ob:gyn postpartum hemorrhage sanlucas

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Postpartum Hemorrhage & Abnormal Placentation Manuel Fonseca MSIII Hospital San Lucas Guayama OB/GYN Dr.Miranda

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Postpartum Hemorrhage & Abnormal PlacentationManuel FonsecaMSIIIHospital San Lucas GuayamaOB/GYNDr.Miranda

PostPartum HemorrhageBleeding more than 500 ml after vaginal delivery or more than 1000 mL following cesarean deliveryEarly postpartum bleeding ocurrs within 24 hours of deliveryLate postpartum bleeding ocurrs 24 hours to 6 weeks later

The diagnosis is reserved for pregnancies that have more than 20 weeks gestation.

Less than 20 weeks gestational age are spontaneous abortions.

Post Partum HemorrhageUterine Atony Risk Factors - Anesthesia -Uterine over distention (twins, Polyhydramnios) -Prolonged laborBimanual examinationR/O uterine rupture , Retained placentaIf unresponsive to bimanual massage administer oxytocin

PostPartum HemorrhageRetained placenta (Accreta)Genital lacerations

Failure to progress during the second stage of labor

Large-for-gestational-age (LGA) newborn

Hypertensive disorders

Augmentation of labor with oxytocin

Sheehan SyndromeMassive bleeding and hypotension ->Infarction of pituitary ->Hypopituitarism-No lactation -Amenorrhea-Cold intolerance - Loss of pubic hair

4 TsToneTissueTrauma-Cervical laceration-Uterine ruptura-Very prolongad or vigorous labor-Vaginal sidewall laceracin-Lower vaginal trauma, either spontaneously or because of episiotomyThrombosis-Thrombocytopenia idiopathic thrombocytopenic purpura-acquired secondary to HELLP syndrome -Abruptio placentae-(DIC)-Coagulopathies -Sepsis

Layers of endometriumStratum compactum*Stratum spongiosum*Stratum basale = Base layerMyometrium

Placenta PreviaImplantation of the placenta in the lower uterine segment;

placenta overlies cervical os (opening).

Presents as third-trimester painless bleeding

Placenta Previa

Dx.UltrasoundRisk Factors: -Multiparity-Prior C-sectionTx: C-section

Vasa PreviaFetal blood vessels cover cervizRisk of fetal hemorrhage

Placenta AccretaImproper implantation of placenta into the myometrium with little or no intervening decidua(directly to myometrium)

Presents with difficult delivery of the placenta and postpartum bleeding ( Cannot detach after delivery)

Tx. Hysterectomy

Placenta incretaPlacenta grows into wall of uterusPlacenta percretaPlacenta perforates through uterusRisk factor : previous c-section

Placenta AbruptionSeparation of placenta from the decidua prior to delivery of the fetus

Painful Vaginal Bleeding 3rd trimester

Common cause of stillbirth (fetus dies in utero)

Can Lead to DIC or fetal death

Risk Factors- Trauma, Abuse-Smoking , HTN , Cocaine

DX: Kleihauer-Betke test

Indicactions for vaginal delivery and c-sectionC-section-uncontrollable maternal hemorrhage-rapidly expanding concealed hemorrhage-fetal distress -rapid placenta separationVaginal Delivery-placental separation is limited -separation is extensive and fetus is dead