Antepartum & Postpartum Haemorrhage.pptx

Antepartum and postpartum hemorrhage

1. ANTEPARTUM&POSTPPARTUM HEMORRHAGE

2. Definition: This is defined as vaginal bleeding after 20 weeks gestation Etiology: The causes can be classified into placental, fetal and maternal: - Placental causes: placental abruption; placenta praevia. - Fetal cause: vasa praevia. - Maternal causes: vaginal trauma; cervical ectropion; cervical carcinoma; vaginal infection and cervicitis ANTEPARTUM HEMORAGE:-

3. predisposing factor: - previous abruption -Hypertension -Poor nutrition -Others PLACENTAL ABRUPTION

4. A- Clinical presentation B- laboratory finding and imaging Diagnosis

5. hemoglobin and hematocrits Peripheral blood smear Fibrinogen and FDP US investigation

6. US

7. Emergency Conservative Vaginal delivery c/s TREATMENT

8. CASE

9. Most likely diagnosis : Placental abruption. Complications that can occur : Hemorrhage, fetal to maternal bleeding, coagu- lopathy, and preterm delivery. Best management for this condition : Delivery (at 35 weeks, the risks of abruption significantly outweigh the risks of prematurity

10. Prior cesarean delivery. Advanced maternal age. Multiparty. Prior uterine surgery. Multiple gestation. Uterine structural anomaly. Assisted conception. Smoking. Association was found with fetal abnormality, IUGR, and may coexist with placental abruption (in 10%).   Risk factors:

11. Sign and symptoms ( painless vaginal bleeding ) Us Examination in theater diagnosis

12. A- Expectant therapy B- delivery treatment

13. A 30-year-old G5P4 woman at 32 weeks’ gestation complains of significant bright red vaginal bleeding. She denies uterine contractions, leakage of fluid, or trauma. The patient states that 4 weeks previously, after she had engaged in sexual intercourse, she experienced some vaginal spotting. On examination, her blood pressure is 110/60 mm Hg, heart rate (HR) is 80 beats per minute (bpm), and temperature is 99°F (37.2°C). The heart and lung examinations are normal. The abdomen is soft and uterus nontender . Fetal heart tones are in the range of 140 to 150 bpm. » What is the most likely diagnosis? case

14. A 35-year-old G5P4 woman at 39 weeks’ gestation is undergoing a vaginal deliv - ery . She has a history of previous myomectomy and one prior low-transverse cesarean delivery. She was counseled about the risks, benefits, and alternatives of vaginal birth after cesarean, and elected a trial of labor. She proceeded through a normal labor. The delivery of the baby is uneventful. The placenta does not deliver after 30 minutes, and a manual extraction of the placenta is undertaken. The placenta seems to be firmly adherent to the uterus. » What is the most likely diagnosis? case

15. Post partum hemorrhage

16. PPH : is one of the most common obstetric emergencies; in UK hemorrhage was the third most common cause of death. It is defined as: *primary PPH : loss of ≥ 500 ml blood from genital tract within 24 hours of delivery. *secondary PPH : loss of ≥ 500 ml blood from genital tract after 24 hours till 12 week post-delivery.  

17. cause

18.   * Early recognition of blood loss & rapid action is vital in the management of PPH * Appreciation of risk factors * accurate estimation of blood loss & recognition of the maternal signs of cardiovascular compromise are vital these include tachycardia, low BP, pallor, slow capillary refill (greater than 2 second ). * The BP does not fall until massive hemorrhage has occurred (often 1200-1500 ml of blood).

19. case

20. Most likely diagnosis : Uterine atony . Next step in therapy : Dilute intravenous (IV) oxytocin, bedside uterine mas- sage and compression, and if this is ineffective, then intramuscular prostaglan- din F,-alpha ( Hemabate ) or rectal misoprostol.

21. Uterine inversion

22. Uterine inversion

23. Mismanagement of the third stage – e.g. premature or excessive cord traction during active management of the third stage, a combination of fundal pressure and cord traction to deliver the placenta or use of fundal pressure when the uterus is atonic during placental deliver. Abnormally adherent placenta. Spontaneous inversion of unknown etiology Short umbilical cord . Sudden emptying of a distended uterus.   causes

24. management

25. case

26. Most likely diagnosis: Uterine inversion. Most likely complication : Postpartum hemorrhage

27. Thanks for your listening