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    PPH

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    Dhananjaya Shivalingappa
    1. The document discusses complications of the third stage of labour such as postpartum haemorrhage, retention of placenta, shock, and pulmonary embolism. 2. Postpartum haemorrhage is defined as blood loss exceeding 500 ml following birth and can be caused by an atonic or traumatic uterus. 3. Management of postpartum haemorrhage involves emptying the uterus, replacing blood loss, and ensuring hemostasis through techniques such as uterine massage, ergometrine administration, and in severe cases manual removal of the placenta or hysterectomy.

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    PPH

    Uploaded by

    Dhananjaya Shivalingappa
    94 views21 pages
    1. The document discusses complications of the third stage of labour such as postpartum haemorrhage, retention of placenta, shock, and pulmonary embolism. 2. Postpartum haemorrhage is defined as blood loss exceeding 500 ml following birth and can be caused by an atonic or traumatic uterus. 3. Management of postpartum haemorrhage involves emptying the uterus, replacing blood loss, and ensuring hemostasis through techniques such as uterine massage, ergometrine administration, and in severe cases manual removal of the placenta or hysterectomy.

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    1. The document discusses complications of the third stage of labour such as postpartum haemorrhage, retention of placenta, shock, and pulmonary embolism. 2. Postpartum haemorrhage is defined as blood loss exceeding 500 ml following birth and can be caused by an atonic or traumatic uterus. 3. Management of postpartum haemorrhage involves emptying the uterus, replacing blood loss, and ensuring hemostasis through techniques such as uterine massage, ergometrine administration, and in severe cases manual removal of the placenta or hysterectomy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    94 views21 pages

    PPH

    Uploaded by

    Dhananjaya Shivalingappa
    1. The document discusses complications of the third stage of labour such as postpartum haemorrhage, retention of placenta, shock, and pulmonary embolism. 2. Postpartum haemorrhage is defined as blood loss exceeding 500 ml following birth and can be caused by an atonic or traumatic uterus. 3. Management of postpartum haemorrhage involves emptying the uterus, replacing blood loss, and ensuring hemostasis through techniques such as uterine massage, ergometrine administration, and in severe cases manual removal of the placenta or hysterectomy.

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    COMPLICATIONS OF THIRD STAGE OF LABOUR

    1. 2. 3.

    4.
    5.

    Post partum haemorrhage Retention of placenta Shock Pulmanary embolism Uterine inversion

    POSTPARTUM HAEMORRHAGE
    QUANTATIVE: ANY AMOUNT OF BLOOD LOSS IN EXCESS >500 ML FOLLOWING BIRTH OF BABY CLINICAL: ANY AMOUNT OF BLEEDING FROM OR INTO THE GENITAL TRACT FOLLOWING BIRTH OF THE BABY UPTO THE END OF PUERPERIUM WHICH ADVERSELY AFFECTS THE G C EVIDENCED BY ^ PULSE RATE& FALLING B.P.

    TYPES
    PRIMARY: with in 24 hrs, in majority with in 2 hrs Third stage haemorrhage bleeding before expulsion of placenta True pph- after expulsion of placenta SECONDARY: after 24 hrs & with in puerperium (delayed/ late PPH)

    PRIMARY PPH
    CAUSES

    ATONIC TRAUMATIC MIXED BLOOD COAGULOPATHY

    ATONIC UTERUS (80%)


    Grand multipara Over-distended uterus Malnutrition & anemia Antepartum hemorrhage Prolonged labour Anaesthesia Oxytocin use

    ATONIC UTERUS
    Persistent uterine distension Malformation of uterus Uterine fibroid Mismanaged third stage of labour Constriction ring Precipitate labour

    TRAUMATIC (20%)
    Episiotomy Lscs Trauma to cx,vagina,perineum,paraurethral region Rupture of uterus Vulvo-vaginal/ broad ligament hematoma Mixed Coagulation disorders

    1.
    2. 3. 4. 5.

    Mixed Coagulation disordersAbruptio Jaundice TTP HELLP syndrome IUD

    DIAGNOSIS& CLINICAL EFFECTS


    BLEEDING VISIBLE OUTSIDE,rarely concealed Effects depends on: A) predelivery hb% B)degree of hypervolemia C)speed of blood loss Tachycardia , hypotension Uterus 1) flabby- atonic pph 2)contracted- traumatic pph

    PREVENTION
    Antenatal Improvement in health status High risk patients Blood grouping and Rh typing Intranatal -Judicious use of sedatives & analgesics -hasty delivery of head avoided -Local anaesthesia

    PREVENTION

    Expert anaesthesist AMTSL Kneading& fiddling of uterus Examination of placenta Oxytocin infusion to be continued Exploration of UV canal Observation for 2 hrs

    Intelligent anticipation, skilled supervision, prompt detection, effective institution of therapy

    MGM OF THIRD STAGE BLEEDING

    PRINCIPLES 1. Empty the uterus 2.Replace blood 3.Ensure effective hemostasis Steps: placental site bleeding traumatic bleeding

    PLACENTAL SITE BLEEDING


    To palpate fundus & massage Ergometrine Sedation I v line Catheterisation Signs of placental seperation +/ + deliver - MRP

    MANUAL REMOVAL OF PLACENTA


    STEP- I GA, painting,draping,cathetirisation STEP-II hand introduced into uterus STEP-III counter pressure with other hand STEP-IV seperation STEP- V extraction STEP- VI ergometrine STEP- VII examination

    Difficulties : Hour glass contraction Morbid adherent placenta


    COMPLICATIONS Hemorrhage Shock Injury to uterus Infection Inversion Subinvolution embolism

    MGM OF TRUE PPH


    PRINCIPLES: Diagnose cause Control bleeding Correct hypovolemia

    Management Call for help 2 16g iv cannula Blood grouping cross matching Infuse 2 ltr NS colloids Monitoring pulse,BP,i/o,drugs CVP

    ATONIC UTERUS

    STEP-I massage, methergin, oxytocin,catheterisation,examine placenta STEP-II explore uterus under GA

    STEP-III

    BIMANUAL COMPRESSION

    STEP-IV hot intrauterine douche STEP-V tight intra uterine packing

    HYSTERECTOMY LIGATION OF UTERINE ,OVARIAN,INT ILIAC ARTERIES EMBOLISATION TRAUMATIC- REPAIR

    SECONDARY PPH
    CAUSES: 1.retained bits 2. Separation of slough 3.Subinvolution 4.Lscs > 14 days a) Separation of slough granulation tissue 5.Estrogen therapy 6.Chorion epithelioma, cacx,placental polyp,infected polyp,inversion

    b)from

    MANAGEMENT
    Diagnosis: bright red bleeding Examination- sepsis,subinvolution MGM: principles: 1. assess blood loss& replace 2.Cause detect & rectify Supportive ;BT,methergin ,antibiotics Active treatment: exploration of uterus under GA , digital, curretage,methergin,HPE Bleeding due to seperation of slough- by sutures LSCS suturing,int iliac art ligation ,hysterectomy

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