss. It further describes performing bimanual compression of the uterus if bleeding continues, which involves emptying the bladder, inserting a gloved hand into the vagina to apply pressure on the uterus while the other hand applies counter pressure on the abdomen.
This document discusses complications of the third stage of labor, specifically postpartum hemorrhage. It defines postpartum hemorrhage, classifies it by severity and timing, and identifies the main causes as being an atonic uterus, trauma, retained placental tissues, and coagulation disorders. The management of postpartum hemorrhage is described in stages from immediate resuscitation through bimanual compression, uterine tamponade, surgery such as ligation of arteries, and hysterectomy if needed. Specific approaches are provided for addressing atonic, traumatic, or coagulation-related causes of bleeding.
The third stage of labor, which involves delivery of the placenta, is the most crucial stage for the mother's health. A major complication is postpartum hemorrhage (PPH), excessive bleeding after childbirth. PPH can be primary (within 24 hours) or secondary (24+ hours later). The main causes of primary PPH are uterine atony (95%), retained tissue, trauma, and coagulopathy. Treatment involves controlling bleeding through uterine massage, medications, and in severe cases, surgery. While clinical examination and ultrasound are used for diagnosis, homeopathy may also help prevent PPH complications.
Management of true postpartum hemorrageIshta Thakur
This document discusses the management of true postpartum hemorrhage (PPH). It begins by defining true PPH as bleeding following the delivery of the placenta. It then outlines the principles of management which include communication, resuscitation, monitoring, and arresting bleeding. Next, it describes the immediate measures taken such as IV fluids and medications. It discusses monitoring vitals and outputs. The actual management involves addressing atonic, traumatic, retained tissues, or coagulation causes. Specific treatment steps are provided for managing atonic uterus and other causes if bleeding continues. Surgical methods like compression sutures and arterial ligation are described. Secondary PPH causes and treatments are also summarized.
The document discusses the third stage of labor and postpartum hemorrhage. It describes the stages of labor including the third stage which involves placental separation and expulsion. The events of the third stage and mechanisms of placental separation are explained. Active management of the third stage is recommended to prevent postpartum hemorrhage. The etiology, diagnosis, and management of primary postpartum hemorrhage are outlined. Prevention focuses on risk assessment and active management of labor and delivery. True postpartum hemorrhage is managed through resuscitation, arresting bleeding, and involvement of senior staff.
This document provides information on third stage complications of labour including secondary postpartum hemorrhage, retained placenta, morbidly adherent placenta, inversion of the uterus, and amniotic fluid embolism. It discusses the causes, risk factors, diagnosis, and management of these complications. Key points covered include the definition of retained placenta, grades of morbidly adherent placenta, risk factors for placenta accreta, and manual and hydrostatic methods for managing an inverted uterus.
The third stage of labor is the period from when the baby is delivered until the placenta is delivered, which usually occurs within a few minutes. There are two types of management for the third stage: active management, which involves administering uterotonics after birth, and physiological management. Postpartum hemorrhage and retained placenta are risks during this stage. Primary PPH occurs within 24 hours of delivery with blood loss of 500-1000ml, while secondary PPH occurs between 24 hours to 12 weeks postpartum. Causes of PPH include uterine atony, retained tissue, trauma, and coagulopathies. Prevention involves uterotonics and active management, while treatment involves uterine massage, medications,
Postpartum haemorrhage remains a major cause of maternal mortality. Primary PPH occurs within 24 hours of delivery while secondary PPH occurs between 24 hours to 12 weeks postpartum. The main causes of PPH are uterine atony, retained placenta or clots, genital tract trauma, and coagulation disorders. Management involves early recognition, fluid resuscitation, medical treatment including uterotonics, surgical interventions if needed, and potentially hysterectomy for severe or uncontrolled bleeding. Prevention strategies focus on risk factor identification and active management of the third stage of labor.
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. It can be primary (within 24 hours of delivery) or secondary (24 hours to 6 weeks postpartum). Primary PPH is usually due to uterine atony or trauma during delivery. Management involves emptying the uterus, replacing blood loss, and ensuring haemostasis. Secondary PPH is often caused by infection or retained placental fragments. Treatment focuses on identifying and addressing the underlying cause while providing supportive care.
This document presents information on postpartum haemorrhage (PPH) from a case study. PPH is defined as blood loss exceeding 500 ml following vaginal delivery or 1000 ml following cesarean delivery. It can be classified as minor, major, or severe depending on blood loss. The main causes of PPH are tone (atonic uterus), trauma, tissue (retained placenta), and thrombin coagulation disorders. Management involves emptying the uterus, replacing blood loss, and achieving hemostasis. Surgical methods like uterine artery ligation may be needed in severe cases of PPH. Prevention strategies include active management of the third stage of labor and being vigilant for high-risk cases.
1. Postpartum hemorrhage is defined as blood loss over 500ml following childbirth and is a leading cause of maternal mortality worldwide.
2. The most common cause is uterine atony, accounting for around 90% of cases. Other causes include retained tissue, trauma, and coagulopathy.
3. Treatment begins with medical management including uterine massage, oxytocics, and bimanual compression. If bleeding continues, further steps may include misoprostol, B-Lynch suture, or ligation of arteries. Hysterectomy is a last resort to control life-threatening bleeding.
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include prior tubal surgery or infections, IUD use, smoking, and assisted reproductive technologies.
2. Clinical features may include abdominal pain, vaginal bleeding, and cervical motion tenderness. Diagnosis is made through ultrasound and beta-hCG levels. Treatment options include medical management with methotrexate or surgical management via laparoscopy or laparotomy.
3. Proper diagnosis and treatment are important to prevent potential complications of ectopic pregnancy such as tubal rupture and hemorrhage. Serial beta-hCG and ultrasound exams are used to monitor
This document provides information on the management of the third stage of labour and complications. It discusses the three phases of the third stage, signs of placental separation, and mechanisms of controlling bleeding. It describes expectant and active management approaches. For retained placenta, steps include uterine massage, oxytocics, and controlled cord traction. Manual removal under anesthesia may be needed. Complications include postpartum hemorrhage, retained placenta, uterine inversion, and shock. Risk factors, diagnosis, and conservative management are outlined for morbidly adherent placenta such as placenta accreta.
The document discusses complications of the third stage of labor, with a focus on postpartum hemorrhage (PPH). PPH is defined as blood loss over 500mL following birth. The most common cause is an atonic uterus, accounting for 80% of cases. Other causes include retained tissues, trauma, and blood coagulation issues. Prevention strategies include active management of the third stage of labor for all deliveries, continued oxytocin infusion after delivery, and expert care for high-risk cases like placenta accreta. Management involves emptying the uterus, replacing blood loss, and treating any trauma through measures like uterine massage, uterotonic drugs, and manual removal of the placenta if needed.
The document discusses complications that can occur during the third stage of labour, which include postpartum haemorrhage, retention of placenta, uterine inversion, obstetric shock, and pulmonary embolism. Postpartum haemorrhage is defined as bleeding over 500cc after delivery and can be caused by uterine atony, trauma, retained tissues, or coagulation disorders. Retention of placenta may occur if the placenta is not fully separated or adhered to the uterus. Uterine inversion involves the uterus turning inside out, and can be caused by fundal pressure or a relaxed uterus. Obstetric shock is low blood pressure caused by blood loss, trauma, air embol
Postpartum hemorrhage is the leading cause of maternal death worldwide. Excessive bleeding after childbirth can occur due to uterine atony, retained placenta or blood clots, trauma during delivery, or pre-existing coagulation disorders. Preventing postpartum hemorrhage involves risk assessment, active management of the third stage of labor using uterotonics immediately after delivery of the baby, and controlled cord traction to deliver the placenta. Treatment options for postpartum hemorrhage include non-pharmacological techniques like uterine massage and medical interventions like uterotonics, tranexamic acid, recombinant factor VIIa, and in severe cases, surgical procedures.
The document describes techniques for using uterine and vaginal balloons to control postpartum hemorrhage (PPH). It discusses various balloon devices that have been used historically and their advantages over traditional gauze packing. Key balloon techniques described include the Sengstaken-Blakemore tube, Bakri balloon, Foley catheters, and condom balloons. The document provides details on how to properly insert and remove different balloon devices to exert controlled pressure on the uterus and stop bleeding in cases of PPH.
Dr. Monika Madaan discusses postpartum hemorrhage (PPH), a leading cause of maternal mortality. PPH is defined as blood loss over 500ml after delivery. Risk factors include placenta previa/accreta, coagulopathy, overdistended uterus, grand multiparity, abnormal labor, and previous PPH history. Active management of the third stage of labor can help prevent PPH. Treatment involves resuscitation, fluid replacement, administering uterotonics and other drugs, uterine tamponade, compression sutures, devascularization, and hysterectomy if needed. New developments include tranexamic acid and recombinant factor VII. Proper documentation and debriefing are also
Dr. Sunita Singal discusses postpartum hemorrhage (PPH) and shock. PPH is a leading cause of maternal death worldwide. Early recognition and treatment is important to prevent shock. The document outlines strategies for prevention of PPH through active management of the third stage of labor. It describes the signs and causes of PPH and shock, including the four T's (tone, tissue, trauma, thrombin). Treatment involves following ABCs - airway, breathing, circulation. Circulatory support includes IV fluids and blood transfusion as needed. Management depends on the identified cause, and may involve uterotonic drugs, bimanual compression, aortic compression, or uterine tamponade. Referral
3rd stage of labour and its complications finalPartha Pratim
The document discusses the third stage of labour and its complications. It begins by defining the third stage of labour as beginning with the birth of the baby and ending with the delivery of the placenta. It then discusses normal placental separation and how bleeding is controlled after birth. Complications of the third stage including postpartum hemorrhage, retained placenta, and uterine inversion are enumerated. The document thoroughly explains the steps and benefits of active management of the third stage of labour. Causes and management of postpartum hemorrhage and other complications are provided in detail.
This document provides an overview of postpartum hemorrhage (PPH). It defines PPH, classifies it as primary (occurring within 24 hours of birth) or secondary (occurring beyond 24 hours), and describes the types including uterine atony, trauma, and retained tissues. Risk factors, diagnosis, prognosis, prevention through antenatal and intranatal guidelines, and management including exploration and hemostatic sutures for traumatic bleeding or manual removal of placenta under anesthesia for atonic bleeding are discussed. The learning objectives are to understand what PPH is, its classification, causes, risk factors, diagnosis, effects, prevention, and management.
3rd stage of labor & abnormalities by liza tarca, mdLiza Tarca
The third stage of labor involves the delivery of the placenta and membranes after childbirth. Abnormalities in the third stage include retained placenta requiring manual extraction, postpartum hemorrhage from uterine atony or lacerations, and abnormal placentation issues like placenta previa, abruption, and accreta. Management involves medical treatments like uterotonics and surgical interventions like uterine packing, vessel ligation, or hysterectomy in severe cases.
Baloon tamponade in management of postpartum haemorrhageAboubakr Elnashar
Uterine balloon tamponade is an effective treatment for postpartum haemorrhage when standard medical treatments have failed. Various balloon devices can be inserted into the uterine cavity and inflated to exert pressure and stop bleeding. Balloons are made of materials like condoms, Foley catheters, or purpose-built devices. When inflated, they work by applying pressure against the uterine walls to compress blood vessels and control bleeding. Balloon tamponade is a minimally invasive option that can prevent the need for hysterectomy in many cases by controlling bleeding without surgery.
The document summarizes the third stage of labor and postpartum hemorrhage (PPH). It defines PPH, describes the causes including uterine atony, retained tissues, trauma, and coagulopathy. It outlines prevention strategies, signs and symptoms, management which includes emptying the uterus, replacing blood loss, achieving hemostasis, and surgical procedures like hysterectomy if needed. PPH is a leading cause of maternal mortality and this document provides guidance on diagnosing and treating both primary and secondary PPH.
This document summarizes causes, risk factors, diagnosis, and management of postpartum hemorrhage (PPH). PPH is defined as blood loss of 500 ml or more within 24 hours of delivery. Common causes include uterine atony (70%), retained placenta, genital tract trauma, and bleeding disorders. Risk factors include previous uterine surgery, uterine abnormalities, and operative delivery. Diagnosis involves estimating blood loss and identifying the cause. Management involves resuscitation, arresting the bleeding through uterotonic drugs, manual removal of retained placenta, repairing lacerations, and in severe cases, surgical procedures like hysterectomy.
Harnessing the great arteries in p.p.h dr vivekpatkardrvivekpatkar
The document discusses postpartum hemorrhage (PPH) and intractable PPH. It provides statistics on annual births and cases of PPH from an Indian hospital from 1999-2005. It also discusses classifications of blood loss, causes of PPH, and steps in managing PPH, including uterine artery ligation and hypogastric artery ligation (HAL) as salvage procedures when bleeding cannot be controlled by other means. HAL is described as an emergency life-saving surgery that aims to reduce blood flow and pressure in the pelvis to allow clot formation when PPH becomes intractable.
The document discusses complications of the third stage of labor and postpartum hemorrhage (PPH) management. It defines PPH as blood loss exceeding 500 ml after birth and describes primary PPH occurring within 24 hours and secondary PPH occurring beyond 24 hours. Causes of PPH include uterine atony, trauma, retained tissues, and coagulopathy. The management of PPH involves controlling blood loss, replacing blood volume, and treating the underlying cause. For primary PPH, this includes uterotonic drugs, uterine massage, exploration for trauma. For secondary PPH, common causes are retained placental fragments, so uterine exploration is often needed.
This document discusses postpartum hemorrhage (PPH), defined as blood loss exceeding 500 mL following childbirth. It describes the types and causes of PPH, including atonic uterus, trauma, retained tissues, and thrombin deficiencies. Prevention methods are outlined, such as active management of the third stage of labor. Treatment protocols are provided for various PPH situations, including uterotonic drugs, uterine massage, tamponade, and surgical techniques if bleeding cannot be controlled otherwise. Primary PPH occurs within 24 hours of delivery while secondary PPH develops after 24 hours from retained tissues or infection.
Postpartum haemorrhage remains a major cause of maternal mortality. Primary PPH occurs within 24 hours of delivery while secondary PPH occurs between 24 hours to 12 weeks postpartum. The main causes of PPH are uterine atony, retained placenta or clots, genital tract trauma, and coagulation disorders. Management involves early recognition, fluid resuscitation, medical treatment including uterotonics, surgical interventions if needed, and potentially hysterectomy for severe or uncontrolled bleeding. Prevention strategies focus on risk factor identification and active management of the third stage of labor.
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. It can be primary (within 24 hours of delivery) or secondary (24 hours to 6 weeks postpartum). Primary PPH is usually due to uterine atony or trauma during delivery. Management involves emptying the uterus, replacing blood loss, and ensuring haemostasis. Secondary PPH is often caused by infection or retained placental fragments. Treatment focuses on identifying and addressing the underlying cause while providing supportive care.
This document presents information on postpartum haemorrhage (PPH) from a case study. PPH is defined as blood loss exceeding 500 ml following vaginal delivery or 1000 ml following cesarean delivery. It can be classified as minor, major, or severe depending on blood loss. The main causes of PPH are tone (atonic uterus), trauma, tissue (retained placenta), and thrombin coagulation disorders. Management involves emptying the uterus, replacing blood loss, and achieving hemostasis. Surgical methods like uterine artery ligation may be needed in severe cases of PPH. Prevention strategies include active management of the third stage of labor and being vigilant for high-risk cases.
1. Postpartum hemorrhage is defined as blood loss over 500ml following childbirth and is a leading cause of maternal mortality worldwide.
2. The most common cause is uterine atony, accounting for around 90% of cases. Other causes include retained tissue, trauma, and coagulopathy.
3. Treatment begins with medical management including uterine massage, oxytocics, and bimanual compression. If bleeding continues, further steps may include misoprostol, B-Lynch suture, or ligation of arteries. Hysterectomy is a last resort to control life-threatening bleeding.
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include prior tubal surgery or infections, IUD use, smoking, and assisted reproductive technologies.
2. Clinical features may include abdominal pain, vaginal bleeding, and cervical motion tenderness. Diagnosis is made through ultrasound and beta-hCG levels. Treatment options include medical management with methotrexate or surgical management via laparoscopy or laparotomy.
3. Proper diagnosis and treatment are important to prevent potential complications of ectopic pregnancy such as tubal rupture and hemorrhage. Serial beta-hCG and ultrasound exams are used to monitor
This document provides information on the management of the third stage of labour and complications. It discusses the three phases of the third stage, signs of placental separation, and mechanisms of controlling bleeding. It describes expectant and active management approaches. For retained placenta, steps include uterine massage, oxytocics, and controlled cord traction. Manual removal under anesthesia may be needed. Complications include postpartum hemorrhage, retained placenta, uterine inversion, and shock. Risk factors, diagnosis, and conservative management are outlined for morbidly adherent placenta such as placenta accreta.
The document discusses complications of the third stage of labor, with a focus on postpartum hemorrhage (PPH). PPH is defined as blood loss over 500mL following birth. The most common cause is an atonic uterus, accounting for 80% of cases. Other causes include retained tissues, trauma, and blood coagulation issues. Prevention strategies include active management of the third stage of labor for all deliveries, continued oxytocin infusion after delivery, and expert care for high-risk cases like placenta accreta. Management involves emptying the uterus, replacing blood loss, and treating any trauma through measures like uterine massage, uterotonic drugs, and manual removal of the placenta if needed.
The document discusses complications that can occur during the third stage of labour, which include postpartum haemorrhage, retention of placenta, uterine inversion, obstetric shock, and pulmonary embolism. Postpartum haemorrhage is defined as bleeding over 500cc after delivery and can be caused by uterine atony, trauma, retained tissues, or coagulation disorders. Retention of placenta may occur if the placenta is not fully separated or adhered to the uterus. Uterine inversion involves the uterus turning inside out, and can be caused by fundal pressure or a relaxed uterus. Obstetric shock is low blood pressure caused by blood loss, trauma, air embol
Postpartum hemorrhage is the leading cause of maternal death worldwide. Excessive bleeding after childbirth can occur due to uterine atony, retained placenta or blood clots, trauma during delivery, or pre-existing coagulation disorders. Preventing postpartum hemorrhage involves risk assessment, active management of the third stage of labor using uterotonics immediately after delivery of the baby, and controlled cord traction to deliver the placenta. Treatment options for postpartum hemorrhage include non-pharmacological techniques like uterine massage and medical interventions like uterotonics, tranexamic acid, recombinant factor VIIa, and in severe cases, surgical procedures.
The document describes techniques for using uterine and vaginal balloons to control postpartum hemorrhage (PPH). It discusses various balloon devices that have been used historically and their advantages over traditional gauze packing. Key balloon techniques described include the Sengstaken-Blakemore tube, Bakri balloon, Foley catheters, and condom balloons. The document provides details on how to properly insert and remove different balloon devices to exert controlled pressure on the uterus and stop bleeding in cases of PPH.
Dr. Monika Madaan discusses postpartum hemorrhage (PPH), a leading cause of maternal mortality. PPH is defined as blood loss over 500ml after delivery. Risk factors include placenta previa/accreta, coagulopathy, overdistended uterus, grand multiparity, abnormal labor, and previous PPH history. Active management of the third stage of labor can help prevent PPH. Treatment involves resuscitation, fluid replacement, administering uterotonics and other drugs, uterine tamponade, compression sutures, devascularization, and hysterectomy if needed. New developments include tranexamic acid and recombinant factor VII. Proper documentation and debriefing are also
Dr. Sunita Singal discusses postpartum hemorrhage (PPH) and shock. PPH is a leading cause of maternal death worldwide. Early recognition and treatment is important to prevent shock. The document outlines strategies for prevention of PPH through active management of the third stage of labor. It describes the signs and causes of PPH and shock, including the four T's (tone, tissue, trauma, thrombin). Treatment involves following ABCs - airway, breathing, circulation. Circulatory support includes IV fluids and blood transfusion as needed. Management depends on the identified cause, and may involve uterotonic drugs, bimanual compression, aortic compression, or uterine tamponade. Referral
3rd stage of labour and its complications finalPartha Pratim
The document discusses the third stage of labour and its complications. It begins by defining the third stage of labour as beginning with the birth of the baby and ending with the delivery of the placenta. It then discusses normal placental separation and how bleeding is controlled after birth. Complications of the third stage including postpartum hemorrhage, retained placenta, and uterine inversion are enumerated. The document thoroughly explains the steps and benefits of active management of the third stage of labour. Causes and management of postpartum hemorrhage and other complications are provided in detail.
This document provides an overview of postpartum hemorrhage (PPH). It defines PPH, classifies it as primary (occurring within 24 hours of birth) or secondary (occurring beyond 24 hours), and describes the types including uterine atony, trauma, and retained tissues. Risk factors, diagnosis, prognosis, prevention through antenatal and intranatal guidelines, and management including exploration and hemostatic sutures for traumatic bleeding or manual removal of placenta under anesthesia for atonic bleeding are discussed. The learning objectives are to understand what PPH is, its classification, causes, risk factors, diagnosis, effects, prevention, and management.
3rd stage of labor & abnormalities by liza tarca, mdLiza Tarca
The third stage of labor involves the delivery of the placenta and membranes after childbirth. Abnormalities in the third stage include retained placenta requiring manual extraction, postpartum hemorrhage from uterine atony or lacerations, and abnormal placentation issues like placenta previa, abruption, and accreta. Management involves medical treatments like uterotonics and surgical interventions like uterine packing, vessel ligation, or hysterectomy in severe cases.
Baloon tamponade in management of postpartum haemorrhageAboubakr Elnashar
Uterine balloon tamponade is an effective treatment for postpartum haemorrhage when standard medical treatments have failed. Various balloon devices can be inserted into the uterine cavity and inflated to exert pressure and stop bleeding. Balloons are made of materials like condoms, Foley catheters, or purpose-built devices. When inflated, they work by applying pressure against the uterine walls to compress blood vessels and control bleeding. Balloon tamponade is a minimally invasive option that can prevent the need for hysterectomy in many cases by controlling bleeding without surgery.
The document summarizes the third stage of labor and postpartum hemorrhage (PPH). It defines PPH, describes the causes including uterine atony, retained tissues, trauma, and coagulopathy. It outlines prevention strategies, signs and symptoms, management which includes emptying the uterus, replacing blood loss, achieving hemostasis, and surgical procedures like hysterectomy if needed. PPH is a leading cause of maternal mortality and this document provides guidance on diagnosing and treating both primary and secondary PPH.
This document summarizes causes, risk factors, diagnosis, and management of postpartum hemorrhage (PPH). PPH is defined as blood loss of 500 ml or more within 24 hours of delivery. Common causes include uterine atony (70%), retained placenta, genital tract trauma, and bleeding disorders. Risk factors include previous uterine surgery, uterine abnormalities, and operative delivery. Diagnosis involves estimating blood loss and identifying the cause. Management involves resuscitation, arresting the bleeding through uterotonic drugs, manual removal of retained placenta, repairing lacerations, and in severe cases, surgical procedures like hysterectomy.
Harnessing the great arteries in p.p.h dr vivekpatkardrvivekpatkar
The document discusses postpartum hemorrhage (PPH) and intractable PPH. It provides statistics on annual births and cases of PPH from an Indian hospital from 1999-2005. It also discusses classifications of blood loss, causes of PPH, and steps in managing PPH, including uterine artery ligation and hypogastric artery ligation (HAL) as salvage procedures when bleeding cannot be controlled by other means. HAL is described as an emergency life-saving surgery that aims to reduce blood flow and pressure in the pelvis to allow clot formation when PPH becomes intractable.
The document discusses complications of the third stage of labor and postpartum hemorrhage (PPH) management. It defines PPH as blood loss exceeding 500 ml after birth and describes primary PPH occurring within 24 hours and secondary PPH occurring beyond 24 hours. Causes of PPH include uterine atony, trauma, retained tissues, and coagulopathy. The management of PPH involves controlling blood loss, replacing blood volume, and treating the underlying cause. For primary PPH, this includes uterotonic drugs, uterine massage, exploration for trauma. For secondary PPH, common causes are retained placental fragments, so uterine exploration is often needed.
This document discusses postpartum hemorrhage (PPH), defined as blood loss exceeding 500 mL following childbirth. It describes the types and causes of PPH, including atonic uterus, trauma, retained tissues, and thrombin deficiencies. Prevention methods are outlined, such as active management of the third stage of labor. Treatment protocols are provided for various PPH situations, including uterotonic drugs, uterine massage, tamponade, and surgical techniques if bleeding cannot be controlled otherwise. Primary PPH occurs within 24 hours of delivery while secondary PPH develops after 24 hours from retained tissues or infection.
PPH Postpartum hemorrhage, affecter the delivery of fetus vaginal bleeding you can see with in 24 hours this primary PPH, secondary PPH will be up 28 of delivery.
This document discusses postpartum hemorrhage (PPH), including definitions, causes, risk factors, diagnosis, and management approaches. PPH can be primary (occurring within 24 hours of delivery) or secondary (occurring beyond 24 hours). The main causes are uterine atony, trauma, retained placenta or uterine fragments. Management involves emptying the uterus, replacing blood loss, arresting bleeding through medical or surgical interventions like uterine massage, medications, and in severe cases, hysterectomy. Complications of PPH like placenta accreta, uterine inversion are also summarized.
Third stage complications of labour- post partum hemorrhage in obstetrics and...sreya paul
management of postpartum hemorrhage in obstetrics and gynecology,bleeding can lead to death of mother after delivery. it is a very serious problem that need immediate interventions
New microsoft office power point presentationShaells Joshi
This document discusses third stage labor complications and injuries to the birth canal. It defines third stage complications as postpartum hemorrhage, retained placenta, inverted uterus, and amniotic fluid embolism. It describes the causes, signs, and management of these complications. It also discusses classifications and causes of injuries to the birth canal during childbirth, such as lacerations and ways to prevent and manage them. The document provides detailed information on diagnosing and treating various third stage labor complications and birth canal injuries.
Complications of third stage of labou rpptDrisya Nidhin
1. The document discusses postpartum hemorrhage, its causes, types, signs and symptoms, diagnosis, prevention, and management.
2. Primary PPH can be caused by uterine atony or trauma during delivery. Management involves massaging the uterus, administering uterotonics like oxytocin and methergine, and exploring the uterus surgically if needed.
3. Secondary PPH has causes like retained placental fragments or endometritis and is managed by assessing blood loss, replacing blood, and treating the underlying cause.
The document discusses complications of the third stage of labour, including postpartum haemorrhage. Postpartum haemorrhage is defined as blood loss exceeding 500 ml after childbirth. Primary haemorrhage occurs during or within 24 hours of delivery, while secondary occurs after 24 hours until 6 weeks postpartum. Causes include uterine atony, retained placenta, genital tract lacerations, and infection. Diagnosis involves examining blood loss amount and symptoms. Management focuses on prevention during pregnancy and delivery, as well as treatments like uterotonic drugs, bimanual compression, uterine artery ligation, and hysterectomy in severe cases.
Amniocentesis is a procedure that involves inserting a needle through the mother's abdomen into the amniotic sac surrounding the fetus to extract a small sample of amniotic fluid. This fluid contains fetal cells that can be analyzed to detect genetic abnormalities and conditions in the fetus, determine fetal lung maturity, or check for infections. It carries some risks for both the mother and fetus, so nurses counsel patients on the potential benefits and risks before obtaining consent for the procedure.
The third stage of labour involves the delivery of the placenta after childbirth. It typically lasts 10-20 minutes and involves signs of placental separation like lengthening of the umbilical cord. Controlled cord traction is the standard technique for placental delivery but if not successful within 20 minutes, manual removal is required. Complications can include postpartum hemorrhage, retained placenta, and inversion of the uterus. Postpartum hemorrhage is the leading cause of maternal mortality and morbidity, with uterine atony being the most common cause. Management involves uterine massage, oxytocic drugs, bladder catheterization, and other measures, with blood transfusion and surgery as a last resort.
The document discusses complications of the third stage of labour and their management. It defines labour as the process of expelling the products of conception from the womb through the vagina. The stages of labour are outlined as first, second, third, and fourth. Complications of the third stage include postpartum hemorrhage, retained placenta, shock, inversion of the uterus, and amniotic fluid embolism. Postpartum hemorrhage is defined and types, causes, and risk factors are explained. The prevention and management of third stage hemorrhage and retained placenta are described. Other complications such as shock, inversion of the uterus, and disseminated intravascular coagulation are also summarized
Post-partum haemorrhage (PPH) is excessive bleeding following childbirth. It can be primary (within 24 hours of delivery) or secondary (24 hours to 12 weeks postpartum). Primary PPH is typically caused by uterine atony, retained placenta or birth tissues, genital tract trauma, or coagulation disorders. Diagnosis involves assessing blood loss and vital signs. Management involves expediting delivery of the placenta, administering uterotonic drugs to contract the uterus, performing uterine massage, and transfusing blood products if needed. Surgical interventions like balloon tamponade or hysterectomy may be required if bleeding cannot be controlled nonsurgically. PPH is a leading cause of maternal mortality
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
This document discusses postpartum haemorrhage, which is excessive bleeding following childbirth. It defines primary and secondary postpartum haemorrhage and lists common causes such as an atonic uterus. Risk factors include prior issues like anaemia. Management involves massaging the uterus, administering drugs like ergometrine, and potentially performing procedures like manual removal of the placenta or bimanual compression if bleeding continues. Hysterectomy is a last resort treatment if other methods fail to stop the bleeding.
3rd stage of labour by dr shazia a khan 4 mar 19mahmoodayub2
The third stage of labor involves delivery of the placenta and ends with delivery of the membranes, normally lasting 5-15 minutes. Complications during this stage can include postpartum hemorrhage (PPH), the leading cause of maternal mortality worldwide. PPH is primarily caused by uterine atony, genital tract trauma, retained placental tissue, or uterine inversion. Management involves resuscitation, uterotonics to contract the uterus, examination under anesthesia, and potentially surgical interventions like uterine artery ligation.
This document summarizes causes, risk factors, diagnosis, and management of postpartum hemorrhage (PPH). PPH is defined as blood loss of 500 ml or more within 24 hours of delivery. Common causes include uterine atony (70%), retained placenta, genital tract trauma, and bleeding disorders. Risk factors include previous uterine surgery, operative delivery, and bleeding abnormalities. Diagnosis involves estimating blood loss and identifying the cause. Management involves resuscitation, arresting the bleeding through uterotonic drugs, manual removal of retained placenta, repairing lacerations, and in severe cases, surgical procedures like hysterectomy.
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
1. Inversion of the uterus is a life-threatening complication where the uterus turns inside out, either partially or completely. It most commonly occurs within 24 hours of delivery.
2. Inversion of the uterus can be classified based on the severity, from first degree where only the fundus is inverted to the internal os, to third degree where the entire uterus, cervix and vagina are inverted.
3. Symptoms include severe abdominal pain, a vaginal mass, and cardiovascular collapse. Diagnosis involves inability to palpate the fundus of the uterus. Treatment aims to manually reposition the uterus or use hydrostatic pressure with saline. Surgery may be required if conservative methods fail.
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1. Complication Of
Third Stage of Labour
And Management
TOPIC
Submitted To:
Mrs. Snehlata Parashar
(Lecturer, OBG)
Submitted By:
Nagendra Singh
(Bsc Nursing 4t Year)
2. INTRODUCTION
COPLICATIONS OF THIRD STAGE
POST PARTUM HEAMORRHAGE
1. DEFINITION
2. TYPES
3. DIAGNOSIS
4.PREVENTION & MANAGEMENT
INVERSION OF UTERUS
RETAINED PLACENTA
3. Third stage of labor:
This stage extends from delivery of baby to the
delivery of placenta and membranes . It lasts for 15 to 30
mins.
There are several complication may arises during this
stage of labor.
The incedence is about 4 % to 6 % in all deliveries
5. DEFINITION:
1.Clinical definiton:
Any amount of bleeding from genital tract following
the birth of baby upto the end of the puerperuim which
adversly affect the general condition of the mother
which is evedenced by increase in pulse rate and falling
blood pressure
2. Quantitative definition:
It is the amount of blood loss more then 500 ml in
normal delivery and more then 1000 ml in caesarean
delivery
7. Haemorrhage occur within 24hours following birth of
baby is called primary PPH.
There are two types of primary pph :
1. Third stage haemorrhage:
Bleeding occurs before expulsion of placenta is
called third stage haemorrhage.
2.True postpartum haemorrhage:
Bleeding occurs subsequent to expulsion of placenta is
called true postpartum haemorrhage
8. • Tone(Atonic uterus) (80%):-
It is most common cause of PPH. with the seperation
of placenta , the uterine sinuses, which are torn , cannot
be compressed effectively due to imperfect contraction
and retraction of the uterus and bleeding continues.
Traumatic(20%):-
Trauma to the genital tract usually following
operative delivery even after spontaneous delivery.
Thrombin:-
Blood coagulation disorders are less common cause of
primary PPH.
Tissue:- Retained placenta
9. Prevention of postpartum haemorrhage may be done in
all three periods
1. Antpartum period
2. Intrapartum period
3. Post partum period
1. During antipartum period:-
i)Improve health and nutrition
ii)Blood group and Hb should be detected early.
iii) Avoid unnecessory vaginal examination.
iv)Maintain normal blood pressure.
v)Anemia should be corrected .
10. 2. During Intra partum period :-
i)Follow strict aseptic technique.
ii)Administer blood ad fluid if necessory.
iii)Avoid unnecessory vaginal examination and
manipulation of uterus.
iv) Examination of the placenta and membrane should
be done.
3. During post partum period
i)Avoid unnecessory vaginal examination
ii)Proper cleanliness of vulva after delivery.
11. The principles in the management are :-
To empty the uterus of its contents and to make it
contract.
To replace the blood. On occasion, patient may be
in shock. In that case patient is managed for shock
first .
To ensure effective hemostasis in traumatic
bleeding
12. • Placental site bleeding
• To palpate the fundus and massage
• To start crystalloid solution
• Oxytocin
• To catheterize the bladder.
• To give antibiotics (Ampicillin 2 g and Metronidazole
500 mg IV).
• Traumatic bleeding
The uterovaginal canal is to be explored under
general anesthesia after the placenta is expelled and
hemostatic sutures are placed on the offending sites
13. Step 1 – The operation is done under general anesthesia.
In extrem urgency where anesthetist is not available,
the operation may have to be done under deep
sedation with 10mg diazepam given I/V. The patient
placed in lithotomy position. With all aseptic
measures, the bladder is catheterized .
Step 2- One hand is introduced into the uterus after
smearing with the antiseptic solution is cone shaped
manner following the cord, which is made taut by the
other hand .While introducing the hand, the labia are
seperated by the fingers of the other hand. The fingers
of the uterine hand should locate the margin of the
placenta.
14. Step 3- Counter pressure on the uterine fundus is
applied by the other hand placed over the abdomen.
The abdominal hand should steady the fundus and
guide the movement of the finger inside the uterine
cavity until the placenta is completely separated.
Step 4- As soon as the placental margin is reached, the
finger are insinuated between the placenta and uterine
wall with the back of the hand in contect with the
uterine wall. The placenta is gradually separated with a
side ways slicing movement of the fingers, untill
whole of the placenta is seperated
15. Step 5- when the placenta is completely seprated, it is
extracted by traction of the cord by the other hand.
The uterine hand is still inside the uterus for
exploration of the cavity to be sure that nothing is left
behind.
Step 6- I/V methargine 0.2mg is given and uterine hand
is gradually removed while massaging the uterus by
the external hand to make it hard.
Step 7- The placenta and membranes are inspected for
completeness and be sure that the uterus remains hard
and contracted.
16.
17. • Communication
• Resuscitation
• Monitoring
• Arrest of bleeding
Immediate measures are to be taken:-
Call for extra help- Involve the obstetric
registrar(senior staff )on call.
Put in two large bore (14-gauge)and I/V cannulas
Keep patient flat and worm.
Send blood for full blood count, group, cross
matching, diagnostic test (RFT, LFT),coagulation
screen , including fibrinogen and ask for 2 units (at
least)of blood
18. Infuse rapidly 2 liters of NS or plasma substitudes like
haemaccel, an urea-linked geletine, to reexpand the
vascular bed. It does not interfere with cross matching.
Give O2 by mask 10-15 liters/min.
Start 20 units of oxytocin in 1liter of NS I/V at the rate
of 60 dpm. Transfuse blood as soon as possible
One midwife/ rotating house man should be assigned
to monitor the following –
i)Pulse ii)B.P iii)Temp. iv)R.R. and oxymeter.
v) Type and amount of fluids
vi) Urine output vii) Drugs- type, dose and time
19. 1) Atonic 2) Traumatic
3)Retained tissue 4) Coagulopathy
The first step is to control the fundus and note the feel of the
uterus. If the uterus is flabby , the bleeding likely to be
from the atonic uterus . If the uterus is firm and contracted
, the bleeding is likely of traumatic origin . Atonic uterus .
Step 1. ( a ) massage the uterus (b) methergine 0.2mg IV (c)
injection oxytoxcin (d) foley catheter to the empty and to
monitor urine output (e) To examine the expelled placenta
and membranes
Step 2. The uterus is to be explore under genral anesthesia
Step 3. uterine massage and bimanual compression .
20. PROCEDURES –
(a) The whole hand is introduce into the vagina in
cone – shaped fashion after separating the labia with
the finger of other hand
(b) the vaginal hand is clenched into a fist with the
back of the hand dirceted posteriorly and knuckles in
the anterior fornix
(c) the other hand is placed over the abdomen behind
the uterus to make it anti verted
(d) the uterus is firmly squeezed between the two
hands . This is evidence by absence of bleeding if the
compression is released
21. During the period , the resuscitative measures are to
be continued . If , in spite of therapy , the uterus
remains refractory and the bleeding continues , the
possibility of blood coagluation disorders should be
kept in mind and massive fresh whole blood
transfusion should be given until specific measures
can be employed . However , with oxytocics and blood
transfusion , almost all cases respond well . Where
uterine contraction and retraction regain and bleeding
stops. But in rare cases , when the uterus failed to
contract, the following may be tried desperately as an
alternative to hysterectomy.
22.
23. Step – 4. Uterine tamponade –
(a) Tight intra uterine packing is done
uniformaly under general anesthesia
(b) Balloon tamponade
24. Haemorrhage occurs beyond 24 hours and within
puerperium is called secondary PPH.
CAUSES:-
The causes of late postpartum hemorrhage are:
1) Retained bits of cotyledon or membranes (most common),
2) Infection and separation of slough over a deep cervicovaginal
laceration,
3) Endometritis and subinvolution of the placental site—due to
delayed
healing process,
25. 4) Secondary hemorrhage from cesarean section wound
usually occur between 10–14 days. It is probably due
to—
(a) separation of slough exposing a bleeding vessel or
(b) from granulation tissue,
5) Withdrawal bleeding following estrogen therapy for
suppression of lactation,
6) Other rare causes are: chorionepithelioma—occurs
usually beyond 4 Weeks of delivery; carcinoma cervix;
placental polyp; infected Fibroid or Fibroid polyp and
puerperal inversion of uterus.
27. Principles:
To assess the amount of blood loss and to replace it
(blood transfusion).
To find out the cause and to take appropriate steps to
rectify it.
Supportive therapy:
Blood transfusion, if necessary,
To administer methergine 0.2 mg intramuscularly, if
the bleeding is uterine in origin,
To administer antibiotics (clindamycin and
metronidazole) as a routine.
28. Conservative: If the bleeding is slight and no
apparent cause is detected, a careful watch for a period
of 24 hours or so is done in the hospital.
Active treatment: As the most common cause is due
to retained bits of cotyledon or membranes, it is
preferable to explore the uterus urgently under general
anesthesia. One should not ignore the small amount
of bleeding; as unexpected alarming hemorrhage may
follow sooner or later. The products are removed by
ovum forceps. Gentle curettage is done by using
flushing curette. Methergine 0.2 mg is given
intramuscularly. The materials removed are to be sent
for histological examination.
29. It is a life threatening condition in which the uterus is
turned outside partially or completely.
The incidence is about 1 in 20,000 deliveries
Degree of uterine inversion
i) 1st degree :- fundus is depressed while reaching
upto internal os .
ii) 2nd degree:- The fundus passed through the cervix
but lies inside vagina .
iii)3rd degree:- The endometrium with or without the
placenta is visible outside the vulva
30.
31. To replace that part which is inverted last .
To apply counter support by the other hand placed on
abdoman .
Afte replacement, the hand should be remain inside
the uterus untill the uterus become contracted by inj.
Oxytocin.
The placenta remove manually only after uterus
become contracted .
Proper management of shock.
32. The placenta is said to be retained when it is not
expelled out even after 30 minutes after the birth of
baby.
Causes :-
Placenta completely sepertated but retained due to
poor voluntary expulsive force
Simple adherent of placenta is due to atonic uterus.
33. To express the placenta by controlled traction
Manual removal of placenta
Management of shock
Antibiotics to prevent infection
34. Step 1 – General anasthesia is given and bladder is
catheterised
Step 2- One hand is inserted in cone shaape
manner and counter pressure is applied on uterine
fundus by other hand.
Step 3 – as soon as placental margine has reacher ,
fingers are insinuated with dorsum of hand in
contect with uterine wall and placenta seperated
by slicing movement.
Step 4- Extraction of placenta by traction ofcord
by other hand