1. Rupture of uterus Ob & Gy Department, First Hospital, Xi’an Jiao Tong University SHU WANG

2. Etiology  Fetal descent arrest  Surgical delivery history  Misuse of oxytocin  Obstetrical operative injury

3. Clinical findings  Impending uterine rupture  Abdominal pain and tenderness  Pathologic retraction ring  Increased uterine irritability  Hematuria  Sign of hypovolemic shock  Fetal distress or fetal death

4. Clinical findings  Uterine rupture  complete uterine rupture  severe abdominal pain  Sign of hypovolemic shock  PE:abdominal tenderness ;fetal body under abdominal wall;absence of fetal heart  PV:vaginal bleeding;acent of fetal presentation  incomplete uterine rupture  mild symptoms and signs  Haematoma in broad ligment

5. Diagnosis & differential diagnosis  Diagnosis  History  Symptom  Physical signs  B echo  Differential diagnosis  Severe placenta abruption  Intrauterine infection

6. treatment  Impending uterine rupture  to inhibit uterine contraction:general anesthesia,dolatin,et al.  cesarean section  Uterine rupture  reverse the shock  perform operation  Preventive antibiotic using

7. Postpartum hemorrhage  Definition excessive bleeding (>500ml )following 24h after fetal delivery

8. Etiology  Uterine atony  General factor:  excessive nervous of parturient;  excessive sedative drug;  chronic disease;  weakness,et al.

9. Uterine atony Etiology  Obstetrical factor:  prolonged labor,  previa placenta,placenta abruption,  severe anemia;  intrauterine infection,et al.

10. Uterine atony Etiology  Uterine factor:  maldevelopment of myometrium fiber,  malformation of uterine,  overextendeduterien:twins,polyhydramnios

11. Placenta causation  Retention of placenta tissue  Placenta adhesion  Placenta implant  Retained placenta and membrane tissue

12. Soft tissue laceration  Rigid perineum  Precipitate or uncontrolled delivery  Inappropriate vaginal surgey  Due to episiotomy

13. Coagulation defect  Obstetrical complication disease: DIC in amniotic fluid embolism,severe placenta abruption,PIH,fetal death.  Parturient combined with hematological disease

14. Clinical presentation  Vaginal bleeding  With atony uterine  With placenta retention  With coagulation defect  With large haematoma  Sigh of hypovolemic shock  Dizziness,paleness,mild pulse,hypotension

15. Diagnosis  Uterine inertia  Placenta examination  Soft tissue laceration  cervix laceration  Vaginal laceration  Perinium laceration  Coagulation defection  History  Symptom  Laboratory investigation

16. Treatment  Uterine atony  Explore the reason of bleeding  Uterine massage  Oxytocin infusion  intrauterine bandage padding  Pelvic vessel ligation  hysterectomy

17. Treatment  Retained placenta tissue  manual exploration of the uterine  curretage  Soft tissue laceration  repair the laceration  Clear the haematoma  Coagulation defect  blood replacement