gynecology

1. Post-partum haemorrhage
(PPT)
2015-2016

2. • Primary PPH..loss of blood estimated to be >
500 ml in NVD & > 1000 ml in CS within 24 hr
of delivery.
• Secondary PPH..abnormal vaginal bleeding
from 24 hrs-6 wks after delivery.

3. Brasss-V drape

4. Primary PPH
• Aetiology....4 T.s
• Tone
• Tissue
• Trauma
• Thrombosis

5. Assessment
History & Examination
...continious bleeding after delivery of placenta
...feeling unwell &/or fainting
...pallor, cold extremities
...hypotension, tachycardia
...agitation &/or confusion
...exam of lower genital tract.

6. Management
• 1-recognition
• 2-communication
• 3-resuscitation
• 4-monitoring & investigations
• 5-treatment

7. 3-resuscitation
• *immidiate call for help
• *assessment of airway & breathing initially
• *wide bore IV line with bl sent for cross match
• *rapid IV infusion
• *give blood, colloid & crystalloid
• *keep the patient warm & lying flat
• *IV antibiotics

8. 4-monitoring & investigations
• *monitoring of pulse rate, bl.p, urine output &
O2 saturation.
• *CVP monitoring

9. 5-treatment
A-mechanical & medical
a-Tone
• ...mechanical uterine message
• ...bimanual uterine compression
• ...non-pnematic anti-shock garment (NASG).
• ...Oxytocin (syntocinon)
• ...Ergometrine
• ...Dinoprost & Carboprost.

11. NASG

13. b-Trauma of genital tract
• ...pressure & repaire
c-Tissue
• ...oxytocin
• ...empty the bladder
• ...transfer to the theater.
d-Thrombin

14. B-Surgical treatment
a-balloon tamponade
b-hemostatic uterine bracing suture (B-Lynch)
c-bilateral ligation of uterine arteries.
d-bilateral ligation of internal iliac arteries.
e-selective arterial embolization
f-hysterectomy.

15. catheter
Bakri balloon
.
Sengstaken
Blakmore.

16. B-Lynch suture

17. Complications
• -Shock
• -Collapse
• -DIC
• -Sheehan syndrome.
• -Maternal mortality.

18. Prevention
• *be aware of risk factors
• *treat anemia antenatally
• *active management of 3rd stage of labour
• *prophylactic oxytocin or syntometrine
• *nipple stimulation & breast feeding.

19. Secondary PPH
Aetiology
1-subinvolution of uterus (retained tissue,
endometritis).
2-lower genital tract laceration
3-surgical injury
4-dehiscence of CS
5-coagulopathy & bleeding disorders

20. Endometritis risk factors
• -CS
• -prolong rupture of membranes
• -sever meconium stained liquor
• -long labour with multiple pelvic examination
• -manual removal of placenta
• -at extremes of maternal age
• -low socio-echonomic state
• -maternal anemia
• -prolonged surgery
• -internal fetal monitoring.

21. Assessment
• History & Examination
• ...offensive lochia & abdominal cramp.
• ...fever, rigor, tachycardia
• ...uterine tenderness
• ...enlarged uterus
• ...open cervical os

22. • Investigations
• ...FBC
• ...blood culture
• ...C-reactive protein
• ...high vaginal swab
• ...USG
• ...duplex color doppler.

23. Management
• ...patient observation + antibiotics
• ...oxytocine &/or ergometrine
• ...misoprostol
• ...retained tissue should removed by forceps.
• ...ellective curettage with antibiotics.
• ...iron supplementation
• ...packing of uterus
• ...laprotomy & tie the uterus or internal iliac A.s
• ...hysterectomy (rarly).