2. Case Scenario
• A 35 year old Primigravida who is a known case of Gestational
diabetes mellitus delivered a baby weighing 4.2 kgs through forceps
delivery . After the delivery it is noted that the mother’s BP falls to
90/60 mm Hg and the heart rate is found to be 120 bpm .
• On palpation , the Uterus is not flabby and is well contracted .
• What do you suspect ?
3. Let us consider these 2 situations
• Situation 1 : Excessive bleeding either from the vagina or in the
perineal area .
• Situation 2: Excessive pain in the episiotomy site after 1 hour of
delivery but there is no complaints of excessive bleeding although the
vitals are showing signs of hemorrhage.
Think of traumatic PPH
4. Situation 1 : Excessive bleeding
• Can be due to
1) Tear in the Perineal region or vagina
2) Tear in the cervix or Uterus
Why was this seen in our patient ? What were the risk factors ?
9. Situation 2 : Excessive pain but no frank
excessive bleeding
Local examination finding
10. • It is a vulval hematoma
• Beware that the hematoma need not always be a frankly visible
hematoma. It can be concealed if it is present in the cervix or Broad
ligament .
11. How do we manage this patient ?
What are the investigations ?
12. Managing the tear
• Perineal tear :
Repair done under 1% lignocaine or general anesthesia . Repair by
using interrupted vicryl sutures
13. • For cervical tears we use chromic or catgut sutures
• Hematoma treatment : If hematoma <5 cm – cold compress
If hematoma > 5cm – Drain the hematoma .
Clear clots , identify bleeder and ligate
and suture the wound.
Uterine Rupture : Subtotal hysterectomy or repair and sterilization .
