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    Postpartum Hemorrhage (PPH)

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    Asteway Mesfin
    Postpartum hemorrhage (PPH) is excessive vaginal bleeding during or after delivery. It is clinically defined as bleeding causing hypovolemia symptoms/signs, or blood loss of 500+ ml for vaginal delivery or 1000+ ml for c-section, or 10% drop in hematocrit. PPH is primary (during delivery) or secondary (24 hours to 6 weeks postpartum). The main causes are uterine atony (80%), genital tract lacerations, retained placenta, and coagulopathies. Risk factors include prior multiple births, macrosomia, rapid labor, and oxytocin use. Treatment begins with uterine massage, fluids, and uterotonics, then

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    Postpartum Hemorrhage (PPH)

    Uploaded by

    Asteway Mesfin
    303 views12 pages
    Postpartum hemorrhage (PPH) is excessive vaginal bleeding during or after delivery. It is clinically defined as bleeding causing hypovolemia symptoms/signs, or blood loss of 500+ ml for vaginal delivery or 1000+ ml for c-section, or 10% drop in hematocrit. PPH is primary (during delivery) or secondary (24 hours to 6 weeks postpartum). The main causes are uterine atony (80%), genital tract lacerations, retained placenta, and coagulopathies. Risk factors include prior multiple births, macrosomia, rapid labor, and oxytocin use. Treatment begins with uterine massage, fluids, and uterotonics, then

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    Postpartum hemorrhage (PPH) is excessive vaginal bleeding during or after delivery. It is clinically defined as bleeding causing hypovolemia symptoms/signs, or blood loss of 500+ ml for vaginal delivery or 1000+ ml for c-section, or 10% drop in hematocrit. PPH is primary (during delivery) or secondary (24 hours to 6 weeks postpartum). The main causes are uterine atony (80%), genital tract lacerations, retained placenta, and coagulopathies. Risk factors include prior multiple births, macrosomia, rapid labor, and oxytocin use. Treatment begins with uterine massage, fluids, and uterotonics, then

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    303 views12 pages

    Postpartum Hemorrhage (PPH)

    Uploaded by

    Asteway Mesfin
    Postpartum hemorrhage (PPH) is excessive vaginal bleeding during or after delivery. It is clinically defined as bleeding causing hypovolemia symptoms/signs, or blood loss of 500+ ml for vaginal delivery or 1000+ ml for c-section, or 10% drop in hematocrit. PPH is primary (during delivery) or secondary (24 hours to 6 weeks postpartum). The main causes are uterine atony (80%), genital tract lacerations, retained placenta, and coagulopathies. Risk factors include prior multiple births, macrosomia, rapid labor, and oxytocin use. Treatment begins with uterine massage, fluids, and uterotonics, then

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    POSTPARTUM

    HEMORRHAGE (PPH)
    Basliel ,MD
     Excessive vaginal bleeding that occurs during and after the
    third stage of labour.
     Best defined clinically as any amount of bleeding that causes

    symptoms and/or signs of hypovolemia.


     Traditionally defined as

    > =500 ml blood loss for vaginal delivery


    >=1000ml blood loss for ceaseran delivery
    or
    > = 10% drop in Hct from pre -partum value
    primary (early) and secondary(late) PPH
     Primary (early) PPH
     Third stage hemmorhage (before placental

    delivery )
     True PPH (after placental delivery)

     Secondary ( late ) PPH


     Is defined as bleeding occuring between 24 hours and 6 weeks
    after delivery
    what normally prevents
    excess blood loss?
    • tourniquet effect of uterine contraction
    • local decidual haemostatic factors
    • systemic coagulation factors.
    Incidence
     Vaginal birth: 3.9%

     Cesarean: 6.4%

     Delayed postpartum hemorrhage: 1-2%

    Mortality
     5% of maternal deaths
    Etiologies & Risk factors
    May result from:
     Uterine atony

     Lower genital tract lacerations

     Retained products of conception

     Uterine rupture

     Uterine inversion

     Placenta accreta
     adherence of the chorionic villi to the myometrium
     Coagulopathy
     Hematoma
    Uterine Atony
     Lack of closure of the spiral arteries and venous sinuses

     The commonest cause of PPH as high as 80%

    Risk factors:
     Over distension of the uterus secondary to multiple gestations
     Polyhydramnios
     Macrosomia
     Rapid or prolonged labor
     Grand multiparty
     Oxytocin administration
     Intra-amniotic infection
    Lower genital tract lacerations
     Result of obstetrical trauma
     More common with operative vaginal deliveries
     Forceps
     Vacuum extraction

    Other predisposing factors:


     Macrosomia
     Precipitous delivery
     Episiotomy
    laboratory evaluation
     CBC
     Platelet count
     PT,PTT
     Serum fibrinogen level
     RFT
    complication

     Death
     Hypovolemic shock and organ failure
     postpartum hypopituitarism (sheehan syndrome)
     Anemia
     Transfusion related complication
     Asherman syndrome etc…
    Overview of management
     Intial intervention
     Uterine massage
     Resuscitation with crystalloids or blood
     Uterotonics
     Secondary intervention
     Inspection and repair of lacerations
     Remove retained products of conceptus
     Uterine tamponade
     Arterial embolization
     laparatomy
    Thank you

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