Postpartum haemorrhage refers to bleeding after childbirth and can be primary (during or within 24 hours of delivery) or secondary (24 hours to 6 weeks after delivery). Primary causes include an atonic uterus, trauma, retained placenta, or coagulation disorders. Secondary causes include infection or retained membranes. Symptoms include heavy bleeding, dizziness, and low blood pressure. Treatment depends on cause but may include uterine massage, uterotonic drugs, surgery to repair lacerations, or hysterectomy in severe cases.

1. POSTPARTUM HAEMORRHAGE
Presented by Faisal Janahi

2. Postpartum haemorrhage refers to any amount of
bleeding from or into the genital tract following
birth of the baby upto the end of puerperium .

3. ⦁ 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.

4. Primary postpartum hemorrhage are:
⦁ Atonic uterus
⦁ Trauma
⦁ Mixed ( combination of both atonic and trauma)
⦁ Retained product of conception
⦁ Uterine rupture
⦁ Uterine inversion
⦁ Blood coagulopathy

5. Secondary postpartum haemorrhage include:
⦁ Retained bits of membranes.
⦁ Infection
⦁ Cervico-vaginal laceration
⦁ Endometritis
⦁ invasive placenta
⦁ Secondary hemorrhage from caesarean section
⦁ Other rare causes – chorion epithelioma, carcinoma
cervix, placental polyp and fibroid polyp

6. ⦁ Prolonged third stage of labor
⦁ Multiple delivery
⦁ Episiotomy
⦁ Fetal macrosomia
⦁ History of postpartum hemorrhage.
⦁ Grandmultiparity
⦁ Placenta previa
⦁ Placental abruption
⦁ Pregnancy induced hypertension
⦁ Infection

7. ⦁ Massive blood loss
⦁ Passing large clots
⦁ Dizziness
⦁ Fatigue.
⦁ Decreased blood pressure.
⦁ Increased heart rate
⦁ Swelling and pain in tissues in the vaginal and
perineal area

8. ⦁ Tone – Atonic uterus 70%
⦁ Trauma – laceration, hematoma,
inversion, rupture 20%
⦁ Tissue – Retained tissue, invasive
placenta 10%
⦁ Thrombin – Coagulopathies 1%

9. ⦁ Slow delivery of the baby.
⦁ Spontaneous separation and delivery of placenta
during caesarean section.
⦁ 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.

10. ⦁ Rub up the uterus to stimulate contraction and
retraction.
⦁ Administer ergometrine IM or Syntometrine IM
⦁ Expel the placenta with the next uterine
contraction by fundal pressure or controlled cord
traction.
⦁ Empty the urinary bladder by catheterization.

11. Tone
⦁ Uterine massage
⦁ Uterotonic agents - Uterotonic agents include
oxytocin, ergot alkaloids, and prostaglandins.

12. Trauma
⦁ Lacerations and hematomas- resulting from
birth trauma can cause significant blood loss
⦁ Uterine Rupture - Symptomatic uterine
rupture requires surgical repair of the defect
or hysterectomy.
⦁ Uterine inversion- is rare.

13. 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.

14. Thrombin
Coagulation disorders, a rare cause of post-
partum hemorrhage. Most coagulopathies are
identified before delivery, allowing for
advance planning preventing postpartum
hemorrhage.

15. ⦁ Transvaginal uterine packing
⦁ Conservative surgical approach - Uterine
Artery Ligation, OvarianArtery Ligation,
V
aginalArtery Ligation, Internal Iliac
Ligation,AngiographicArterial Embolization,
Hysterectomy.

16. ⦁ Blood loss
⦁ Shock
⦁ Death
⦁ Septicemia
⦁ Orthostatic hypotension
⦁ Anemia
⦁ Fatigue