SlideShare a Scribd company logo
1 of 38
Antepartum &
     Postpartum
Hemorrhage (APH &PPH)
     Al-Momtan
Antepartum & Postpartum Hemorrhage

• Obstetrics is "bloody business."

• Death from hemorrhage still remains a leading
  cause of maternal mortality.

• Hemorrhage was a direct cause of more than
  18 percent of 3201 pregnancy-related
  maternal deaths.
Postpartum Hemorrhage
• In spite of marked improvements in management, PPH
  remains a significant contributor to maternal morbidity and
  mortality both in developing and developed countries.

• One of the most challenging complications a clinician will face.

• Prevention, early recognition and prompt appropriate
  intervention are the keys to minimizing its impact.
DEFINITION:

          The loss of >500ml of blood from the genital tract in
the first 24 hrs after delivery

                                      (or)

     < 500 ml with haemodynamic changes in the mother.

                                      (or)

     >1000 ml – cesarean section within 24 hrs.

                                      (or)

     > 1400 ml – Elective cesarean hysterectomy

                                      (or)

     > 3000 ml – Emergency cesarean hysterectomy
- In a recent ACOG study PPH is defined as Haematocrit       change of 10% or the
need for red cell transfusion.



  Severe PPH -                   > 1500ml blood loss
                                       or
                             Drop in Hb concentration 40g/l.
                                       or
                              units of blood transfusion.
                              4
Secondary PPH - Blood loss between 24 hrs and 6 weeks
                             Post-delivery.
In general, early PPH involves heavier bleeding and greater morbidity.
Incidence:
       Subjective : 2 – 11%
       Objective : 20%
Classification of primary PPH
       Atonic PPH – 80%
       Traumatic PPH – 15%
       Retained placenta, membranes,
       coagulation failure – 5%
Haematological Changes in Pregnancy
• 40% expansion of blood volume by 30 weeks

• 600 ml/min of blood flows through intervillous space

• Appreciable increase in concentration of Factors I (fibrinogen),
  VII, VIII, IX, X

• Plasminogen appreciably increased

• Plasmin activity decreased

• Decreased colloid oncotic pressure secondary to 25%
  reduction in serum albumin
Reduced Maternal Blood Volume

• Small stature

• Severe preeclampsia/eclampsia

• Early gestational age
PPH
PPH
• The etiologies of early PPH are most easily understood as abnormalities of
  one or more of four basic processes.

• The four “T” processes.

• Previous PPH!!
The Four “T”

    Tone
   Tissue
  Trauma
 Thrombin
PPH Risk Factors
• Many factors affect a woman’s risk of PPH.

• Each of these risk factors can be understood
  as predisposing her to one or more of the four
  “T” processes.
PPH Risk Factors
PPH Risk Factors
PPH Risk Factors
PPH Risk Factors
PREVENTION OF PPH
• Although any woman can experience a PPH, the
  presence of risk factors makes it more likely.

• For women with such risk factors, consideration
  should be given to extra precautions such as:
   –   IV access
   –   Coagulation studies
   –   Crossmatching of blood
   –   Anaesthesia backup
   –   Referral to a tertiary centre
PREVENTION OF PPH
• UTEROTONIC DRUGS

  – Routine oxytocic administration in the third stage of labour
    can reduce the risk of PPH by more than 40%

  – The routine prophylaxis with oxytocics results in a reduced
    need to use these drugs therapeutically

  – Management of the third stage of labour should therefore
    include the administration of oxytocin after the delivery of
    the anterior shoulder.
Intranatal:

• Hasty delivery of the baby is to be avoided.

• Adequate amount of blood should be cross matched and
  available when haemorrhage is anticipated.

• Coagulation studies are done in cases of Abruptio
  placenta and retained dead fetus.
Active Management of 3rd Stage of Labour:
1. Uterotonic Agents:
  •   10 units of oxytocin IM or
  •   Syntometrine (5 units of oxytocin and 0.5mg
      ergonovine maleate).
  • Misoprostol, a prostaglandin E1 analogue, 600g
   orally.
2. Early cord clamping
3. Controlled cord traction.
MANAGEMENT OF PPH
• Early recognition of PPH is a very important factor in
  management.

• An established plan of action for the management of
  PPH is of great value when the preventative
  measures have failed.
• Lab:
-   CBC / BG / Cross match of 4-6 units of blood
-   KFT / Coagulation profile
-   Give FFP / cryoprecipitate if coagulation test results are abnormal
-   Give platelet concentrates if the platelet count is < 50 X 109/L & bleeding continues
MANAGEMENT OF PPH
MANAGEMENT OF PPH
DRUG THERAPY FOR PPH
MANAGEMENT OF PPH
MANAGEMENT OF PPH
MANAGEMENT OF PPH
Evaluation of response
- Monitor pulse, blood pressure, blood gas status, &
acid-base status + monitoring central venous pressure.
- Measure urine output using an indwelling catheter
- Order regular FBC counts and coagulation tests to
guide blood component therapy
Summary: remember 4 Ts
• “TONE”                   •   Palpate fundus.
• Rule out Uterine Atony   •   Massage uterus.
                           •   Oxytocin
                           •   Methergine
                           •   Hemabate
Summary: remember 4 Ts
• “Tissue”                • Inspect placenta for
• R/O retained placenta     missing cotyledons.
                          • Explore uterus.
                          • Treat abnormal
                            implantation.
Summary: remember 4 Ts
• “TRAUMA”                  • Obtain good exposure.
• R/O cervical or vaginal   • Inspect cervix and
  lacerations.                vagina.
                            • Worry about slow
                              bleeders.
                            • Treat haematomas.
Summary: remember 4 Ts
• “THROMBIN”    • Check labs if suspicious.
Thank you..

More Related Content

What's hot

POST PARTUM HAEMORRHAGE (PPH).pptx
POST PARTUM HAEMORRHAGE (PPH).pptxPOST PARTUM HAEMORRHAGE (PPH).pptx
POST PARTUM HAEMORRHAGE (PPH).pptx
deepikaagarwal68
 
Umbilical cord prolapse
Umbilical cord prolapseUmbilical cord prolapse
Umbilical cord prolapse
enas mostafa
 

What's hot (20)

Post Partum Hemorrhage (PPH).ppt
Post Partum Hemorrhage (PPH).pptPost Partum Hemorrhage (PPH).ppt
Post Partum Hemorrhage (PPH).ppt
 
Pph drill
Pph drillPph drill
Pph drill
 
Uterus Transplantation Utx (obstetric and gynecology)
Uterus Transplantation Utx (obstetric and gynecology) Uterus Transplantation Utx (obstetric and gynecology)
Uterus Transplantation Utx (obstetric and gynecology)
 
POST PARTUM HAEMORRHAGE (PPH).pptx
POST PARTUM HAEMORRHAGE (PPH).pptxPOST PARTUM HAEMORRHAGE (PPH).pptx
POST PARTUM HAEMORRHAGE (PPH).pptx
 
Post Partum Hemorrhage (PPH)
Post Partum Hemorrhage (PPH)Post Partum Hemorrhage (PPH)
Post Partum Hemorrhage (PPH)
 
Umbilical cord prolapse
Umbilical cord prolapseUmbilical cord prolapse
Umbilical cord prolapse
 
Baloon tamponade in management of postpartum haemorrhage
Baloon tamponade in management of postpartum haemorrhageBaloon tamponade in management of postpartum haemorrhage
Baloon tamponade in management of postpartum haemorrhage
 
Version
VersionVersion
Version
 
Epilepsy in pregnancy
Epilepsy in pregnancy Epilepsy in pregnancy
Epilepsy in pregnancy
 
Eclampsia drill for the OBSTETRICIANS
Eclampsia drill  for the OBSTETRICIANSEclampsia drill  for the OBSTETRICIANS
Eclampsia drill for the OBSTETRICIANS
 
Abortion -what it is
Abortion -what it isAbortion -what it is
Abortion -what it is
 
Obstructed labour
Obstructed labourObstructed labour
Obstructed labour
 
Placenta accreta
Placenta accretaPlacenta accreta
Placenta accreta
 
Postpartum haemorrhage pf
Postpartum haemorrhage pfPostpartum haemorrhage pf
Postpartum haemorrhage pf
 
presentaion on perineal tear
presentaion on perineal tearpresentaion on perineal tear
presentaion on perineal tear
 
Step wise pelvic devascularisation
Step wise pelvic devascularisationStep wise pelvic devascularisation
Step wise pelvic devascularisation
 
Caesarean section
Caesarean sectionCaesarean section
Caesarean section
 
Partograph
PartographPartograph
Partograph
 
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANILABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
 
Medical Management of Post-partum Hemorrhage (PPH)
Medical Management of Post-partum Hemorrhage (PPH) Medical Management of Post-partum Hemorrhage (PPH)
Medical Management of Post-partum Hemorrhage (PPH)
 

Viewers also liked

PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal
PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal
PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal
Lifecare Centre
 
Hemorrhage in late pregnancy
Hemorrhage in late pregnancyHemorrhage in late pregnancy
Hemorrhage in late pregnancy
Prativa Dhakal
 
Thoracic aortic aneurysm
Thoracic aortic aneurysmThoracic aortic aneurysm
Thoracic aortic aneurysm
Ahmed Almumtin
 
Primary Postpartum Haemorrhage
Primary Postpartum HaemorrhagePrimary Postpartum Haemorrhage
Primary Postpartum Haemorrhage
Victor Ordu
 

Viewers also liked (20)

Antepartum hemorrhage
Antepartum hemorrhageAntepartum hemorrhage
Antepartum hemorrhage
 
Pilonidal sinus defect closure, reconstruction methods
Pilonidal sinus defect closure, reconstruction methodsPilonidal sinus defect closure, reconstruction methods
Pilonidal sinus defect closure, reconstruction methods
 
approach to patient vaginal bleeding in 2nd half of pregnancy
approach to patient  vaginal bleeding in 2nd half of pregnancyapproach to patient  vaginal bleeding in 2nd half of pregnancy
approach to patient vaginal bleeding in 2nd half of pregnancy
 
Postpartum hemorrhage
Postpartum hemorrhagePostpartum hemorrhage
Postpartum hemorrhage
 
PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal
PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal
PPH Drill Dr. Jyoti Bhaskar , Dr. Sharda Jain , Dr. Jyoti Agarwal
 
Hemorrhage in late pregnancy
Hemorrhage in late pregnancyHemorrhage in late pregnancy
Hemorrhage in late pregnancy
 
Medical management of postpartum hemorrhage pph lecture
Medical management of postpartum hemorrhage pph lectureMedical management of postpartum hemorrhage pph lecture
Medical management of postpartum hemorrhage pph lecture
 
Postpartum Haemorrhage
Postpartum HaemorrhagePostpartum Haemorrhage
Postpartum Haemorrhage
 
Postpartum hemorrhage and Its Management
Postpartum hemorrhage and Its ManagementPostpartum hemorrhage and Its Management
Postpartum hemorrhage and Its Management
 
Obstructive jaundice management
Obstructive jaundice managementObstructive jaundice management
Obstructive jaundice management
 
Thoracic aortic aneurysm
Thoracic aortic aneurysmThoracic aortic aneurysm
Thoracic aortic aneurysm
 
Acute appendicitis
Acute appendicitisAcute appendicitis
Acute appendicitis
 
Haemorrhage during late pregnancy
Haemorrhage during late pregnancyHaemorrhage during late pregnancy
Haemorrhage during late pregnancy
 
Primary Postpartum Haemorrhage
Primary Postpartum HaemorrhagePrimary Postpartum Haemorrhage
Primary Postpartum Haemorrhage
 
Antepartum Hemorrhage
Antepartum Hemorrhage Antepartum Hemorrhage
Antepartum Hemorrhage
 
Aph
AphAph
Aph
 
Wk4 epidemocd
Wk4 epidemocdWk4 epidemocd
Wk4 epidemocd
 
Pph
PphPph
Pph
 
Hypertensive disorders in Pregnancy
Hypertensive disorders in PregnancyHypertensive disorders in Pregnancy
Hypertensive disorders in Pregnancy
 
د.فاطمة
د.فاطمةد.فاطمة
د.فاطمة
 

Similar to Overview management of postpartum haemorrhage

Similar to Overview management of postpartum haemorrhage (20)

Anaesthetic management of obstetric emergencies
Anaesthetic management of  obstetric emergenciesAnaesthetic management of  obstetric emergencies
Anaesthetic management of obstetric emergencies
 
Postpartum haemorrhage
Postpartum haemorrhagePostpartum haemorrhage
Postpartum haemorrhage
 
Post partum Haemorrhage
Post partum HaemorrhagePost partum Haemorrhage
Post partum Haemorrhage
 
TJ MASHAMBA.ppt
TJ MASHAMBA.pptTJ MASHAMBA.ppt
TJ MASHAMBA.ppt
 
Overview and medical management of pph
Overview and medical management of pphOverview and medical management of pph
Overview and medical management of pph
 
PPH Bundle.pptx
PPH Bundle.pptxPPH Bundle.pptx
PPH Bundle.pptx
 
Postpartum-Haemorrhage 2 slides.ppt
Postpartum-Haemorrhage 2 slides.pptPostpartum-Haemorrhage 2 slides.ppt
Postpartum-Haemorrhage 2 slides.ppt
 
Post partum hemorrhage of gynecology and obstetrics
Post partum hemorrhage of gynecology and obstetricsPost partum hemorrhage of gynecology and obstetrics
Post partum hemorrhage of gynecology and obstetrics
 
Post Partum Haemorrhage
Post Partum HaemorrhagePost Partum Haemorrhage
Post Partum Haemorrhage
 
Obstetric emergencies in ICU
Obstetric emergencies in ICUObstetric emergencies in ICU
Obstetric emergencies in ICU
 
ANTEPARTUM HEMMORRHAGE - pregnancy complication
ANTEPARTUM HEMMORRHAGE - pregnancy complicationANTEPARTUM HEMMORRHAGE - pregnancy complication
ANTEPARTUM HEMMORRHAGE - pregnancy complication
 
PPH.pptx
PPH.pptxPPH.pptx
PPH.pptx
 
ANTEPARTUM HAEMORRHAGE.pptx
ANTEPARTUM HAEMORRHAGE.pptxANTEPARTUM HAEMORRHAGE.pptx
ANTEPARTUM HAEMORRHAGE.pptx
 
Post Partum Hemorrhage in ED
Post Partum Hemorrhage in EDPost Partum Hemorrhage in ED
Post Partum Hemorrhage in ED
 
Emergency Obstetrics
Emergency ObstetricsEmergency Obstetrics
Emergency Obstetrics
 
Blood transfusion in obstetric haemorrhage
Blood transfusion in obstetric haemorrhageBlood transfusion in obstetric haemorrhage
Blood transfusion in obstetric haemorrhage
 
Postpartum
PostpartumPostpartum
Postpartum
 
POSTPARTUM HAEMORRHAGE IN MIDWIFERY .ppt
POSTPARTUM HAEMORRHAGE IN MIDWIFERY .pptPOSTPARTUM HAEMORRHAGE IN MIDWIFERY .ppt
POSTPARTUM HAEMORRHAGE IN MIDWIFERY .ppt
 
ANTEPARTUM HEMORRHAGE-150512150815-lva1-app6892.pptx
ANTEPARTUM HEMORRHAGE-150512150815-lva1-app6892.pptxANTEPARTUM HEMORRHAGE-150512150815-lva1-app6892.pptx
ANTEPARTUM HEMORRHAGE-150512150815-lva1-app6892.pptx
 
Postpartum hemorrhage - with pictures.pptx
Postpartum hemorrhage - with pictures.pptxPostpartum hemorrhage - with pictures.pptx
Postpartum hemorrhage - with pictures.pptx
 

More from Ahmed Almumtin (15)

Approach to Trauma in Urology
 Approach to Trauma in Urology Approach to Trauma in Urology
Approach to Trauma in Urology
 
Meconium ileus surgical management
Meconium ileus surgical managementMeconium ileus surgical management
Meconium ileus surgical management
 
Surgical anatomy of breasts
Surgical anatomy of breastsSurgical anatomy of breasts
Surgical anatomy of breasts
 
Carcinoid Tumour
Carcinoid TumourCarcinoid Tumour
Carcinoid Tumour
 
Arrhythmia
ArrhythmiaArrhythmia
Arrhythmia
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
 
Otitis externa
Otitis externaOtitis externa
Otitis externa
 
Wounds in forensic medicine
Wounds in forensic medicineWounds in forensic medicine
Wounds in forensic medicine
 
Blood spatter analysis
Blood spatter analysisBlood spatter analysis
Blood spatter analysis
 
Surgical drains, tube, catheters and central lines
Surgical drains, tube, catheters and central linesSurgical drains, tube, catheters and central lines
Surgical drains, tube, catheters and central lines
 
an Approach to Dyspepsia
an Approach to Dyspepsiaan Approach to Dyspepsia
an Approach to Dyspepsia
 
orthopedic and rheumatologic disorders of the knee joint
orthopedic and rheumatologic disorders of the knee jointorthopedic and rheumatologic disorders of the knee joint
orthopedic and rheumatologic disorders of the knee joint
 
regional anesthesia and beir block
regional anesthesia and beir blockregional anesthesia and beir block
regional anesthesia and beir block
 
Psychotic disorders
Psychotic disordersPsychotic disorders
Psychotic disorders
 
Anatomy of appendix
Anatomy of appendixAnatomy of appendix
Anatomy of appendix
 

Recently uploaded

Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Abortion pills in Kuwait Cytotec pills in Kuwait
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
Naveen Gokul Dr
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
MedicoseAcademics
 
Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf
Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdfUnveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf
Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf
NoorulainMehmood1
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
claviclebrown44
 

Recently uploaded (20)

ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATROROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
 
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
 
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
 
Creeping Stroke - Venous thrombosis presenting with pc-stroke.pptx
Creeping Stroke - Venous thrombosis presenting with pc-stroke.pptxCreeping Stroke - Venous thrombosis presenting with pc-stroke.pptx
Creeping Stroke - Venous thrombosis presenting with pc-stroke.pptx
 
Benefits of Chanting Hanuman Chalisa .pdf
Benefits of Chanting Hanuman Chalisa .pdfBenefits of Chanting Hanuman Chalisa .pdf
Benefits of Chanting Hanuman Chalisa .pdf
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifier
 
Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...
 
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door StepBangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
 
SEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdf
SEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdfSEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdf
SEMESTER-V CHILD HEALTH NURSING-UNIT-1-INTRODUCTION.pdf
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
Top 15 Sexiest Pakistani Pornstars with Images & Videos
Top 15 Sexiest Pakistani Pornstars with Images & VideosTop 15 Sexiest Pakistani Pornstars with Images & Videos
Top 15 Sexiest Pakistani Pornstars with Images & Videos
 
Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf
Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdfUnveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf
Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf
 
duus neurology.pdf anatomy. phisiology///
duus neurology.pdf anatomy. phisiology///duus neurology.pdf anatomy. phisiology///
duus neurology.pdf anatomy. phisiology///
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
 
Drug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxDrug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptx
 
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.GawadHemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
 
High Purity 99% PMK Ethyl Glycidate Powder CAS 28578-16-7
High Purity 99% PMK Ethyl Glycidate Powder CAS 28578-16-7High Purity 99% PMK Ethyl Glycidate Powder CAS 28578-16-7
High Purity 99% PMK Ethyl Glycidate Powder CAS 28578-16-7
 
Histopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseasesHistopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseases
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answers
 

Overview management of postpartum haemorrhage

  • 1. Antepartum & Postpartum Hemorrhage (APH &PPH) Al-Momtan
  • 2. Antepartum & Postpartum Hemorrhage • Obstetrics is "bloody business." • Death from hemorrhage still remains a leading cause of maternal mortality. • Hemorrhage was a direct cause of more than 18 percent of 3201 pregnancy-related maternal deaths.
  • 3. Postpartum Hemorrhage • In spite of marked improvements in management, PPH remains a significant contributor to maternal morbidity and mortality both in developing and developed countries. • One of the most challenging complications a clinician will face. • Prevention, early recognition and prompt appropriate intervention are the keys to minimizing its impact.
  • 4. DEFINITION: The loss of >500ml of blood from the genital tract in the first 24 hrs after delivery (or) < 500 ml with haemodynamic changes in the mother. (or) >1000 ml – cesarean section within 24 hrs. (or) > 1400 ml – Elective cesarean hysterectomy (or) > 3000 ml – Emergency cesarean hysterectomy
  • 5. - In a recent ACOG study PPH is defined as Haematocrit change of 10% or the need for red cell transfusion. Severe PPH - > 1500ml blood loss or Drop in Hb concentration 40g/l. or  units of blood transfusion. 4 Secondary PPH - Blood loss between 24 hrs and 6 weeks Post-delivery. In general, early PPH involves heavier bleeding and greater morbidity.
  • 6. Incidence: Subjective : 2 – 11% Objective : 20% Classification of primary PPH Atonic PPH – 80% Traumatic PPH – 15% Retained placenta, membranes, coagulation failure – 5%
  • 7. Haematological Changes in Pregnancy • 40% expansion of blood volume by 30 weeks • 600 ml/min of blood flows through intervillous space • Appreciable increase in concentration of Factors I (fibrinogen), VII, VIII, IX, X • Plasminogen appreciably increased • Plasmin activity decreased • Decreased colloid oncotic pressure secondary to 25% reduction in serum albumin
  • 8. Reduced Maternal Blood Volume • Small stature • Severe preeclampsia/eclampsia • Early gestational age
  • 9. PPH
  • 10. PPH • The etiologies of early PPH are most easily understood as abnormalities of one or more of four basic processes. • The four “T” processes. • Previous PPH!!
  • 11. The Four “T” Tone Tissue Trauma Thrombin
  • 12. PPH Risk Factors • Many factors affect a woman’s risk of PPH. • Each of these risk factors can be understood as predisposing her to one or more of the four “T” processes.
  • 17. PREVENTION OF PPH • Although any woman can experience a PPH, the presence of risk factors makes it more likely. • For women with such risk factors, consideration should be given to extra precautions such as: – IV access – Coagulation studies – Crossmatching of blood – Anaesthesia backup – Referral to a tertiary centre
  • 18. PREVENTION OF PPH • UTEROTONIC DRUGS – Routine oxytocic administration in the third stage of labour can reduce the risk of PPH by more than 40% – The routine prophylaxis with oxytocics results in a reduced need to use these drugs therapeutically – Management of the third stage of labour should therefore include the administration of oxytocin after the delivery of the anterior shoulder.
  • 19. Intranatal: • Hasty delivery of the baby is to be avoided. • Adequate amount of blood should be cross matched and available when haemorrhage is anticipated. • Coagulation studies are done in cases of Abruptio placenta and retained dead fetus.
  • 20. Active Management of 3rd Stage of Labour: 1. Uterotonic Agents: • 10 units of oxytocin IM or • Syntometrine (5 units of oxytocin and 0.5mg ergonovine maleate). • Misoprostol, a prostaglandin E1 analogue, 600g orally. 2. Early cord clamping 3. Controlled cord traction.
  • 21. MANAGEMENT OF PPH • Early recognition of PPH is a very important factor in management. • An established plan of action for the management of PPH is of great value when the preventative measures have failed. • Lab: - CBC / BG / Cross match of 4-6 units of blood - KFT / Coagulation profile - Give FFP / cryoprecipitate if coagulation test results are abnormal - Give platelet concentrates if the platelet count is < 50 X 109/L & bleeding continues
  • 24.
  • 26.
  • 29.
  • 30.
  • 31.
  • 33. Evaluation of response - Monitor pulse, blood pressure, blood gas status, & acid-base status + monitoring central venous pressure. - Measure urine output using an indwelling catheter - Order regular FBC counts and coagulation tests to guide blood component therapy
  • 34. Summary: remember 4 Ts • “TONE” • Palpate fundus. • Rule out Uterine Atony • Massage uterus. • Oxytocin • Methergine • Hemabate
  • 35. Summary: remember 4 Ts • “Tissue” • Inspect placenta for • R/O retained placenta missing cotyledons. • Explore uterus. • Treat abnormal implantation.
  • 36. Summary: remember 4 Ts • “TRAUMA” • Obtain good exposure. • R/O cervical or vaginal • Inspect cervix and lacerations. vagina. • Worry about slow bleeders. • Treat haematomas.
  • 37. Summary: remember 4 Ts • “THROMBIN” • Check labs if suspicious.