2. DEFINATION
• 500 ml or more blood loss after vaginal delivery
• 1000 ml or more blood loss after cesarean deliver
• Clinical symptoms play a critical role in diagnosing pph
4. Etiology and risk factors
Tone Tissue (Retained
placental tissue)
Trauma Thrombin (Coagulation
disorders)
Prior history of PPH
Urinary retention
Grand multiparity
Multiple gestation
Polyhydramnios
Macrosomia
Chorioamnionitis
General anesthesia
Magnesium sulfate
therapy
Precipitous delivery
Induction of labour
Prolonged labor
Anomalies of the uterus
Ante partum
Haemorrhage
Praevia/accreta
Cord avulsion
Preterm delivery
Succenturiate lobe
Manual extraction of
the placenta
(Operative) Vaginal
delivery can cause
cervical/vaginal/perineal
lacerations
Episiotomy
Improper/delayed
perineal repair can lead to
significant bleeding
Excessive cord traction
can cause uterine
inversion
Uterine rupture
Intrauterine fetal demise
Abruption
Placenta previa
Pre-
eclampsia/Eclampsia
HELLP
Inborn coagulation
disorders
5. Management
• Call for help
• Stabilize – ensure a patent airway, sufficient breathing .
• Fix two large bore cannulas and urethral catheter . Samples for gxm,
fhg, uec. Iv ringers lactate .
• Identify cause and manage
6. Atony
• Bimanual massage till uterus, start 20 IU oxytocine in 500 mls NS, to
run freely.
• Give Misoprostol 800 mcg preferably oral.
• Give ergometrine 0.25 mcg im
• Insert Foleys catheter, fill with 60mls of NS.
• Theatre management - conservative surgery like B-Lynch, artery
ligation. Hysterectomy when necessary .
7. Tissue (Retained placental tissue)
If bleeding
• start oxytocine 10IU in 500 mls ns
• give analgesia,
• manual removal
• treat PPH
8. Trauma
Any type of lacerations to be sutured as soon as possible, either in
LW or in theatre.
9. Coagulation disorders
• bedside clotting test
• give fresh blood
• platelets transfusion
• Tranexamic acid 4 g over 1 hour, then infusion of 1 g/hour over 6
hours.
