Postpartum hemorrhage is a leading cause of maternal mortality, accounting for over 100,000 deaths per year globally. It is defined as blood loss exceeding 500 mL after delivery. The main causes are uterine atony, trauma, and retained placental tissue. Management involves uterine massage, uterotonic drugs like oxytocin and prostaglandins, repair of lacerations, and conservative surgical procedures if bleeding cannot be controlled. Significant blood loss can result in complications like shock and death.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Menstrual cycle irregularities can have many different causes. For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.
Infections of the Genital Tract - Part IHelen Madamba
Lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of infections affecting the vulva, such as infections of the Bartholin's gland, ectoparasites and infections presenting as vulvar ulcers. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
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.
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.
2. Post-partum haemorrhage (PPH) remains
a major cause of maternal mortality and
morbidity worldwide. Approximately,
half a million women die annually from
causes related to pregnancy and
childbirth.
3. Postpartum haemo-
rrhage refers to any
amount of bleeding
from or into the
genital tract following
birth of the baby upto
the end of
puerperium.
4. In the developing world, several countries
have maternal mortality rates in excess of
1000 women per 100,000 live births, and
World Health Organization statistics suggest
that 25% of maternal deaths are due to PPH,
accounting for more than 100,000 maternal
deaths per year.
5. Primary postpartum hemorrhage is the
hemorrhage occurring during the third stage of
labor and within 24 hours of delivery.
Secondary postopartum hemorrhage is
hemorrhage occurring after 24hours of
delivery and within 6weeks of delivery. It is
also referred to as puerperal hemorrhage.
6. Primary postpartum hemorrhage are:
Atonic uterus
Trauma
Mixed ( combination of both atonic and trauma)
Retained product of conception
Uterine rupture
Uterine inversion
Blood coagulopathy
7. 2.Secondary postpartum haemorrhage include:
Retained bits of cotyledon or membranes.
Infection
Cervico-vaginal laceration
Endometritis
Subinvolution of the placental site
Secondary hemorrhage from caesarean section
Other rare causes – chorion epithelioma, carcinoma
cervix, placental polyp, fibroid polyp and puerperal
inversion of uterus.
8. Prolonged third stage of labor
Multiple delivery
Episiotomy
Fetal macrosomia
History of postpartum hemorrhage.
Grandmultiparity
Placenta previa
Placental abruption
Pregnancy induced hypertension
Infection
9. massive blood loss
passing large clots
dizziness
lightheadedness or fatigue.
Decreased blood pressure.
Increased heart rate
Swelling and pain in tissues in the vaginal and
perineal area
11. Antenatal
Improvement of the health status.
High risk patients.
Blood grouping
Intranatal
Slow delivery of the baby.
Expert obstetric anesthetist needed.
Spontaneous separation and delivery of
placenta during caesarean section.
12. Active management of third stage of labor.
Examination of placenta.
Induced or accelerated labor by oxytocin.
Exploration of utero-vaginal canal.
To observe the patient for about two hours
after delivery.
13. Rub up the uterus to stimulate contraction and
retraction.
Administer ergometrine(0.2mg) intramuscularly .
Syntometrine (1ml) intramuscularly may be given
instead of ergometrine.
Expel the placenta with the next uterine contraction by
fundal pressure or controlled cord traction.
Empty the urinary bladder by catheterization.
A second dose of syntometrine or ergometrine may be
given in ten minutes if bleeding is not controlled.
14. Tone
Uterine massage - If the uterus is soft,
massage is performed by placing one hand in
the vagina and pushing against the body of the
uterus while the other hand compresses the
fundus from above through the abdominal
wall. The posterior aspect of the uterus is
massaged with the abdominal hand and the
anterior aspect with the vaginal hand.
15.
16. Uterotonic agents - Uterotonic agents include
oxytocin, ergot alkaloids, and prostaglandins.
Oxytocin - 10 international units (IU) should be
injected intramuscularly, or 20 IU in 1 L of saline
may be infused at a rate of 250 mL per hour. As much
as 500 mL can be infused over 10 minutes without
complications.
Methylergonovine (Methergine) and ergometrine,
a typical dose of methylergo-novine, 0.2 mg
administered intramuscularly, may be repeated as
required at intervals of two to four hours.
17. Prostaglandins –
Carboprost can be administered intra-
myometrially or intramuscularly in a dose of
0.25 mg; this dose can be repeated every 15
minutes for a total dose of 2 mg.
Misoprostol is another prostaglandin; It can
be administered sublingually, orally, vaginally,
and rectally. Doses range from 200 to 1,000
mcg; the dose recommended by FIGO is 1,000
mcg administered rectally.
18. Trauma
Lacerations and hematomas resulting from
birth trauma can cause significant blood loss
that can be lessened by hemostasis and timely
repair.
Uterine Rupture - Symptomatic uterine
rupture requires surgical repair of the defect or
hysterectomy.
Uterine inversion is rare.
19.
20. Classic signs of placental
separation include a small
gush of blood with
lengthening of the umbilical
cord and a slight rise of the
uterus in the pelvis. Placental
delivery can be achieved by
use of the Brandt-Andrews
maneuver, which involves
applying firm traction on the
umbilical cord with one hand
while the other applies
suprapubic counter-pressure.
21. Thrombin
Coagulation disorders, a rare cause of
post-partum hemorrhage, are unlikely to
respond to the measures described above.
Most coagulopathies are identified before
delivery, allowing for advance planning
preventing postpartum hemorrhage.
23. Blood loss
Shock
Death
Septicemia
Orthostatic hypotension
Anemia
Fatigue
24. Postpartum hemorrhage, defined as the loss of more
than 500 mL of blood after delivery, occurs in up to
18 percent of births.1,2 Blood loss exceeding 1,000
mL is considered physiologically significant and can
result in hemodynamic instability. Uterine atony is
responsible for most cases and can be managed with
uterine massage in conjunction with oxytocin,
prostaglandins, and ergot alkaloids.