post partum hemorrhage. shraddha Tamshettiwar

Post partum hemorrhage (PPH) is any amount of bleeding from or into the genital tract following birth of the baby up to the end of puerperium which adversely affects the general condition of the mother evidenced by rise in pulse rate and falling blood pressure.”
. Post partum haemorrhage is bleeding from the genital tract after delivery of the baby. The amount of bleeding is around 500-600 ml or more and causing deterioration in the patients condition.
Post partum haemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. The incidence is 1% among the hospital deliveries.
Post partum hemorrhage causes loss of tone in the uterine muscles, bleeding disorder, placental falling or tearing.

1. POST PARTUM HAEMORRHAGE Ms. Shraddha Tamshettiwar Basic BSc 4 th year

2. OBJECTIVES Introduction of PPH Definition of PPH Causes of PPH Symptoms of PPH Types of PPH Management of PPH

3. INTRODUCTION Post partum haemorrhage is bleeding from the genital tract after delivery of the baby. The amount of bleeding is around 500-600 ml or more and causing deterioration in the patients condition. Post partum haemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. The incidence is 1% among the hospital deliveries. Post partum haemorrhage causes loss of tone in the uterine muscles, bleeding disorder, placental falling or tearing.

4. DEFINITION “ Post partum haemorrhage (PPH) is any amount of bleeding from or into the genital tract following birth of the baby up to the end of puerperium which adversely affects the general condition of the mother evidenced by rise in pulse rate and falling blood pressure.”

5. CAUSES OF PPH 1. Mismanaged 3 rd stage of labour. 2. Anaesthesia. 3. Oxytocin induced contraction during pregnancy. 4. Persistent uterine distension retention.

6. TYPES OF PPH post partum haemorrhage is of two types: 1. Primary post partum haemorrhage. 2. Secondary post partum haemorrhage.

7. PRIMARY POST PARTUM HAEMMORRAGE

8. INTRODUCTION Primary postpartum hemorrhage (PPH) is characterized by a total blood loss ≥1000 mL (including intrapartum loss) or the presence of signs and symptoms of hypovolemia occurring within 24 hours after childbirth, irrespective of the mode of delivery.

9. CAUSES OF PRIMARY OF PPH The causes of primary post partum haemorrhage are: Atonic uterus- It is the most commonest form of PPH, with the separation of placenta the uterine sinuses which are torn cannot be compressed effectively due to imperfect contraction and retraction of the uterus and bleeding continues.

10. - Grand multipara - Over distension of uterus - Antepartum haemorrhage - Malnutrition and anaemia - Incomplete separation of placenta - Prolonged labour - Anaesthesia - Initiation or augmentation of delivery by oxytocin - Persistent uterine distension - Malformation of the uterus - Uterine fibroid

11. Traumatic haemorrhage - Can be due to extension of episiotomy, perineal tear, paraurethral tear, vaginal laceration. Hypofibrinogenemia -Can occurs in cases of premature separation of the placenta, dead foetus and shock associated with haemorrhage.

12. ANATENATAL MANAGEMENT: Improvement of health status of the patient specially to raise the HB level as near to normal as possible. High risk patients who are likely to develop PPH are to be screened and delivered in a well equipped hospital. In vulnerable group, blood grouping and typing should be done.

13. INTRANATAL MANAGEMENT: During Intranatal period, administration of sedative and analgesic drugs is done. Hasty delivery of the baby is avoided. One should take at least 2-3 minutes to deliver the trunk after the head is born. Baby should be pushed out by retracted uterus and not to be pulled out. Local or epidural anesthesia is preferable to general anesthesia. Third stage should be managed carefully specially of high risk patients. Kneading or pulling the cord should be avoided. Examination of placenta and membrane should be done routinely to detect any missing part. The patient should be observed for about 2 hours after delivery.

14. SECONDARY POST PARTUM HAEMMORRAGE

15. INTRODUCTION DEFINITION: “Secondary or late postpartum hemorrhage occurs 24 hours to 12 weeks postpartum.” Secondary PPH is one which occurs beyond 24 hours and within puerperium, bleeding usually occurs between 8th to 14th day of delivery. 3/1/20XX SAMPLE FOOTER TEXT 15

16. CAUSES 1. Retained bits of membranes (commonest) 2. Subinvolution of the placental site. 3. Separation of slough over a deep cervico-vaginal laceration following infection. 4. Secondary hemorrhage from caesarean section wound which usually occurs between 10 to 14 days. 5.Withdrawal bleeding following estrogen therapy for suppression of lactation .

17. NURSING MANAGEMENT 1.Assess the amount of blood lost and replace it by blood transfusion. 2. Find out the cause of secondary PPH and try to rectify it. 3. If bleeding is uterine in origin, administer 0.5 mg ergometrine I/M. 4. Administer antibiotics routinely. 5. Give the patient bed rest. Bladder is emptied

18. 6. Materials removed are sent for histological examination. 7. Ferrous gluconate (300 mg TDS) or ferrous sulphate (200 mg TDS) is given orally. Folic acid (5 mg) may also be given daily. 8 . If the patient delivers in an unhygienic environment, anti tetanus serum and anti gas gangrene serum are administered .

19. Summary Today, we have discussed about the following points: Introduction of PPH Definition of PPH Causes of PPH Types of PPH Primary PPH- causes and management Secondary PPH- causes and management Nursing management of PPH 3/1/20XX SAMPLE FOOTER TEXT 20

20. Conclusion Postpartum hemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. Approximately, half a million women die annually from causes related to pregnancy and childbirth.it should be diagnosed early and properly managed by the obstetrical team. A good referral system, transfusion services and well trained personnels should therefore be put in place if deaths associated with this complication after delivery are to be avoided.

21. Thank you