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PPH

PPH is present when blood loss exceeds : 500 ml : within : 24 hours of

beginning of 3rd stageof labour

MC causeofPPH : uterine atony (feb 97)

Mc cause ofPPH I multipara :atonic uterus

MC causeof secondary PPH : uterine inertia

Increase risk of PPH : macrosomia ,twin pregnancy , hydramnios (AI 06)

[HT/preeclampsia is not a RF of PPH]overdistension of uterus , cervical

laceration , prolong labour (sep 96) [in PTL PPH not occur] fibroid

,malnutrition ,epidural analgesia

Atonic uterus is morecommon in: multigravida (max chance of PPH)

Cause of PPH in contracted uterus : (rules out atonic PPH traumatic PPH+)vaginal/cervical tear

Drug used in treatment of PPH : (dec 97 /may 02 / AI03)

o Prostaglandin : Misoprostol / carboprost

o Methyl ergometrine

o Oxytocin

o Syntometrine

Mifepristone (RU 486) not used in Rx of PPH

B lynch suture isapplied on : uterus (AI 03)

Placenta accreta is : seen in CS scar (nov99)

Treatment of placenta accreta : hysterectomy

To decrease PPH drug used prophylactically : methrgin / therapeutically :

prostaglandins

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PPH

Treatment of PPH

o ResuscitationIn atonic PPH massage uterusoxytocin &

methergin/ergometrine injection im/iv FAIL15 methyl PGF2 alpha

(prostdin/carboprost) i.m. or PG E1 (misoprostol)vaginally/rectally

FAIL bimanual compression uterine packing under anesthesia

ballon temponade with sangstaken tube FAIL if female has

completed family hysterectomy OTHERWISE B lynch/brace

sutureuterine& ovarian artrery ligation ANTERIOR division of

internal iliac arteryligation FAILhysterectomy

MC cause of death in inversipon of uterus : hemorrhage

MCc auseof retained placenta :atonic uterus