Postpartum hemorrhage1
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This document defines and describes postpartum hemorrhage (PPH). PPH is bleeding after childbirth within 24 hours (primary) or anytime after 24 hours (secondary). Primary PPH is blood loss over 500ml vaginally or 1000ml for c-section. The main causes are atonic PPH from the uterus failing to contract (90% of cases), traumatic due to birth injuries, coagulopathy, and retained placenta. Risk factors include prior PPH, macrosomia, and prolonged labor. Prevention focuses on risk assessment, monitoring for complete placenta removal, and having protocols for rapid response to hemorrhage. Secondary PPH can be caused by infection, retained fragments, or uterine inc
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Retained placenta
A retained placenta occurs when the placenta is not expelled from the uterus within 30 minutes of childbirth. Risk factors include previous retained placentas, uterine injuries or surgeries, preterm births, induced labor, and multiple pregnancies. Causes can include failure of the placenta to separate fully from the uterine wall or abnormal placenta attachments like placenta accreta. Treatment involves controlled cord traction, manual removal in the operating room if needed, or hysterectomy for deeply embedded placentas. Complications can be life-threatening bleeding, infections, or shock if not properly managed.
Rupture uterus
Uterine rupture is a life-threatening condition where the wall of the uterus tears, potentially exposing the fetus and placenta to the mother's abdominal cavity. It most commonly occurs in women with a previous cesarean section scar. Signs include acute abdominal pain, fetal distress, and hemorrhage. Diagnosis is often made using ultrasound or MRI to detect tears in the uterine wall. Immediate exploratory laparotomy and cesarean delivery is usually required for treatment. Conservative uterine repair may be attempted for some cases but hysterectomy is often necessary due to severe hemorrhage. Prevention focuses on careful management of trial of labor for women with previous scars.
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Retained placenta
A retained placenta occurs when the placenta is not expelled from the uterus within 30 minutes of childbirth. Risk factors include previous retained placentas, uterine injuries or surgeries, preterm births, induced labor, and multiple pregnancies. Causes can include failure of the placenta to separate fully from the uterine wall or abnormal placenta attachments like placenta accreta. Treatment involves controlled cord traction, manual removal in the operating room if needed, or hysterectomy for deeply embedded placentas. Complications can be life-threatening bleeding, infections, or shock if not properly managed.
Rupture uterus
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Postpartum haemorrhage
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Postpartum hemorrhage (PPH) is a potentially life-threatening complication that occurs after childbirth. It is defined as excessive bleeding, either visible or concealed, that occurs within 24 hours of delivery and results in a decrease in hemoglobin concentration or requires transfusion of blood products.
There are several causes of PPH, including uterine atony (failure of the uterus to contract properly), trauma to the birth canal, retained placenta, and coagulation disorders. Risk factors for PPH include previous PPH, multiple gestation, prolonged labor, large fetal size, and placenta previa.
Symptoms of PPH can include heavy or continuous bleeding, a decrease in blood pressure, an increase in heart rate, and signs of shock. If PPH is suspected, immediate medical attention is required. Treatment may include medication to stimulate uterine contractions, manual removal of any retained placental tissue, or surgery.
Prevention of PPH can be achieved through proper management of labor and delivery, including active management of the third stage of labor (delivery of the placenta) and early recognition of risk factors. Close monitoring of the patient's vital signs, blood loss, and hemoglobin levels is also essential.
PPH is a serious and potentially life-threatening complication, but with appropriate management and early intervention, the risk of morbidity and mortality can be minimized.
POST PARTUM HEMORRHAGE PPH POST PERTUM DELIVERY
POST PARTUM HEMORRHAGE IS A CONDITION WHERE A EXCESS BLOOD LOSS FROM THE GENITAL TRACT MORE THEN 500 ML AFTER DELIVERY.
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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.
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Postpartum hemorrhage (PPH) is excessive bleeding after childbirth, defined as blood loss over 500 ml for vaginal births or 1000 ml for C-sections. The main causes of PPH are uterine atony (failure of the uterus to contract), retained placenta, and trauma to the genital tract. Management involves bimanual uterine massage, uterotonic drugs, vaginal packing, balloon tamponade, and in severe cases surgical interventions like B-Lynch sutures or hysterectomy.
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Postpartum haemorrhage (PPH) is still a major cause of maternal mortality, responsible for 20-25% of deaths. Risk factors include home deliveries, delayed resuscitation of the mother, and delayed transportation to the hospital. The main causes of PPH are uterine atony (80-90% of cases), retained placenta, genital tract lacerations, and coagulation disorders. Proper management of PPH involves early recognition, calling for help, resuscitation, and treating the specific cause through techniques like uterine massage, uterotonic drugs, manual removal of placenta, or surgery.
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Shoulder dystocia
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
Cervical stitches
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Postpartum hemorrhage (PPH) is excessive bleeding following childbirth. It is a leading cause of maternal mortality, accounting for nearly one quarter of maternal deaths worldwide. The most common cause is uterine atony, or failure of the uterus to contract after delivery. Other causes include retained placenta, trauma during delivery, coagulation disorders, and issues like placenta previa. Risk factors include previous PPH, macrosomia, multiple pregnancy, and uterine overdistention. Prevention focuses on risk assessment and active management of the third stage of labor. Treatment depends on the severity but may include uterine massage, uterotonic drugs, uterine packing, arterial ligation, embolization, compression sutures,
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This document discusses breech presentation, which occurs when a fetus is positioned feet or buttocks first in the birth canal rather than head first. It defines breech presentation and classifies the different types. It then covers the etiology, diagnosis, complications, mechanism of labor, and management both antenatally and during delivery. Management may involve external cephalic version, planned cesarean section, or attempted vaginal breech delivery depending on the situation. Close monitoring and potential interventions are needed during a breech delivery to avoid complications for both mother and baby.
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Postpartum hemorrhage is a leading cause of maternal mortality. Uterine atony accounts for 95% of cases. The 4Ts framework is used to evaluate causes: Tone (uterine atony), Tissue (retained placenta), Trauma (lacerations), and Thrombin (coagulopathy). Prevention focuses on active management of the third stage of labor using uterotonics like oxytocin and ergometrine. Management involves assessing blood loss, vital signs, and treating the underlying cause, such as through uterine massage, manual exploration, additional uterotonics, or surgical interventions if needed.
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The document discusses two conditions that can cause bleeding in late pregnancy - abruptio placenta and placenta previa. Abruptio placenta involves the separation of the placenta from the uterus prior to delivery and common risk factors include hypertension and trauma. Placenta previa occurs when the placenta implants in the lower uterine segment over the cervical os. Management of both conditions involves monitoring for maternal and fetal stability and either emergency c-section or planned c-section depending on gestational age and severity of bleeding. Complications can include disseminated intravascular coagulation for abruptio placenta or placenta accreta if placenta previa occurs over a previous c-section
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Polyhydramnios is an excess of amniotic fluid, which is normally 500-1500ml at term. It is diagnosed clinically or via ultrasound. Causes include maternal diabetes or fetal abnormalities. Management depends on if the excess fluid is acute or chronic, and involves bed rest, ultrasound, draining fluid via needle if fetus is normal, or inducing labor. Oligohydramnios is the opposite condition of low amniotic fluid which can be associated with fetal abnormalities and complications like preterm labor and death.
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1. Induction of labor aims to stimulate uterine contractions to achieve a normal vaginal delivery before spontaneous labor begins, usually done after 36 weeks of gestation.
2. The incidence of induction has increased globally from 90 per 1,000 live births in 1989 to 184 per 1,000 live births in 1997.
3. Cervical ripening methods like prostaglandin gels are often used before labor induction to soften and dilate the cervix, making induction more successful and reducing the length of the induction process.
Cardiotocography
Cardiotocography (CTG) involves continuous electronic monitoring of the fetal heart rate and uterine contractions. It is done externally via ultrasound transducers on the mother's abdomen or internally via an electrode attached to the fetal scalp. CTG is used to evaluate the fetal heart rate patterns including baseline rate, variability, accelerations, and decelerations which can indicate fetal well-being or distress. Abnormal patterns may necessitate changes to labor management or delivery.
Pph drill
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
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Postpartum hemorrhage (PPH) is a potentially life-threatening complication that occurs after childbirth. It is defined as excessive bleeding, either visible or concealed, that occurs within 24 hours of delivery and results in a decrease in hemoglobin concentration or requires transfusion of blood products.
There are several causes of PPH, including uterine atony (failure of the uterus to contract properly), trauma to the birth canal, retained placenta, and coagulation disorders. Risk factors for PPH include previous PPH, multiple gestation, prolonged labor, large fetal size, and placenta previa.
Symptoms of PPH can include heavy or continuous bleeding, a decrease in blood pressure, an increase in heart rate, and signs of shock. If PPH is suspected, immediate medical attention is required. Treatment may include medication to stimulate uterine contractions, manual removal of any retained placental tissue, or surgery.
Prevention of PPH can be achieved through proper management of labor and delivery, including active management of the third stage of labor (delivery of the placenta) and early recognition of risk factors. Close monitoring of the patient's vital signs, blood loss, and hemoglobin levels is also essential.
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Complications of peuperium
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Anaethetic management of obstetric haemorrhage
Obstetric haemorrhage is a leading cause of maternal mortality. It can be classified as antepartum or postpartum haemorrhage. Antepartum haemorrhage includes conditions like placenta previa and placental abruption. Placenta previa occurs when the placenta implants in the lower uterine segment, and can cause painless bleeding. Caesarean section is usually required for delivery. General anaesthesia is preferred but regional anaesthesia can be used if the patient is haemodynamically stable. Uterine atony is a major cause of postpartum haemorrhage. Oxytocin is first-line treatment but other uterotonics may
POST PARTUM HAEMORRHOEGE PPT.pptx
Post partum haemorrhage is defined as excessive bleeding following childbirth up to 6 weeks post-delivery. The main causes are an atonic uterus which fails to contract properly (80% of cases) and trauma to the genital tract during delivery (20% of cases). Management involves resuscitation with fluids and blood transfusions, massaging the uterus to help it contract, administering uterotonic drugs like oxytocin and methylergonovine, and potentially more invasive procedures like uterine artery ligation if bleeding cannot be controlled. Prevention efforts include risk assessment and management during pregnancy and delivery to minimize postpartum bleeding risk factors.
PPH - Nirmala.pptx
Postpartum hemorrhage is defined as blood loss greater than 500 ml within 24 hours of delivery. The most common cause is uterine atony or failure of the uterus to contract strongly after delivery, which accounts for 70% of cases. Other causes include trauma during delivery, retention of placental tissue, and coagulation disorders. Risk factors include prolonged labor, multiple gestation, and placental abnormalities. Active management of the third stage of labor including administration of uterotonics after delivery of the baby can help prevent postpartum hemorrhage. Treatment depends on the cause but may include uterine massage, aortic compression, manual removal of the placenta, repair of tears, and in severe cases procedures like uterine artery e
Pph
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.
PPH.pptx
Postpartum hemorrhage (PPH) is excessive bleeding from the genital tract following childbirth up to 42 days post-delivery. It is classified as primary (occurring within 24 hours of delivery) or secondary. Primary PPH is most often caused by uterine atony due to factors like multiparity, prolonged labor, or large placenta. Its management involves uterine massage, medication to induce contractions, fluid resuscitation, and potential surgical interventions if bleeding cannot be stopped. Preventing anemia prior to delivery and identifying risk factors for uterine atony can help reduce cases of primary PPH.
post partal haemorrhage ppt.pdf
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PPH
1. Post-partum haemorrhage (PPH) remains a major cause of maternal mortality worldwide, accounting for approximately 100,000 deaths annually.
2. PPH can be primary (within 24 hours of delivery) or secondary (after 24 hours) and is usually caused by uterine atony (80%) or trauma (20%). Prevention focuses on risk identification, active management of the third stage of labour, and prompt treatment.
3. Initial management of PPH involves uterotonic drugs, uterine massage, IV fluids, and bimanual compression. If bleeding continues, additional measures may include condom catheter tamponade, uterine or internal iliac artery ligation, or hysterectomy.
Obstetric emergencies
1. Obstetric emergencies include antepartum and postpartum hemorrhage from conditions like placenta previa, placental abruption, and uterine rupture.
2. Placenta previa is when the placenta implants in the lower uterine segment, potentially blocking the cervix and causing painless bleeding late in pregnancy.
3. Anesthetic management for placenta previa and other hemorrhages involves ensuring large bore IV access, blood product availability, and invasive monitoring while determining the need for general or neuraxial anesthesia depending on maternal stability.
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Post Partum Haemorrhage (B-Lynch, Stepwise uterine devascularization)
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5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Postpartum hemorrhage1
- 2. DEFINITION Hemorrhage occurring after the delivery of the baby Hemorrhage occurring within 24 hours of delivery – Primary postpartum hemorrhage Hemorrhage occurring anytime after 24 hours of delivery- Secondary postpartum hemorrhage
- 3. PRIMARY POSTPARTUM HEMORRHAGE Blood loss of more than 500ml from the genital tract in the first 24 hours of childbirth. For caesarean section, a blood loss more than 1000ml is considered significant. Incidence of about 5% of all deliveries. A more practical definition is a haematocrit drop of 10% or a hemorrhage that requires immediate transfusion.
- 4. CAUSES 1 . Atonic postpartum hemorrhage 2 . Traumatic postpartum hemorrhage 3 . Coagulopathy 4 . Retained placenta and placental fragments 5 . Morbidly adherent placenta 6 . Uterine inversion
- 5. ATONIC POSTPARTUM HEMORRHAGE Most common cause (90%) Bleeding occurs because the blood vessels have not been obliterated by contraction and retraction of the uterine muscle fibres.
- 6. PREDISPOSING FACTORS Grand multiparity Over distended uterus due to multiple pregnancy hydramnios or macrosomia Previous history of postpartum hemorrhage Antepartum hemorrhage Fibroids of uterus General malnutrition Prolonged labour leading to uterine exhustion Precipitate labour
- 7. TRAUMATIC POSTPARTUM HEMORRHAGE It occurs due to genital tract injuries. Include lacerations of the cervix , vagina and perineum Vulvovaginal hematomas may be a concealed cause
- 8. PREDISPOSING FACTORS Instrumental delivery Vaginal birth after caesarian Face to pubis delivery Precipitate labour Macrosomia
- 9. COAGULOPATHY Disseminated intravascular coagulation and hypofibrinogenemia should be considered in all patients at high risk for coagulopathy. PREDISPOSING FACTORS • Abruption • Sepsis • Intrauterine death • Amniotic fluid embolism
- 10. PREVENTION OF PPH Anemia should be corrected in the antenatal period. In high risk patients PPH should be anticipated and institutional delivery should be arranged. Blood should be arranged in high risk patients Use of partogram during labour will help to avoid prolonged labour. Dehydration should be promptly corrected Premature attempts to express a placenta that has not yet seperated are to be avoided.
- 11. After delivery completeness of placenta is checked for. The genital tract should be exposed in case of instrumental delivery. Oxytocin infusion can be continued and vital signs monitored closely Every hospital should have a protocol for managing PPH
- 12. SECONDARY POSTPARTUM HEMORRHAGE • Hemorrhage occurring after the first 24 hours of delivery and within 6 weeks AETIOLOGY • Sepsis • Retained placental fragments • Poor healing of the uterine incisions in previous caesarian section. • Choriocarcinoma
- 13. SHEEHAN SYNDROME • Described by Sheehan and colleagues in 1983 • Rare consequence of severe PPH • There is anterior pituitary necrosis and pituitary failure • There is failure of lactation, amenorrhoea, hypothyroidism and adrenocorticalinsufficiency.