INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
This presentation contains :-
1.Introduction of normal labour
2. Definiation of normal labour
3.Criteria of normal labour
4. Physiology of normal labour
5. Pathophysiology of labor
6.Estrogen
7. Prostaglandin
8. Oxytocin
9. True labor and false labor difference
10. Uterine contraction in labor
11. Stages of labour
12. Management of 1 st stage
13. management of 2 nd stage
14. mamagement of 3 rd stage of labor
15. Cervix dilation
16. Friedman's curve
17. Fetal skull
18. Diameter of fetal skull
19. Sutures in fetal head
20. Moulding
21. Mechanism of labour
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
This presentation contains :-
1.Introduction of normal labour
2. Definiation of normal labour
3.Criteria of normal labour
4. Physiology of normal labour
5. Pathophysiology of labor
6.Estrogen
7. Prostaglandin
8. Oxytocin
9. True labor and false labor difference
10. Uterine contraction in labor
11. Stages of labour
12. Management of 1 st stage
13. management of 2 nd stage
14. mamagement of 3 rd stage of labor
15. Cervix dilation
16. Friedman's curve
17. Fetal skull
18. Diameter of fetal skull
19. Sutures in fetal head
20. Moulding
21. Mechanism of labour
a detail study on normal labour ( definition, stages of labour, management ,p...martinshaji
The World Health Organization (WHO) defines normal birth as follows: The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. this is study on detailed study on physiology and stages of normal labour .
please comment
thank u
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
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.
a detail study on normal labour ( definition, stages of labour, management ,p...martinshaji
The World Health Organization (WHO) defines normal birth as follows: The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. this is study on detailed study on physiology and stages of normal labour .
please comment
thank u
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
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.
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
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
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.
2. According to WHO it is define as the amount of blood
loss in excess of 500ml following birth of baby
Any amount of bleeding from or into the genital tract
following birth up to the end of the puerperium, which
adversely affects the general condition of the patient
evidenced by rise in pulse rate and falling blood pressure
is called post partum hemorrhage
3. Obstetrics emergency
leading cause of maternal death world wide
Occurs in up to 18% of total births
Among different factors, PPH due to uterine atony
is the primary and direct cause of maternal
mortality comprising about 90%
4. Depending upon the amount of blood loss, PPH
can be
1. Minor PPH (estimated blood loss of up to 1000 mls.)
2. Major PPH (estimated blood loss over 1000 mls.)
3. Severe PPH (estimated blood loss over 2000 mls.)
The average blood loss following vaginal delivery, cesarean
delivery and cesarean hysterectomy is 500 ml, 1000 ml and 1500
ml respectively.
5. Types
1. Primary PPH(within 24hrs following birth of baby)
a. Third stage hemorrhage(before expulsion of placenta)
b. True post partum haemorrhage(subsequent to expulsion of placenta)
2. Secondary PPH(beyond 24 hrs & within puerperium)
. Also k/a delayed or late puerperal hemorrhage
6. CAUSE OF PRIMARY
POSTPARTUM HEMORRHAGE
Four basic pathologies are expressed as the four
Ts’
Tone-uterine atony
Tissue-retained placenta ,blood clots
Trauma-genital tract injury
thrombin-coagulopathy
7. ATONIC UTERUS(80%)
• Commonest cause of PPH
• As long as placenta remains unseparated ; bleeding is unlikely.
• with separation of the placenta , the uterine sinuses torn, which
cannot be compressed effectively due to the imperfect contraction
and retraction of uterus and bleeding continues.
8. Predisposing factors
1.Grand multipara
• Inadequate retraction and frequent adherent
contribute to it.
2. Overdistension of the uterus
-multiple pregnancy
-hydramnios
-big baby(>4kg)
3.Malnutrition and anemia(<9g/dl)
10. 7.Initiation and agumentation of delivery by oxytocin
-if oxytocin is contine for at least one hour following delivery.
8.Malformation of uterus
-implantation of the placenta inuterine septum of septate uterus or in cornual
region of bicornute uterus.
9.Uterine fibroid
11. 10.Mismanaged third stage of labour
-too rapid delivery of the baby preventing the uterine wall to adapt to the
diminising content
-premature attempt to deliver the placenta before it separate
-pulling the cord
-manual separation of placenta increase blood loss during cesarean delivery
11.Placenta
-morbidly adherent (accreta,percreta)
-partially or compeletly seprated
12.precipitate labor
12. • Other causes of atonic hemorrhage are;
-obesity(BMI>35)
-previous PPH
-age(>40 years)
-drugs; ritodrine,mgso4,nifidepine
13. TRAUMATIC
• Trauma to genital tract due to
-operative delivery
-episitomy
-cesarean section
14. RETAINED TISSUE
-bits of placenta
-blood clots
THROMBIN
-blood coagulation disorder ; acquired or congenital
-blood coagulopathy; diminised procoagulant or increase fibrinolytic
activity
15. CAUSE OF SECONDARY POSTPARTUM
HEMORRHAGE
1.Retained bits of cotyledon or membranes
2.Infection and separation of slough over a deep
cervicovaginal laceration
3.Endometritis and subinvolution of placental sites-due to
delayed healing process
4.Secondary hemorrhage from cesarean section wound
usually occurs between 10 and 40 days
5.Withdrawal bleeding following estrogen therapy for
suppression of lactation
6.Other cause are; chorionepithelioma,carcinoma of
cervix,placental polyp,infected fibroid, uterine
arteriovenous fistula formation and puerperal inversion
18. 1. Communication
• Alert all relevant professionals
• Involve the obstetric registrar on call
• Communicate with patient and partner
19. 2. Resuscitation
• Access airway, breathing and circulation
• Give oxygen 10-15L/min via mask
• Two wide bore cannula is inserted and crystalloid is
infused
20. •Send blood for full count, group, cross
matching, coagulation screen and ask for 2
unit of blood
22. 4. Arrest the bleeding
• Bleeding can be treated
I. Mechanically
II. Pharmacologically
III. Surgically
23. Step 1
•Uterine massage: to make uterus hard and express
blood clot
•I.V Methergine 0.2 mg
•Inj. Oxytocin
•To examine expelled placenta and membrane
24. Step 2
• The uterus is explored under general anesthesia to
exclude coexisting bleeding site from injured area
• In refractory cases
Misopristol 1000mcg per rectum
Calcium gluconate 1gm I.V slowly
26. •In spite of this therapy bleeding continues
then it is due to coagulation disorders.
Massive blood transfusion is done until
special measure can be taken.
•Almost all cases respond well with oxytocin
and blood transfusion
27. Management of secondary PPH
• For retained bits of placenta: removal by ovum
forceps. Curettage is done by using flushing
curette
• I.M methergine 0.2mg
• Blood transfusion
• To administer antibiotic (clindamycin and
metronidazole)
29. It is the final method when all the other methods fail to control post partum
haemorrhage.
It includes two steps,
Devascularisation procedure
a) B lynch compression suture
b) Ligaton of uterine artery
c) Ligation of utero-ovarian artery anastomosis
d) Ligation of ant. Div. of Internal iliac artery
e) Angiograhic arterial embolisation
Hysterectomy
30. B lynch suture
Christopher B Lynch developed it in 1997
Objective-To compress the uterus without occluding the UA or the
uterine cavity.
Ind: Atonic PPH,PPH with coagulopathy
Suture: absorbable-Polyglactin ,Chromic .
Procedure: A compression test is done and if the uterus responds this
suture is attempted
31. Bimanual compression
Wearing hld gloves, insert hand into
vagina; form fist
Place fist into anterior fornix and apply
pressure against anterior wall of uterus.
With other hand, press deeply into
abdomen behind uerus, appling pressure
against posterior wall of uterus
Maintain compression for 20-30 min or
until bleeding is controlled and uterus
contracts
32. B-Lynch suture Procedure:Take a suture 3cm below the incision line
and come out 3cm above the line.
Take the suture over the fundus and come posteriorly.
Now take a horizontal suture in the lower segment of uterus posteriorly.
Take this suture over the fundus and come anteriorly.
Insert a suture again 3cm above the incision ,then come out 3cm below
the incision .
Tell the assistant to compress the uterus while you tie the knot.
SR-80% , Avoid hysterectomy
36. B)Ligation of uterine arteries
Ascending branch of uterine artery is ligated at
the lateral border b/n upper and lower uterine
segment.
No.1. chromic catgut is used.
If bleeding continues.
C) Ligation of ovarian & uterine artery
anastamosis
Done just below the ovarian ligament.
Some times, temporary occlusion of
ovarian vessels at infundibulopelvic ligament
is done by rubber sleeved clamps.
37. D)Ligation of anterior division of internal iliac artery
Done unilaterally or bilaterally.
Reduces distal blood flow. It helps stable clot formation by reducing pp up to 85%.
Due to extensive collateral circulation, there is no pelvic tissue necrosis.
Bilateral ligation avoids hysterectomy in 50% of the cases.
E)Angiographic arterial embolization
Under fluroscopy using gel foam as embolus
>90% sucess rate
Avoids hysterectomy
38. Hysterectomy
Final most step.
Rarely indicated.
Only if uterus fails to contract & bleeding continues.
If mother is parous, decision is taken earlier. It may be total or
subtotal depending on the case.
39. MM of traumatic causes
Exploration
And suturing of vaginal tears, paraurethral tears, cx tears
Hemostasis is achieved by appropriate catgut sutures.
Repair is done under GA if necessary.
40. Save the life
of the one
who gives
birth
to a new life
Thank you