OBGYN presentation: Post-partum haemorrhage

8/17/2019 OBGYN presentation: Post-partum haemorrhage

1/16

WEEK 7 PRESENTATION

POST-PARTUMHAEMORRHAGE

Jeremy Yang


2/16

Case

Mrs Jones rang the Labour Ward asadvised by her general practitionerbecause she had noted a small amount ofvaginal bleeding. It was one week before

her due date.

What advice wou d !ou "ive he#$a% No actio&' it(s &o#)a to * eed this

adva&ced i& +#e"&a&c!, It(s +#o*a* ! a* ood! show' a&!wa!, Co)e i& whe&active a*ou# *e"i&s.

*% Advise he# to visit PAC so a +#o+e# H/'E/ a&d I/ ca& *e u&de#ta0e&, A&!


3/16

Causes o1 * eedi&" i& 2 #d t#i)este#

Serious and not to be missedlacental abruptionlacenta praevia

!asa praevia hysiological

"loody show of labour #ther

$"%contact bleeding$ervical polyps

Ta0e a histo#! Pe#1o#)

e/a)i&atio& 3o

i&vesti"atio&s


4/16

What a#e the 1u&ctio&s o1 the )idwi1e')edica sta4 a&d su++o#t +e#so&s i&

achievi&" a &o#)a de ive#!$

Midwi1e &mid = with' wif = woman(

A professional who works in partnershipwith pregnant women, giving necessarysupport, care and advice throughout

pregnancy, labour and early postpartum


5/16

The #o es o1 the Midwi1e )egular community antenatal checks throughout

pregnancy and up to *+%,- postpartum ducation and counselling

Lifestyle advice"reastfeeding

arenthood

Se/ual%gynaecological health 0uides the woman to appropriate medical care or

assistance if complications detected duringpregnancy

Many midwives are also )1s 2 perform nursingduties in hospital

Low3risk pregnancies can be followed in its full

course by midwives only . "ut if there arecomplications% increased risks4


6/16

3octo#s - See& i1 the +#e"&a&c! isco&side#ed hi"he# #is0 tha& &o#)a ' e,",

Increased risk on early pregnancy screening $omplications of pregnancy Signi5cant #6/ et#6 and drugs $omple/ social cases Mental health issues &maternal( #ther medical conditions &maternal and fetal(

Whe#e$ 7S or 7$' clinics &71$' 6)71$' 87 S%$$'

IM6S' 8$79(' hospital


7/16

Ro e o1 the su++o#t +e#so& 5e,", +a#t&e#'1a)i !' 1#ie&d% To +#ovide e)otio&a a&d +h!sica

su++o#t to the wo)a& du#i&" a*ou# &butalso throughout pregnancy($hanging the kitty litter' doing the housework0iving massage' helping shower' pain

management techni:ues6elping pack for' and transport to hospital 9aking her mind o; labour in early stage'distractions

0etting food%drink and ensuring regular eatingand emptying bladder7ssisting midwives with positioning duringcontractions etc.0iving words of comfort and encouragement"eing by her side at all times


8/16

M#s 6o&es has ust de ive#ed a 89::"i&1a&t a1te# 2h#s a*ou#, She is

* eedi&" heavi !,

Post-+a#tu) * ood oss ; what(s&o#)a a&d what(s &ot$

NORMA< < = ,>>mL in ? st hour 1!8'=@,>mL after $%S

A=NORMA< &i.e. ? o 6(< A,>>mL in ? st hour 1!8

A?>>>mL in ? st hour #) causeshaemodynamic compromise 2 severe 6 obstetric emergency


9/16

How wou d !ou )a&a"e this +atie&t$

Simultaneously' not se:uentially< I> access Mo&ito#i&" ? i&vesti"atio& A##esti&" hae)o##ha"e

Resuscitatio&


10/16


Simultaneously' not se:uentially< I> access

?+ or ?B gauge cannula &or /-( Mo&ito#i&" ? i&vesti"atio&

7ppearance' " ' 6)' C%3 urine output&catheter(D3match' E"$' coagulation studies

A##esti&" hae)o##ha"e Resuscitatio&


11/16



Ute#i&e )assa"e=i)a&ua co)+#essio&=a oo& ta)+o&ade@st i&e Medica Re+eat dose 9-@:IU

s!&toci&o&' o# o#"o)et#i&e' s!&to)et#i&eB&d i&e Medica Miso+#osto 5o4- a*e %Su#"ica Radio o"ica ute#i&e a#te#!e)*o isatio&

Resuscitatio&


12/16



Resuscitatio&Restore blood volume and O 2 carryingcapacity

Eluids &6artmannFs G colloid up to H,>>mL(

# - by mask ?>3?,mL%mineep pt warm' and warm uids if possible

)"$ transfusion 7S7 ' #3 if critically needed&and EE ' cryoprecipitate if coags deranged(

7fter -K blood' add ?K EE with every additionalunit of blood


13/16

3iscuss the causes o1 +ost+a#tu)hae)o##ha"e

TONE. 2 uterine atony &most common'@> 6 cases(

TRAUMA. 2vulval%perineal%vaginal%cervical%$3section&-> of cases of 6(

TISSUE 2 retained placental tissue&?> of cases of 6(

THROM=IN. 5coa"u o+ath!%; 3IC'o&"oi&" the#a+eutic a&ticoa"u atio&')ate#&a * eedi&" diso#de# 5 rarely theprimary cause of 6(


14/16

Ris0 1acto#s 1o# PPHAssociated with a su*sta&tia i&c#ease i& #is0 o1 PPH antepartum haemorrhage &especially placental abruption and

placenta praevia( 6 with a previous pregnancy known abnormal placental adherence &e.g. accreta' increta or

percreta( multiple pregnancy &e.g. twins and higher order multiples( disorders of haemostasis inherited bleeding disorders

Associated with a si"&i ca&t thou"h s)a e# i&c#ease i&#is0 grand multiparity &more than 5ve previous births( pre3eclampsia macrosomia maternal obesity elective or previous LKS$S


15/16

Ris0 1acto#s 1o# PPH3u#i&" a*ou# a&d *i#th need for' and use of' o/ytocics in labour prolonged labour &especially prolonged second

and%or third stage( pyre/ia instrumental and surgical delivery episiotomy placental retention


16/16

3iscuss the di4e#e&ces *etwee& +#i)a#! a&dseco&da#! PPH

Bo

PPH /cessive uterine bleeding A-+hrand =B%,- postpartum' most commonly @3?+ days postpartum

Main causes )etained placental tissue C%3 infection &e.g. endometritis(

OBGYN presentation: Post-partum haemorrhage

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