POSTPARTUM HEMORRHAGE

Dr.Suresh Babu Chaduvula

Professor

Dept. of Obstetrics & Gynecology

College of Medicine, Abha, KKU, Saudi Arabia

POSTPARTUM HEMORRHAGE [ PPH ] 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- 4 %

TYPES 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,increta and

percreta & 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.

THE FOUR “T” TO REMEMBER

ToneTissueTrauma

Thrombin

PRIMARY POSTPARTUM HEMORRHAGE Causes: 1] Atonic 2] Traumaic 3] Mixed 4] Retained Placenta 4] Coagulopathy

PPH RISK FACTORS

ATONIC PPH 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

PPH RISK FACTORS

PPH RISK FACTORS

TRAUMATIC PPH 1] Cervix – lacerations 2] Vaginal laceration 3] Perineum injury 4] Paraurethral injury 5] Uterine rupture

Retained Placenta Placenta accreta, increta and

percreta Succentuirate placenta.

PPH RISK FACTORS

Blood coagulation Disorders: Abruptio Placenta, Jaundice,

Thrombocytopenic purpura, HELLP syndrome

Combination of Atonic and Traumatic:

DIAGNOSIS Vaginal bleeding may be revealed or

concealed

Alteration in pulse, Blood pressure and Pulse pressure

Flabby uterus in atonic uterus

PPH

PREVENTION OF PPH 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.

MANAGEMENT OF PPH 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 preventative measures have failed.

MANAGEMENT OF PPH

MANAGEMENT OF PPH

MANAGEMENT OF PPH

DRUG THERAPY FOR PPH

MANAGEMENT OF PPH

MANAGEMENT OF PPH

THE B-LYNCH SUTURING

Description of technique

SUMMARY: REMEMBER 4 TS

Tone Tissue Trauma Thrombin

SUMMARY: REMEMBER 4 TS “TONE” Rule out Uterine

Atony

Palpate fundus. Massage uterus. Oxytocin Methergine Hemabate

SUMMARY: REMEMBER 4 TS “Tissue” R/O retained

placenta

Inspect placenta for missing cotyledons.

Explore uterus. Treat abnormal

implantation.

SUMMARY: REMEMBER 4 TS “TRAUMA” R/O cervical or

vaginal lacerations.

Obtain good exposure.

Inspect cervix and vagina.

Worry about slow bleeders.

Treat hematomas.

SUMMARY: REMEMBER 4 TS “THROMBIN” Replacement with

blood or Fresh frozen plasma or Platelet rich pasma.

THANK YOU