post patum hemorrage presentation that elaborte the clinical features of PPH

post patum hemorrage presentation that elaborte the clinical features of PPH

1. Post Partum Heamorrhage Dr Nabil Riskalla FRCOG Senior Consultant Obs / Gyne

2. Definition: Primary: >500ml 1 st 24 hrs Vag delivery >1000ml C.S N.B HB% Secondary: excessive bleeding 1 st 6 weeks mostly retained part or infection

3. Incidence: 2-8% of hospital deliveries Main cause of maternity Death

4. Risk Factors Grand Multipara Multiple pregnancies Polyhydramnios Prolonged labour Deep anesthesia A.P.H previa abruption H/O PPH or Fibroid Multiple cesarian section / retained placenta Instrumental delivery Big baby. Obstructed delivery

5. Main causes Uterine atony 90% Retained placenta Part/Whole Trauma ( soft tissue laceration) Defective coagulation

6. Management Prevention Assessment of risk Sytometern with anterior shoulder vaginal delivery (beware of 2 nd twin PGF 2alpha. I M or intrauterine & C.S ( beware of bronchospasm) Do not manipulate uterine fundus

7. Diagnosis Estimation of blood loss (visual) Vital signs Pulse, BP Look for sweating palor , drowsiness Feel uterine fundus Ask midwife to check placenta Assess perineum 5 ml of blood in test tube If bleeding is not heavy- think unexplained shock Rupture Uterus, Uterine inversion, Amniotic Fluid Embolism

8. 3. Treatment A. immediate Positioning, O2, Morphine Correct hypovolemia: large IV cannula fluid: saline, haemacele or plasma Send blood of HB, coagulation, grouping &crossmatch 5 units, U&E Rub for contraction and massage If placenta retained controlled cord traction Drugs: Iv Oxytocin, Ergometrin , PGF2 alpha

9. Operative Transfer to theatre. Position, good Light, Anaesthesia 1. If placenta retained> 30minutes Manual removal if whole Retained cotyledon- Polyp forceps Placenta Accreta Conservative : primigravida , cut cord short, antibiotics, mesotrexate .. Radical: Multigrada , consent & S.T.A.H 2. If atonic uterus Bimanual compression Hot uterine douche/ no packing If bleeding persists: Laparotomy bilateral internal iliac artery ligation if fails: S.T.A.H

10. 3. Traumatic (laceration) Valva , vagina or cx need suturing Rupture uterus - Laparotomy or laparoscopy for suturing the rent or S.T.A.H

11. Complication 1. DIC Diagnosis Decreased platelet and HB Increase APTT and INR Decreased fibrinogen Increased fibrinogen deg product Treatment Fresh blood transfusion Fresh frozen plasma Cryo- precipitat Renal Failure diagnosis and treatment