postpartum haemorrhage
TRANSCRIPT
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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