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    3rd Stage of Complications Labour

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    Sindhu Babu
    This document discusses complications in the third stage of labor, specifically postpartum hemorrhage. It defines primary and secondary postpartum hemorrhage and describes their causes such as atonic uterus. It also discusses prevention through active management of the third stage of labor and treatment including fluid replacement, medications to contract the uterus, and surgical procedures if bleeding cannot be controlled.

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    3rd Stage of Complications Labour

    Uploaded by

    Sindhu Babu
    110 views19 pages
    This document discusses complications in the third stage of labor, specifically postpartum hemorrhage. It defines primary and secondary postpartum hemorrhage and describes their causes such as atonic uterus. It also discusses prevention through active management of the third stage of labor and treatment including fluid replacement, medications to contract the uterus, and surgical procedures if bleeding cannot be controlled.

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    obstetrics

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    This document discusses complications in the third stage of labor, specifically postpartum hemorrhage. It defines primary and secondary postpartum hemorrhage and describes their causes such as atonic uterus. It also discusses prevention through active management of the third stage of labor and treatment including fluid replacement, medications to contract the uterus, and surgical procedures if bleeding cannot be controlled.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    110 views19 pages

    3rd Stage of Complications Labour

    Uploaded by

    Sindhu Babu
    This document discusses complications in the third stage of labor, specifically postpartum hemorrhage. It defines primary and secondary postpartum hemorrhage and describes their causes such as atonic uterus. It also discusses prevention through active management of the third stage of labor and treatment including fluid replacement, medications to contract the uterus, and surgical procedures if bleeding cannot be controlled.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    Complications in 3rd stage of

    labour
    Learning outcomes

    Postpartum hemorrhage
    -Primary postpartum hemorrhage
    Secondary postpartum hemorrhage
    Postpartum hemorrhage
    Definition: Hemorrhage occurring after delivery
    Quantitive terms : blood loss more than or equal to 500
    ml in vaginal deliveries.
    - 1000ml in cesarean section.
    Primary postpartum hemorrhage
    - Blood loss 500ml or more within 24 hours.
    Atonic postpartum hemorrhage
    -Prevents proper contraction and retration of uterus.
    Traumatic postpartum hemorrhage
    -Trauma in labour
    Secondary postpartum hemorrhage
    -Sudden loss of blood from genital tract after first 24
    hours postpartum and within 6 weeks of delivery.
    Classification of primary postpartum
    hemorrhage
    Type Volume of blood loss(ml)
    Minor 500-1000
    Major 1000-2000
    Major-Moderate 1000-2000
    Major-Severe More than 2000
    Cause of primary postpartum
    hemorrhage
    Atonic postpartum hemorrhage
    Cause:
    Maternal Pregnancy Labour Effect of drugs
    complications
    Multiparity Antepartum Prolong labour Anesthetic drugs
    hemorrhage
    Previous history PPH Overdistension of Induction of labour Magnesium sulfate
    uterus as in multiple
    pregnancy ,
    hydramnios or
    macrosomia
    Fibroids complicating Precipitate labour Nifedipine
    pregnancy
    Maternal anemia
    Prevention
    Active management of the third stage of
    labour(AMSTL)
    1) Administration of Inj.Oxytocin 10 units IM
    after delivery of baby.
    2) Cord clamping after cessation of cord
    pulsations , followed by removal of placenta
    by traction and countertraction during uterine
    contraction
    3) Uterine massage
    Uterine massage
    Clinical features
    Increase pulse rate and pallor
    Drop in blood pressure
    Restlessness
    Fainting attacks
    Sweating
    Air hunger
    Management
    Prophylaxis
    -Good antenatal and internatal care.
    - In antenatal general nutrition should
    improved and persisting anemia should treat.
    - Determined their blood group.
    - Curative treatment
    - Correct hypovolemia
    - Correct atonicity
    Replacement of loss of blood

    Call for HELP


    2 large bore intravenous cannula , preferably 16 gauge inserted
    Blood should be drawn for crossmatching , estimation of hemoglobin ,
    packed cell volume, coagulation tests , baseline urea and electrolytes.
    Fluid replacement commend immediately. 0.9 % saline infused at 500ml
    in 15 minutes to restore systolic pressure.
    Bladder should be catherised and record the input-output .
    Check pulse, BP, respiration and other vital signs.
    Palpate uterus and ensure atonic PPH.
    Atonicity confirmed-starts 20 units of inj.oxytocin in 500ml of NS or RL and
    run it at rate of 20-40 drops per minutes.
    Blood transfusion started as soon as possible ideally within 30 minutes
    Oxygen should be given by facemask at rate 8-10 minutes.
    Control of bleeding

    Atonic uterus noticed often after placenta expelled.


    1) Recheck placenta to confirm all the placental lobes
    and membrane are expelled.
    2)No response to oxytocin drip, inj. Methylergometrine
    0.25mg can be given intravenously. Avoid this drug in
    maternal hypertension or heart disease. Can be
    repeated 4 doses.
    3) If bleeding continues , inj prostaglandins can be
    given in the dose of 250ugm IM and can be repeated 8
    doses.
    4)Rectal misoprostol tablets in dose of 800ugm used.
    Management options for unresponsive
    hemorrhage
    Conservative
    Tamponade techniques-gauze , balloons, condom , gloves
    Conservative surgical techniques
    Vessel ligation-uterine,ovarian,internal iliac
    Uterine vertical full thickness sutures
    - compression suture(B-lynch)
    - modified B-lynch
    Uterine horizontal full-thickness suture
    - Square suture
    - Figure of eight
    - Combination of sutures
    Uterine artery embolisation
    Hysterectomy
    Tamponade techniques

    1)Sengstaken-Blakemore tube
    2)A large foleys catheter
    3) Rusch urologic hydrostatic balloon
    SOS Bakri tamponade balloon
    Condom
    Traumatic postpartum hemorrhage
    Cause:
    - Trauma in labour
    - Perineal lacerations
    - Episiotomy wounds
    - Cervical lacerations
    - Colporrhexis
    Secondary postpartum hemorrhage
    Cause:
    - Retention of portions of placenta and membranes .
    Rare: submucous fibromyoma and choriosacroma
    Presentation :
    - general conditions of patient- depends upon amount of blood loss.
    Bleeding persistent , foul smelling lochia , subinvolution of uterus &
    fever
    Diagnosis :
    Ultrasound
    Management :
    High vaginal swab take for culture
    Broad spectrum antibiotic should start
    Uterus evacuated under anesthesia
    Bleeding severe- uterine cavity ligation or hysterectomy .

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