This document provides information about postpartum hemorrhage (PPH), including its definition, causes, risk factors, prevention, assessment, management, and treatment. Some key points: - PPH is a leading cause of maternal mortality worldwide, responsible for 1/3 of maternal deaths. The majority occur within 4 hours of delivery. - Causes (4 Ts) include uterine atony (80% of cases), retained placenta or clots, genital tract trauma, and coagulation disorders. - Risk factors include overdistended uterus, rapid/prolonged labor, uterine anomalies, and coagulation disorders. - Prevention is through active management of the third stage of labor

1. Post Partum
Haemorrhage
Dr. Uma Gupta *Head & Prof. Obstetrics &
Gynecology
*M.D, MARD, FAIMER (CMCL 2012), PGDHHM,MHPE.
umankgupta@gmail.com
5/10/2021 Uma Gupta 1

2. 5/10/2021 Uma Gupta 2
Mumtaz Mahal
died
from postpartum
hemorrhage in
Burhanpur on 17
June 1631 while
giving birth to
her fourteenth
child, after a
prolonged labor
of approximately
30 hours.

3. Learning Objectives
1. Define postpartum hemorrhage
2. Differentiate between primary and secondary postpartum
hemorrhage.
2. Describe prevention (active management of the third stage
of labour) and treatment of postpartum hemorrhage.
3. Recall the four Ts as causes of postpartum hemorrhage.
4. Identify risk factors for PPH.
5. Describe the implications of postpartum hemorrhage on
the health of the mother and baby.
6. Prevention and management of PPH
5/10/2021 Uma Gupta 3

4. Postpartum hemorrhage (PPH) is leading
cause of maternal mortality, accounting for
one-third of all maternal deaths worldwide
PPH causes up to 60% of all maternal deaths
in developing countries.
The majority of these deaths - within 4
hours of delivery, indicating they are a
consequence of third stage of labour.
5/10/2021 Uma Gupta 4

5. • Primary (immediate) postpartum hemorrhage is
defined as excessive bleeding that occurs within the
first 24 hours after delivery.
• About 70% of immediate PPH cases are due to uterine
atony.
• Atony of the uterus is defined as the failure of the
uterus to contract adequately after the child is born.
5/10/2021 Uma Gupta 5

6. • Secondary (late) postpartum hemorrhage is
defined as excessive bleeding occurring between 24
hours after delivery of the baby and 6 weeks
postpartum. Most late PPH is due to retained
products of conception, or infection, or both
combined.
5/10/2021 Uma Gupta 6

7. Quantified
PPH has been defined as blood loss in excess of 500
cc in vaginal deliveries and in excess of 1,000 cc in
cesarean section deliveries. For clinical purposes,
any blood loss that has the potential to produce
hemodynamic compromise should be considered a
PPH.
5/10/2021 Uma Gupta 7

8. The amount of blood loss required to cause
hemodynamic compromise will depend on the pre-
existing condition of the woman.
Hemodynamic compromise is more likely to occur in
conditions such as anemia (e.g. iron deficiency, sickle
cell, and thalassemia) or volume contracted states
(e.g. dehydration, gestational hypertension with
proteinuria).
5/10/2021 Uma Gupta 8

9. Classification
• Primary : Loss within 1st 24 hours after delivery
• Secondary : 24 hours till 12 weeks postnatally
• Minor : 500-1000 ml
• Moderate : 1000-2000 ml
• Severe : > 2000 ml
5/10/2021 Uma Gupta 9

10. Clinical Findings With Varying
Amounts of Blood Loss
Blood loss will result in changes to the state of
consciousness, the pulse rate, the respiratory rate,
the temperature, the blood pressure, the status of
the skin and mucous membranes, capillary refilling,
and urine output.
5/10/2021 Uma Gupta 10

11. Estimating Blood Loss
• Accurate estimation of blood loss is essential in the
recognition and management of obstetric
hemorrhage. Underestimation of blood loss may
result in lack of recognition of PPH, and inadequate
or inappropriate management
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12. Direct Measurement
PAD 120 CC
TAMOPNE 50 CC
GUAZE 30 CC
SMALL ABDOMINAL PACK 250 CC
LARGE ABDOMINAL PACK 450 CC
5/10/2021 Uma Gupta 12

13. • Mild hypovolemia, loss of <20% of the blood
volume,
• mild tachycardia,
• mottled skin,
• cool extremities due to increased systemic vascular
resistance and prolonged capillary refilling,
• urinary output may be decreased.
• The woman may report dizziness, although her
neurologic status usually remains normal.
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14. • With moderate hypovolemia, i.e. loss of 20% to 40%
of the blood volume,
• woman will become increasingly anxious.
• pulse will become very fast and weak, >110/bpm
(tachycardia).
• Her respiratory rate will increase to a rate of
>30/bpm.
• will exhibit marked pallor; her eyelids, palms, and
mucous membranes will be very pale.
• Her blood pressure may be normal when she is in the
supine position. However, there may be significant
postural hypotension
5/10/2021 Uma Gupta 14

15. • When blood loss is severe, i.e. >40% of the blood
volume,
• the classic signs of shock will appear.
• The blood pressure declines and becomes unstable
even in the supine position.
• The woman will develop marked tachycardia,
oliguria or anuria, and agitation or confusion.
• Loss of consciousness is an ominous sign.
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16. Rule of 30
This rule is used to measure severity of shock
resulting from at least 30% of blood loss –
• Increase in HR by >30 beats/min
• Fall in Systolic BP >30 mmHg
• RR >30/min
• Hematocrit drops by >30%
• Urine output <30ml/min
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17. 3.SHOCK INDEX (S.I)
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18. • Frequent measuring of birth fluids may help health
care providers become more skilled in assessing
blood loss. Health care providers should become
familiar with the absorbency of maternity pads,
under pads, and other surfaces on which maternal
blood may accumulate during delivery in their
practice location
5/10/2021 Uma Gupta 18

19. ➢REMEMBER
➢ Blood loss is consistently underestimated.
➢ Underestimation may result in inadequate treatment
resulting in complications or death.
➢ Ongoing trickling can lead to significant blood loss.
➢ Blood loss is generally well tolerated by healthy
women, to a point.
➢ Anemia and other underlying health conditions may
profoundly affect a woman‘s ability to tolerate any
amount of blood loss.
5/10/2021 Uma Gupta 19

20. • Complications Associated With Postpartum
Hemorrhage
• Significant blood loss can occur very quickly. Women
can lose up to 500 ml of blood in 1 minute during a
PPH.
• The average woman has approximately 5 litres of
blood in her circulation. At this rate, it is possible for a
woman to become exsanguinated (lose all of her
blood) within 10 minutes. Rapid, efficient action must
be taken to save the woman‘s life and to prevent
complications related to significant blood loss
5/10/2021 Uma Gupta 20

21. Effects of PPH
• PPH is associated with orthostatic hypotension,
anemia, and fatigue.
• Postpartum anemia is associated with lactation failure
placing the health of the newly born infant at risk.
• It is also associated with postpartum depression that
may in turn affect maternal bonding with the
newborn. Maternal attachment to the newborn is
essential for the long-term well-being of the infant.
• Extreme fatigue resulting from anemia may make
maternal care of the newborn and other siblings more
difficult
5/10/2021 Uma Gupta 21

22. Etiology
• Causes of PPH in terms of the Four T‘s:
• Tone - uterine atony
• Tissue - retained placenta or clots
• Trauma - uterine, cervical, or vaginal injury
• Thrombin - pre-existing or acquired coagulopathy
5/10/2021 Uma Gupta 22

23. CAUSES - THE ‘FOUR Ts’ OF PPH
5/10/2021 Uma Gupta 23
CAUSE INCIDENCE (% )
TONE – atonic uterus 80
TRAUMA -
lacerations, rupture
10 – 15
TISSUE – retained
tissue
3 – 5
THROMBIN 1-2

24. Risk factors for postpartum hemorrhage
Etiologic Process (Cause) Clinical Risk Factors
Abnormalities
of Uterine
Contraction
(Tone)
Over-distended uterus
•Polyhydramnios
• Multiple gestation
• Macrosomia
Uterine muscle exhaustion
• Rapid labour
• Prolonged labour
• High parity
Intraamniotic infection • Fever
• Prolonged rupture of membranes
(ROM)
Functional or anatomic
distortion of the uterus, i.e.
distended bladder may
prevent contraction of the
uterus
• Fibroid uterus
• Placenta previa or abruptio
• Uterine anomalies
Uterine-relaxing
medications
• Halogenated anesthetics,
nitroglycerin, magnesium sulphate
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25. Living ligature
• Failure of this living ligature leads to atonicity of
uterus leading to PPH .
5/10/2021 Uma Gupta 25

26. Etiologic Process (Cause) Clinical Risk Factors
Retained
Products of
Conception
(Tissue)
Retained products
abnormal placentation
retained cotyledon or
succinturiate lobe
• Incomplete placenta at
delivery
• previous uterine surgery
• High parity
• Abnormal placenta on
ultrasound
• Retained blood clots •Atonic uterus
5/10/2021 Uma Gupta 26

27. Etiologic Process (Cause) Clinical Risk Factors
Genital Tract
Trauma
(Trauma)
• Tears (lacerations) of the cervix,
vagina, or perineum
• Ruptured vulval varicosities
• Precipitous delivery
• Operative delivery
• Mistimed or inappropriate
use of episiotomy
• Extensions, lacerations at cesarean
section • Malposition
• Deep engagement
Uterine rupture Previous uterine surgery
• Uterine inversion • High parity
• Fundal placenta
5/10/2021 Uma Gupta 27

28. Etiologic Process (Cause) Clinical Risk Factors
Abnormalities
of
Coagulation
(Thrombin)
• Pre-existing states
- hemophilia A
-von Willebrand‘s disease1
History of hereditary
coagulopathies
• History of liver disease
• Acquired in pregnancy
- idiopathic thrombocytopenic purpura2
- thrombocytopenia with preeclampsia
- disseminated intravascular coagulation
- preeclampsia
- dead fetus in utero
- severe infection/sepsis
- placental abruption
- amniotic fluid embolus
• bruising
• elevated BP
• elevated BP
• fetal demise
• fever
• elevated white blood
cells
• antepartum hemorrhage
• sudden collapse
Therapeutic anticoagulation history of thrombotic
disease
5/10/2021 Uma Gupta 28

29. Prevention
• Compared to expectant management, active
management of the third stage of labour (AMTSL) is
associated with
• ↓ maternal blood loss,
• ↓ postpartum hemorrhage,
• ↓ postpartum anemia,
• ↓ need for blood transfusions
• and a ↓ e in the incidence of prolonged third stage
of labour.
5/10/2021 Uma Gupta 29

30. What is active management of 3rd stage of labour?
Active management of 3rd stage of labour (AMTSL)
involves 3 steps after delivery of baby:
1. Uterotonic drug given immediately after birth of baby
2. Placenta delivered by controlled cord traction with
counter-traction on the fundus during contraction
3. Fundal massage after delivery of the placenta
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31. 5/10/2021 Uma Gupta 31

32. What are the oxytocic drugs used in AMTSL?
There are 4 kinds of drugs used in third stage of labor
• Oxytocin- posterior pituitary extract
• Ergometrine- preparation of ergot
• Syntometrine- combination of oxytocin and
ergometrine
• Misoprostol- prostaglandin E1 analogue
5/10/2021 Uma Gupta 32

33. Drugs Advantage Disadvantage
Oxytocin Causes uterus to contract
• Acts within 2.5 minutes when
given IM
• Generally does not cause side
effects
• Safe in hypertension
• IM or IV preparations only
• Not heat stable
Ergometrine Low price
• Effect lasts 2–4 hours
• Takes 6–7 minutes to
become effective when
given IM; oral form
insufficiently effective
• Causes tonic uterine
contraction
5/10/2021 Uma Gupta 33

34. Drugs Advantage Disadvantage
Syntometrine Combined effect of
rapid action of oxytocin
and sustained action of
ergometrine
Increased risk of
hypertension, nausea
and vomiting
• Not heat stable
Misoprostol
• Effective orally,
buccally, vaginally and
rectally
• Rapid absorption after
oral 3 minutes
T1/2 life = 20-40
minutes
• Predictable side
effects: shivering,
pyrexia, nausea,
vomiting and diarrhea
• Rate of PPH is higher
with misoprostol
compared to oxytocin.
5/10/2021 Uma Gupta 34

35. Management
of third stage
of labor
Blood Loss (>
1000 ml)
Physiologic 13-18%
Active
(oxytocin)
2.9%
Misoprostol 4%
5/10/2021 Uma Gupta 35

36. Management of PPH
Principles of management -
To replace the blood
To empty the uterus
To ensure effective hemostasis
For systematic management of PPH there is algorithm
known as
‘ HEMOSTASIS ’
5/10/2021 Uma Gupta 36

37. HEMOSTASIS
H: Ask for help
A: Assess (vitals, blood loss) & resuscitate
E: Establish etiology & check Ecbolics
(syntometrine, ergometrine)Ensure availability
of blood
M: Massage uterus
O: Oxytocin infusion, prostaglandins
S: Shift to operating room, exclude retained
products & trauma
5/10/2021 Uma Gupta 37

38. CONT…
T: Tissue & Trauma to be excluded , proceed for
Tamponade , bakri balloon, uterine packing
A : Apply compression sutures
S : Systematic pelvic devascularization (uterine,
ovarian, internal iliac artery ligation)
I : Intervention radiologist, uterine artery
embolization
S : Subtotal or total abdominal hysterectomy
5/10/2021 Uma Gupta 38

39. Assess
1. Assess Vital signs & Estimate Blood Loss
2. Adequate venous access : 2 large bore I/v
cannula(16-18G)
3. Draw Blood sample (~20ml) for haemogram,
Blood Group, Cross Match, Coagulation
screen, RFT & LFT
4. Foley’s catheter : Monitoring adequate renal
perfusion.
5/10/2021 Uma Gupta 39

40. Volume Replacement
5. Fluid of Choice – Crystalloid over colloids
6. Crystalloid of choice – Ringer Lactate
7. Loss of 1 Lit of blood requires replacement
with 4-5 Lit of crystalloids (NS or RL) or
colloids until cross matched blood Is available
(1 ml of blood loss= 3 ml of crystalloids)
8. The recommended transfusion ratio for
PRBC:FFP:RDP IS 1:1:1
5/10/2021 Uma Gupta 40

41. Medical management
1 . FIRST LINE DRUG
Oxytocin:
• Start with 10 units im and Infusion of 20 units in 1L
@ 60 drops /min.
• Continue same dose @ 40 drops/min until bleeding
stops.
• Maximum dose of 3 liters of oxytocin infusion
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42. SECOND LINE DRUG
Ergometrine/ methyl ergometrine:
• Dose: 0.2 mg im or slow iv Repeat 0.2mg after 15
min.
• Maximum 5 doses (1 mg) can be given
• Syntometrine im
5/10/2021 Uma Gupta 42

43. Third line
Carboprost / (PGF2alpha)
Dose: 0.25mg (250µgm) mg im.
Can be repeated every 15 min. Maximum
upto 2 mg or8 doses can be given .
Misoprostol
• 200-800 µg sublingually. Do not exceed 800 µg
5/10/2021 Uma Gupta 43

44. 3. Bimanual
Compression
5/10/2021 Uma Gupta 44
•
•
•
•
Form a fist.
Place the fist in anterior
fornix & apply pressure
against the anterior wall of
uterus.
With the other hand press
deeply into the abdomen
behind the uterus to make it
anteverted.
Pressure against the posterior
wall of uterus Maintain
pressure until bleeding is
controlled & uterus contracts.

45. 4. Shift to OT
• Patient is to be shifted to O.T
• By P/S examination rule out trauma to perineum ,
vagina, and cervix .
• If required then hemostasis sutures are to be taken by
catgut suture.
• Also examine the placenta for its completeness.
• Exploration of uterus is done .
• Evacuation of any product of conception if retained.
5/10/2021 Uma Gupta 45

46. 5. Uterine tamponade
1.Tight uterine packing
2. Balloon tamponade
a. Bakri balloon
b. Sengstaken Blakemore catheter
c. Condom catheter
5/10/2021 Uma Gupta 46

47. Intrauterine packing
• A long gauze of 5 metre soaked in antiseptic cream
is introduced inside the uterus and placed in to the
fundal area.
• Exerts direct haemostatic effect to open uterine
sinuses.
• Obselete now days because of risk of intra uterine
sepsis .
5/10/2021 Uma Gupta 47

48. Balloon tamponade
• Balloon Inflate balloon with 200- 500 ml warm 0.9 %
Sodium chloride.
• It adapts to shape of the uterine cavity and occludes
the venous sinus.
• If the bleeding is controlled it known as Positive
Tamponade Test.
• The catheter should not be removed within 12-
24hrs.
• Effectiveness – 88%
5/10/2021 Uma Gupta 48

49. 5/10/2021 Uma Gupta 49

50. 5/10/2021 Uma Gupta 50

51. 6.Compression sutures
1. B - Lynch suture
2. Hayman suture
3. Cho suture
✓ These suture causes bimanual compression of the
uterus.
✓ Apposes anterior and posterior wall of uterus.
5/10/2021 Uma Gupta 51

52. Cho and hayman suture
5/10/2021 Uma Gupta 52

53. 5/10/2021 Uma Gupta 53
B- Lynch suture

54. 7. Systematic pelvic devascularization
▪ Ligation of Uterine arteries
▪Ligation of Tubal branch of ovarian artery
▪ Ligation of Internal iliac artery
➢ Ascending branch of uterine artery is ligated at
lateral border b/w upper and lower segment.
➢ And ovarian artery is ligated just below ovarian
ligament.
5/10/2021 Uma Gupta 54

55. Ligation of uterine and internal iliac
artery ( ascending branch)
5/10/2021 Uma Gupta 55

56. 8. Interventional radiology
• Angiographic selective arterial embolization
• Possible where facility of interventional radiology
available.
• Avoids hysterectomy
• Success rate of about 90 %
5/10/2021 Uma Gupta 56

57. 9. Hysterectomy
• If all procedures failed to control bleeding
Decision for hysterectomy is taken to
save mother life
• It may be subtotal or total hysterectomy.
5/10/2021 Uma Gupta 57

58. Transferring to referral centre
5/10/2021 Uma Gupta 58
As PPH precedes Death by 2 hours”
If initial medical therapy fails within Golden Hour, then
shift the patient to higher centre.
Two important life savior methods -;
➢ Aortic compression by Skilled Birth Attendant
➢ Non Pneumatic Anti Shock Garment

59. 5/10/2021 Uma Gupta 59

60. •
NASG is a simple device -
Neoprene
•Shunts blood to vital organs
(anti-shock)
•It can shunt about 500- 1500
ml into central pool
NON–PNEUMATIC ANTI SHOCK GARMENT
5/10/2021 Uma Gupta 60

61. PREVENTION:
5/10/2021 Uma Gupta 61
Prevention of PPH is not always possible but however its incidence can be reduced
By substantially assessing the risk factors and following guidelines as mentioned:
•ANTENATAL:
1.Improvement of health status of women and to keep the haemoglobin level
normal(>10g/dl), so that the patient can withstand some amount of blood loss.
2.High risk patients who are likely to develop PPH (such as twins, hydramnios, grand
multipara, history of previous pph, severe anemia) are to be screened.
3.Blood grouping should be done for all womenso that no time is wasted during
emergency.

62. 4. Placental localization should for all women with previous cesarean delivery by USG or
MRI to detect placenta accreta or percreta or to determine morbid adherent placenta.
P.P
5. Women with morbid adherent placenta are at high risk of developing pph. Such a case
should be delivered by senior obstetrician. Availability of blood and blood products must
ensured before hand.
• INTRANATAL:
1. Active management of the third stage, for all women in labor should be a routine as it
reduces PPh by 60%
2. Women delivered by cesarean section, oxytoxin 5 IU slow IV is to be given to reduce
blood loss. Carbetocin 100mcg is very useful to prevent PPH.
3. Exploration of the uterovaginal canal for evidence of trauma following difficult
labor or instrumental delivery.
4. Observation for about two hours after delivery to make sure that the uterus is hard and
well contracted before sending her to ward.
5. During cesarean section spontaneous separation and delivery of the placenta reduces
blood loss by 30%
6. Examination of the placenta and membranes should be a routine to detect at the
earliest any missing part.
5/10/2021 Uma Gupta 62

63. ASSESSMENT
5/10/2021 Uma Gupta 63

64. Question 1
• To be considered a PPH, what would the estimated
blood loss have to be for a C-section?
A. < 550 ML
B. > 600 ML
C. > 1000 ML
D. < 900 ML
5/10/2021 Uma Gupta 64

65. Question 1
• To be considered a PPH, what would the estimated
blood loss have to be for a C-section?
A. < 550 ML
B. > 600 ML
C. > 1000 ML
D. < 900 ML
5/10/2021 Uma Gupta 65

66. Question 2
• What types of trauma during labour and birth
would lead to PPH risk?
A. Instrumental assisted birth (vacuum or forceps)
B. C-Section
C. Lacerations of the cervix or vaginal wall
D. All of the above
5/10/2021 Uma Gupta 66

67. Question 2
• What types of trauma during labour and birth
would lead to PPH risk?
A. Instrumental assisted birth (vacuum or forceps)
B. C-Section
C. Lacerations of the cervix or vaginal wall
D. All of the above
5/10/2021 Uma Gupta 67

68. Question 3
• In which of these cases could you diagnose PPH
following vaginal delivery: 1. > 500 blood loss over
24 hrs 2. hypotension 3. tachycardia
A. 1 & 3
B. 2
C. 3
D. 1
5/10/2021 Uma Gupta 68

69. Question 3
• In which of these cases could you diagnose PPH
following vaginal delivery: 1. > 500 blood loss over
24 hrs 2. hypotension 3. tachycardia
A. 1 & 3
B. 2
C. 3
D. 1
5/10/2021 Uma Gupta 69

70. Question 4
• The 4 “T’s” of PPH are: 1. Trauma 2. Toxins 3.
Travel 4. Tissue 5. Threads 6. Thrombin 7.
Tears 8. Tone
A. 1, 4, 6 & 8
B. 1, 5 7 & 8
C. 1, 2, 3 & 6
D. 3, 4, 5 & 6
5/10/2021 Uma Gupta 70

71. Question 4
• The 4 “T’s” of PPH are: 1. Trauma 2. Toxins 3.
Travel 4. Tissue 5. Threads 6. Thrombin 7.
Tears 8. Tone
A. 1, 4, 6 & 8
B. 1, 5 7 & 8
C. 1, 2, 3 & 6
D. 3, 4, 5 & 6
5/10/2021 Uma Gupta 71

72. Question 5
• The normal blood flow through the placental site
each minute is 500-800 mls per minute.
A. True
B. False
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73. Question 5
• The normal blood flow through the placental site
each minute is 500-800 mls per minute.
A. True
B. False
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74. Question 6
• Which of these implantations would most likely
cause excessive bleeding?
A. Increta & Percreta
B. Normal & Accreta
C. Accreta & Increta
D. None of the above
5/10/2021 Uma Gupta 74

75. Question 6
• Which of these implantations would most likely
cause excessive bleeding?
A. Increta & Percreta
B. Normal & Accreta
C. Accreta & Increta
D. None of the above
5/10/2021 Uma Gupta 75

76. Question 7
• _________________ and ________________ are
the two most common causes of primary PPH.
(Tissue, Tone, Trauma, Thrombin)
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77. Question 7
• _____Tone__ and _Trauma__________ are the two
most common causes of primary PPH. (Tissue,
Tone, Trauma, Thrombin)
5/10/2021 Uma Gupta 77

78. Question 8
Ergometrine to control post-partum hemorrhage :
A. Is contraindicated in patient with high blood
pressure
B. It will not act on the smooth muscle of the blood
vessels
C. Intravenous root is the only way to be given
D. It can be used for induction of labor
E. Is safe in cardiac patient
5/10/2021 Uma Gupta 78

79. Question 8
Ergometrine to control post-partum hemorrhage :
A. Is contraindicated in patient with high blood
pressure
B. It will not act on the smooth muscle of the blood
vessels
C. Intravenous root is the only way to be given
D. It can be used for induction of labor
E. Is safe in cardiac patient
5/10/2021 Uma Gupta 79

80. Question 9
All of the following are used in treatment of PPH
except:
a.Misoprostol
b.Mifepristone
c.Carbaprost
d.Methyl ergometrine
5/10/2021 Uma Gupta 80

81. Question 9
All of the following are used in treatment of PPH
except:
a.Misoprostol
b.Mifepristone
c.Carbaprost
d.Methyl ergometrine
5/10/2021 Uma Gupta 81

82. Question 10
Carbetocin dose for PPH:
a.100 mcg IV
b.50 mcg IV
c.150 mcg IV
d.250 mcg IV
5/10/2021 Uma Gupta 82

83. Question 10
Carbetocin dose for PPH:
a.100 mcg IV
b.50 mcg IV
c.150 mcg IV
d.250 mcg IV
5/10/2021 Uma Gupta 83

84. Question 11
B Lynch suture is applied on:
a.Cervix
b.Uterus
c.Fallopian tube
d.Ovaries
5/10/2021 Uma Gupta 84

85. Question 11
B Lynch suture is applied on:
a.Cervix
b.Uterus
c.Fallopian tube
d.Ovaries
5/10/2021 Uma Gupta 85

86. Save the life of the one who
gives birth to a new life
THANK YOU
5/10/2021 Uma Gupta 86

87. Reference
1. DC Dutta’s OBSTETRICS Including Perinatology and Contraception. 9th Edition.
Jaypee New Delhi
2. Tect Book of Obstetrics Sheila Balakrishnan. Paras Publishers, Delhi
3. Self Assessment Review Obstetrics Sakshi Arora
4. Extracts from: http://www.commonhealth.in/pdf/8.pdf
5. World Health Organization. Managing complications in pregnancy and
childbirth: A
guide for midwives and doctors. . 2003.
5. Obstetrics by Ten Teachers. 20th Edition.CRC Press, Taylor and Francis group UK.
2017.
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88. Twosome
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