postpartum haemorrhage

Postpartum HaemorrhageMohd Fadhli Karim

DefinitionBleeding more than 500ml following deliveryPrimary:

within 24 hoursSecondary:

after 24hours to 6 weeks postpartum

Epidemiology2% of pregnancyMost common cause of maternal mortality

worldwide

AetiologyPrimary:

TONE (MAJOR 90%) myometrium has not contracted to cut off spiral

arteriesTISSUE

Retained placental fragmentsTRAUMA

Lacerations, episiotomy, uterine rupture or inversion

THROMBIN DIC, Haemophilia, vWD

AetiologySecondary:

EndometritisRetained placental tissue

Risk FactorOverdistention Atony

(Multiple pregnancies, polyhydramnios, LGA).Labor & Delivery:

Antepartum haemorrhage, placenta praevia.C-section (Emergency>Elective).Prolonged labor >12hour

Pre-eclampsiaPrevious PPHHELLP

Clinical PresentationBleeding

continuous bleeding after delivery of placenta blood soaked pads and bedding

Shock pallor collapse hypotension tachycardia

Bimanual Compression

B-Lynch Brace Suture

Reduction of Uterine InversionJohnson’s Method

Recognition Replacement Restitution

Management Secondary PPHExclude retention of placental tissue as a

causeUltrasound (identify retained placental tissue)Ultrasound guided removal of placental tissue

under general anaesthesia

EndometritisAntibiotic therapy

SummaryBleeding more than 500 ml from genital tract

after deliveryPrimary and secondary 4t – tone, tissue, trauma, thrombinMultidiscipline management

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