Post-Partum Hemorrhage
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Transcript of Post-Partum Hemorrhage
POST-PARTUM HEMORRHAGE
Nahida Chakhtoura, M.D.
EPIDEMIOLOGY Postpartum hemorrhage (PPH): leading
cause of maternal mortality worldwide Prevalence rate: 6% Africa has highest prevalence rate:
10.5% In Africa and Asia PPH accounts for more
than 30% of all maternal deaths Maternal death rates attributable to PPH
vary considerably between developed and developing countries, suggesting that deaths from PPH are preventable
ETIOLOGY Uterine Atony
Placenta: retained placenta, placental tissue or membrane, incomplete separation
Full bladderAntepartum hemorrhage: placenta
previa or placental abruptionOverstretched uterus: high parity,
multiple pregnancy, polyhydramnios, macrosomia, fibroids
ETIOLOGY Uterine Atony
Prolonged active phaseMedical factors: anemia, coagulopathyOthers: severe pre-eclampsia and eclampsia,
precipitate labor, induction/ augmentation, IUFD, h/o PPH, c/s, gen. anesthesia, chorioamnionitis or endometritis
ETIOLOGY Genital Trauma
PerineumVaginal wallsCervixUterus
Risk FactorsMistimed episiotomy Induced laborPrecipitate laborC/SForceps DeliveryProlonged laborPrevious uterine surgeryAnemiaDelay in Tx
MANAGEMENT Priorities
Call for Help!Rapid assessment of patient’s condition Identify source of bleedingStop the bleedingStabilize/resuscitatePrevent further bleeding
MANAGEMENT Atonic PPH
Massage the uterus to promote contraction and expel clots
Oxytocin 10 IU IM Assess EBL Type and cross, CBC, coagulation profile Start IVF: if shock 1L NS or LR in
15min up to 3L Foley catheter Check placenta and membranes. If
placenta cannot be delivered, manually extract
Examine cervix, vagina, and perineum
MANAGEMENT If bleeding persists…
Oxytocin 20 units in 1L of IVF @ 60 drops per minAdd other IV accessContinue uterine massage Assess clotting status and transfuse if necessaryConsider transferring to higher level Uterine or utero-ovarian ligation; hypogastric
artery ligationUterine balloonB-lynch sutureHysterectomyDocument properly
MANAGEMENT Traumatic PPH
Lithotomy position Identify site of bleeding
and repair
CONTINUING MANAGEMENT Close monitoring over next 24-48hrs
Uterine toneVS; Ins and OutsBlood lossSerial CBC
MANAGEMENT Developing Countries
Active management of laborUterine massageDraining the bladder10 U oxytocin IMMisoprostolUterine packingHysterectomy
THANK YOU!
Fausto Astudillo-Davalos, M.D. Mabel Marotta Danielle Kramer
Nahida Chakhtoura, M.D.