Transcript Postpartum-Hemorrhage-DrSuresh

Dr.Suresh Babu Chaduvula
Professor
Dept. of Obstetrics & Gynecology
College of Medicine, Abha, KKU, Saudi Arabia
 Definition:
 More
than 500 ml of blood loss following
normal vaginal delivery of the fetus or
1000ml following Cesarean section.
 Clinically the amount of blood loss from or
into the genital tract which will adversely
affect the general condition of the patient
 Hemorrhage leading to fall in hematocrit by
10 %.
 Incidence – 1 %
 1]
Primary 2] Secondary
 Primary – bleeding occurs following delivery
of the baby up to 24 hours
 Primary is two types:
 A] Third Stage hemorrhage
 B] True Post Partum hemorrhage
 Third
Stage hemorrhage:
 Bleeding occurs before the expulsion of
placenta
 Example- Placenta accreta, retained
placenta
 True Postpartum hemorrhage:
 Occurs after the expulsion of placenta
 Secondary
or Delayed or Late Postpartum
hemorrhage:
 Bleeding occurs following delivery of the
baby after 24 hours up to 6 weeks.
 Causes:
 1]
Atonic
 2] Traumaic
 3] Mixed
 4] Coagulopathy
 Contributes
for 80 % of PPH
 Commonest cause of PPH
 Cause – Faulty retraction of the uterus
 Etiology:
 1] Grand Multipara
 2] Over- distension of uterus – Multiple
pregnancy, Hydramnios, big baby
 3] Anemia
 4]
Prolonged Labor
 5] Anaesthesia – Halothane. Ether,

Cyclopropane
 6] Uterine fibroid
 7] Precipitate labor
 8] Malformations of uterus – septate uterus,
bicornuate uterus
 9] Ante partum hemorrhage
 10] Initiation & augmentation of delivery
with oxytocin
 1]
Cervix – lacerations
 2] Vaginal laceration
 3] Perineum injury
 4] Paraurethral injury
 5] Uterine rupture
 Combination
 Blood
of Atonic and Traumatic:
coagulation Disorders:
 Abruptio Placenta, Jaundice,
Thrombocytopenic purpura, HELLP syndrome
Tone
Tissue
Trauma
Thrombin
 Vaginal
bleeding may be revealed or
concealed
 Alteration
in pulse, Blood pressure and Pulse
pressure
 Flabby
uterus in atonic uterus
 UTEROTONIC
DRUGS

Routine oxytocic administration in the third
stage of labour can reduce the risk of PPH by
more than 40%

The routine prophylaxis with oxytocics results
in a reduced need to use these drugs
therapeutically

Management of the third stage of labour should
therefore include the administration of
oxytocin after the delivery of the anterior
shoulder.
 Early
recognition of PPH is a very important
factor in management.
 An
established plan of action for the
management of PPH is of great value when
the preventive measures have failed.
Description of technique
 Tone
 Tissue
 Trauma
 Thrombin
 “TONE”
 Rule
out Uterine
Atony
 Palpate
fundus.
 Massage uterus.
 Oxytocin
 Methergine
 “Tissue”
 Inspect
placenta for
missing cotyledons.
 R/O retained placenta
 Explore uterus.
 Treat abnormal
implantation.
 “TRAUMA”
 R/O
cervical or
vaginal lacerations.
 Obtain
good
exposure.
 Inspect cervix and
vagina.
 Worry about slow
bleeders.
 Treat hematomas.
 “THROMBIN”
 Replacement
with
blood or Fresh frozen
plasma or Platelet
rich plasma.
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