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Postpatrum Hemorrhage and Third Stage Emergencies
Postpartum Hemorrhage3-5% of vaginal deliveries Definition: >500ml blood loss Potentially serious complications for mother Common cause of maternal morbidity and mortality worldwide
PPH Risk Factors Antepartum Pre-eclampsia MultiparityMultiple gestation Previous postpartum hemorrhage Previous cesarean section Intrapartum Prolonged third stage (>30 mins) Arrest of descent Episiotomy Lacerations: cervical, vaginal, perineal Assisted delivery: forceps, vacuum Augmented labour
Causes of PPH: The Four “Ts”Tone (70%) Trauma (20%) Tissue (10%) Thrombin (1%)
PPH: Resuscitative MeasuresCall for help Airways, Breathing, Circulation Two large-bore IVs Oxygen Stat labs: type & cross, hb, coags Consider transfusion
Treatment Approach for PPHCatheterise bladder Uterine massage Oxytocics Inspect for lacerations Surgical intervention
Tone – Uterine Atony Most common cause of PPHInitial step = bimanual uterine massage and compression Oxytocic agents Oxytocin Methylergometrine Prostaglandins
Oxytocin Drug of choice 10 – 40 units in 1 litre at 250 cc/hr1M (10 units) or IV infusion No contraindications Hypotension with IV push
Ergot Alkaloide Ergometrine 0.25 mg IM onlyContraindicated in hypertension
Prostaglandins 15-methyl prostaglandin F2acarboprost, Hemabate® 0.25 mg IM or intramyometrial Side effects: nausea, diarrhea, flushing, headache Contraindication: hypersensitivity Caution: asthma, HTN, cardio- pulmonary disease
Trauma Uterine inversion Uterine ruptureVaginal or cervical lacerations Hematoma Perineal tears
Uterine Rupture Associated with uterine surgery Suspect if:vaginal bleeding abdominal tenderness maternal tachycardia signs of shock are out of proportion to viable blood loss
Uterine Inversion Rare, but important to recognize quicklySuspect if shock disproportionate to blood loss Replace uterus immediately or after resuscitation Watch for vasovagal reflex
Tissue Retained placenta Retained placental fragmentsNot delivered within 30 minutes 3% of deliveries Retained placental fragments Invasive placenta
Manual Placental RemovalCease uterine massage Identify cleavage plane Cup cotyledons in palm Explore uterine cavity Give oxytocin
Thrombin - CoagulopathyPre-existing conditions ITP, von Willebrands Coagulaopthic: Obstetric-related Hypertension disorders, HELLP Abruption Fetal demise Sepsis Drugs (e.g. asprin)
Coagulation Lab StudiesFBC with platelet count PT-INR, aPPT Fibrinogen level FDP / D-dimer
Tone, Trauma, Tissue, ThrombinPPH Summary Unpredictable – be prepared Uterine atony is the main cause Remember 4-Ts: Tone, Trauma, Tissue, Thrombin Consider active management of the third term
SALAH M.OSMAN CLINICAL MD. * It is an excessive blood loss from the genital tract after delivery of the foetus exceeding 500 ml or affecting the general.
OBSTETRIC EMERGENCIES OBSTETRIC EMERGENCIES Dr. Malak Al Hakeem.
Nahida Chakhtoura, M.D.. Postpartum hemorrhage (PPH): leading cause of maternal mortality worldwide Prevalence rate: 6% Africa has highest prevalence.
Obstetric Hemorrhage Abike James MD Assistant Clinical Prof. Obstetrics and Gynecology University of Pennsylvania.
Postpartum Hemorrhage(PPH) 产后出血 林建华. Major causes of death for pregnancy women （ maternal mortality) Postpartum hemorrhage （ 28%) heart diseases pregnancy-induced.
Maternal Resuscitation and Postpartum Hemorrhage Workshop
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Postpartum Haemorrhage. Definitions Primary PPH – blood loss of 500ml or more within 24hours of delivery. Secondary PPH – significant blood loss between.
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