| ID | 345 |
|---|---|
| Name | POST-PARTUM HEMORRHAGE |
| Cause | Causes: A. Primary- 1. Ineffective uterine contraction & retraction or atony of uterus (main cause)- a. Uterine exhaustion due to prolonged labour, b. Grand multipara c. Retained placenta, membrane & clot. d. Over distension of uterus due to multiple pregnancy, hydromnios. e. Concealed accidental hemorrhage, f. Uterine fibroid & scar tissue, g. Deep & prolonged anesthesia. 2. Mismanagement of the 3rd stage of labour. 3. Abnormally adherent placenta. 4 Hypofibrinogenemia. 5. Tears of the uterus, cervix, vagina or perineum B. Secondary- 1. Retention of a piece of placenta & complicated by infection. 2. Separation of an infected slough. 3. Infection and sloughing of a sub-mucous fibromyoma. |
| Signs Symptoms | Heavy bleeding from the vagina that doesn't slow or stop. Drop in blood pressure or signs of shock. Signs of low blood pressure and shock include blurry vision; having chills, clammy skin or a really fast heartbeat; feeling confused, dizzy, sleepy or weak; or feeling like you're going to faint |
| Diagnosis | Estimation of blood loss (this may be done by counting the number of saturated pads, or by weighing of packs and sponges used to absorb blood; 1 milliliter of blood weighs approximately one gram) Pulse rate and blood pressure measurement |
| Investigations | Continual monitoring of your pulse rate and blood pressure to detect problems. Blood tests to measure red blood cells (hematocrit) and clotting factors. Ultrasound to get a detailed image of your uterus and other organs |
| Management | Manual removal of the placenta, manual removal of clots, uterine tamponade, and uterine artery embolization. Laceration repair is indicated when PPH is a result of genital tract trauma |
| Introduction | Post partum hemorrhage is excessive bleeding from the genital tract after the birth of the child upto the end of the puerperium. Bleeding should be more than 500ml. The hemorrhage may be immediate or primary or if it occurs more than 24 hours after delivery it is described as secondary. |
| History | |
| Etiology | If the uterus does not contract strongly enough, called uterine atony, these blood vessels bleed freely and hemorrhage occurs. This is the most common cause of postpartum hemorrhage |
| Clinical Features | See Sign and Symptoms |
| Preventions | |
| Treatment | Treatment of postpartum hemorrhage: Treatment will differ according to whether the placenta is still in the uterus or has been deliverd. A. When the placenta has separated and been expelled from the upper into the lower uterine segment- 1 If signs of separation are present-it can be delivered by slight cord traction. 2. If bleeding continues-inj. Ergometrine 5 mg. is given. 3 If the uterus does not contract- bimanual compression is performed untill the uterus is felt to contract. 4. After placental delivery- if part of it is miss-ing it will have to be removed digitally under general anesthesia. B. When the placenta has not separated and it remains in the upper uterine segment- 1. Manual removal of placenta under general anesthesia is immediately performed. 2. Blood transfusion and antibiotics are given. 3. If bleeding still continues & uterus not contracted then-a. Inj. ergometrine 0.5mg i.v. b. Message of uterus, c. Bimanual compression, d. Uterine hot douch (not use due to infection), e. Uterus and vaginal pack under G/A, then bimanual compression is applied if necessary. 4. If bleeding continues inspite of all efforts hysterectomy may be considered. 5. If Uterus contracted - Postpartum hemorrhage from laceration of the birth canal should be controlled- - primarily by clumping & then by suturing. - treatment of hypofibrinogenemia if present. C. Secondary postpartum hemorrhage: It is managed by exploring the uterine cavity under general anesthesia and antibiotic cover to remove any retained placental tissue. |
| Complications | Increased heart rate, rapid breathing and decreased blood flow. These symptoms can restrict blood flow to your liver, brain, heart or kidneys and lead to shock and death if not manage properly |
| Prognosis | Increased heart rate, rapid breathing and decreased blood flow. These symptoms can restrict blood flow to your liver, brain, heart or kidneys and lead to shock and death if not manage properly |
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