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    Post Partum Hemorrhage

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    inmenzoorozcojem
    tackle about the risk after giving birth

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    Post Partum Hemorrhage

    Uploaded by

    inmenzoorozcojem
    23 views15 pages
    tackle about the risk after giving birth

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    © © All Rights Reserved

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    tackle about the risk after giving birth

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    23 views15 pages

    Post Partum Hemorrhage

    Uploaded by

    inmenzoorozcojem
    tackle about the risk after giving birth

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 15

    Post Partum

    Hemorrhage
    Post partum
    hemorrhage (PPH) is
    loss of 500 ml of blood
    or more within 24 hours
    after giving birth.
    Primary postpartum hemorrhage
    may occur within the first 24 hours
    after birth, while secondary
    postpartum hemorrhage occurs
    more than 24 hours and up to 12
    weeks after delivery.
    Primary post-partum hemorrhage
    is the loss of >500 ml of blood per-vagina
    within 24 hours of delivery. It can be
    classified into two main types:
    Minor PPH – 500-1000ml of blood loss
    Major PPH – >1000ml of blood loss
    It is a major cause of obstetric morbidity
    and mortality worldwide.
    The four main causes for
    postpartum hemorrhage are the
    four T’s:
    tone (uterine atony),
    trauma (lacerations,
    hematomas, uterine inversion
    or rupture),
    tissue (retained placental
    fragments), and
    thrombin (disseminated
    intravascular coagulation).
    Tone
    - refers to uterine atony, which is the most
    common cause of primary post-partum
    haemorrhage. This is where the uterus fails to
    contract adequately following delivery, due to a
    lack of tone in the uterine muscle.

    The risk factors for uterine atony include:

    Maternal profile: Age >40, BMI > 35, Asian


    ethnicity.
    Uterine over-distension – multiple
    pregnancy, polyhydramnios, fetal
    macrosomia.
    Labour – induction, prolonged (>12 hours).
    Placental problems – placenta praevia,
    placental abruption, previous PPH.
    Trauma
    - this refers to damage sustained to
    the reproductive tract during
    delivery (e.g. vaginal tears, cervical
    tears).

    Risk factors include:


    Instrumental vaginal
    deliveries (forceps or
    ventouse)
    Episiotomy
    C-section
    Tissue

    ‘Tissue’ refers to retention of


    placental tissue – which prevents
    the uterus from contracting. It is
    the second most common cause of
    primary PPH.
    Thrombin
    refers to coagulopathies and
    vascular abnormalities which
    increase the risk of primary
    post-partum haemorrhage:
    Vascular – Placental
    abruption, hypertension,
    pre-eclampsia.
    Coagulopathies – von
    Willebrand’s disease,
    hemophilia A/B, ITP or
    acquired coagulopathy i.e.
    DIC, HELLP.
    Secondary postpartum hemorrhage
    is defined as excessive vaginal bleeding in
    the period from 24 hours after delivery to
    twelve weeks postpartum.
    The overall incidence of secondary
    postpartum hemorrhage in the developed
    world has been reported as 0.47% – 1.44%
    The main causes of secondary post-partum
    haemorrhage are:
    Uterine infection – (known as endometritis).
    Risk factors include Caesarean section,
    premature rupture of membranes and
    long labour.
    Retained placental fragments or tissue
    Abnormal involution of the placental site
    (inadequate closure and sloughing of the
    spiral arteries at the placental attachment
    site).
    Trophoblastic disease (very rare).
    A personal history of secondary PPH is a
    strong predictive factor; it has a recurrence
    rate of 20–25%.
    PRIMARY PPH
    Definitive Management
    The definitive treatment for primary post-partum
    hemorrhage is dependent on the underlying cause:
    Uterine Atony
    Bimanual compression to stimulate uterine
    contraction – insert a gloved hand into the vagina,
    then form a fist insider the anterior fornix to
    compress the anterior uterine wall and the other
    hand applies pressure on the abdomen at the
    posterior aspect of the uterus (ensure the bladder is
    emptied by catheterization).
    Pharmacological measures (Table 1) – act to
    increase uterine myometrial contraction.
    Surgical measures – intrauterine balloon
    tamponade, hemostatic suture around uterus (e.g.
    B-lynch), bilateral uterine or internal iliac artery
    ligation, hysterectomy (as a last resort).
    Trauma
    Primary repair of laceration, if uterine
    rupture: laparotomy and repair or
    hysterectomy.

    Tissue
    Administer IV Oxytocin, manual removal of
    placenta with regional or general an aesthetic,
    and prophylactic antibiotics in theatre. Start
    IV Oxytocin infusion after removal.

    Thrombin
    Correct any coagulation abnormalities with
    blood products under the advice of the
    hematology team.

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