11-POST PERTUM HEMORRAGE.pptx77777777777777777777

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1. POSTPARTUM HEMORRHAGE

2. GROUP MEMBERS NAMES ID NUMBERS ELIZABETH MARILYN BANGURA 22006 JENEBA BARRIE 22010 MEMUNATU TURAY 22082 LECTURER NAME : DOCTOR DAVID BREWEN CONTEH

3. CONTENTS Definition of PPH Etiology of PPH Risk factors for PPH Signs and symptoms of PPH Diagnosis and tests Managements and treatments Complications preventions

4. POSTPARTUM HEMORRHAGE (PPH) DEFINITION PPH :- Is a severe vaginal bleeding after childbirth. Or When a blood loss measures 500ml or more following delivery. Severe PPH is defined as blood loss of > 1000ml. It is a serious condition but rare. It is an abnormality of the third stage of labour. Types of postpartum hemorrhage primary PPH- excessive vaginal bleeding within 24 hours of childbirth Secondary PPH- excessive vaginal bleeding 24 hours until 6 weeks after childbirth

5. Etiology of postpartum hemorrhage The causes of PPH are classified into 4 groups( 4Ts is used.) Main causes of PPH(4Ts) Specific causes Tone Atonic uterus Trauma (Genital) Cervical, vaginal and perineal laceration, vulval/ pelvic hematoma, uterine inversion and ruptured uterus Tissue Retained tissue, retained placenta Thrombin Coagulopathies( blood clotting disorder)

6. Etiology of postpartum hemorrhage The most common cause of PPH is Uterine atony The other causes of PPH includes Uterine rupture Retained placenta Uterine inversion Hematoma Intra amniotic infection Bleeding disorder Lacerations of the genital tract

7. RISK FACTORS FOR PPH Previous history of PPH Multiple pregnancies Prolonged labour or rapid labour Caesarian section Maternal obesity Large babies Placenta abnormality

8. Signs and symptoms PPH Excessive bleeding( blood loss over 500mlfor vaginal delivery or 1000ml for caesarian section) Abnormal uterine contractions Rapid heart rate low blood pressure Dizziness or fainting Blurred vision Pale skin Cold sweats or clammy skin

9. Diagnosis and tests Healthcare provider diagnose postpartum hemorrhage through visual and physical examinations, lab tests and through a view of your health history. They may detect PPH based on the amount of blood you loss. Monitoring vital signs: continual monitoring of pulse rate and blood pressure. Blood tests to measure red blood cells and clotting factors. Ultrasound to get a detailed image of your uterus and other organs.

10. Managements and treatments Healthcare worker should take emergencies steps listed below to arrest bleeding and to achieve fluid resuscitation. Call for help and massage/rub the uterus to expel clots and induce contraction Fluid resuscitation and sometimes blood transfusion Removal of retained placental tissue from the uterus Repairing vaginal, cervical and uterine tears or laceration Inserts a indwelling urinary catheter or balloon tamponade and assess amount of urine output Uterotonics ( eg oxytocin, prostaglandins, methylergonovine)

11. Complications of PPH Excessive blood loss can cause several complications Death hypovolemic shock Anemia Sheehan's syndrome Cerebral anoxia Renal failure Orthostatic hypotension F atigue

12. Preventions of PPH The best way for healthcare provider to prevent postpartum hemorrhage is to identify those at high risk for postpartum hemorrhage before delivery PPH and its complication can be prevented by: Ensuring skilled attendance at delivery Iron supplements in pregnancy and antenatal screening and treatment of anemia Prevention of prolong labour by using the partogram Performing active management of the third stage of labour like: ensure there is no underdiagnose twin after delivery Do not massage the uterus with the placenta still inside Examine the placenta for completeness and for any abnormality

13. Identifying women who are at risk for atonic uterus Intra amniotic infection( chorioamnionitis) Rapid labour Prolonged labour multiple pregnancy Uterine overdistention Giving additional oxytocin after active management of the third stage of labour

14. R eferences MSD MANUAL professional version www. Verywealthhealth . Com My. Cleavelandclinic.org