Postpartum-Hemorrhage.pptx

Postpartum Hemorrhage (PPH) is a significant and potentially life-threatening medical condition that occurs after childbirth. It is characterised by excessive loss of blood, typically defined as blood loss exceeding 500 millilitres for a vaginal delivery or 1000 millilitres for a cesarean section. PPH is a critical concern due to its capacity to lead to severe maternal morbidity and even mortality.

1. Postpartum Hemorrhage Discover the definition, types, causes, symptoms, and treatment options for postpartum hemorrhage, a serious condition that affects new mothers. Memoona Arshad 10 Sem - Group 11 - ISM-IUK Presented to: Uzakbaeva Manisa

2. Definition of Postpartum Hemorrhage Postpartum Hemorrhage (PPH) is a significant and potentially life-threatening medical condition that occurs after childbirth. It is characterised by excessive loss of blood, typically defined as blood loss exceeding 500 millilitres for a vaginal delivery or 1000 millilitres for a cesarean section. PPH is a critical concern due to its capacity to lead to severe maternal morbidity and even mortality.

3. Types of Postpartum Hemorrhage Primary Postpartum H emorrhage (PPH) This type occurs within the first 24 hours after childbirth. The most common cause of primary PPH is uterine atony, which is when the uterus fails to contract properly after delivery. Other causes may include trauma, retained placental tissue, and blood clotting disorders. Secondary Postpartum Hemorrhage This type occurs between 24 hours and 6 weeks after childbirth. It is often related to issues such as retained placental tissue, infection, or underlying uterine abnormalities that were not initially apparent after delivery.

4. Causes and Pathogenesis of Postpartum Hemorrhage (4 T's) Background Failure of the Uterus to contract sufficiently during & after delivery of a boy. Myometrium doesn't respond to Oxytocin. Most common cause of Postpartum Hemorrhage (Obstetric Emergency) Uterine Atony (Tonicity) One of the most common causes is when the uterus fails to contract effectively after delivery. The uterine muscles should naturally contract to close off blood vessels, but if they don't, it can lead to uncontrolled bleeding. Trauma Physical injuries during childbirth can result in excessive bleeding. This may include tears in the cervix or vaginal wall, often associated with difficult deliveries or the use of forceps.

5. Causes and Pathogenesis of Postpartum Hemorrhage (Contd..) Retained Placental (Tissue) Sometimes, fragments of the placenta or membranes may remain in the uterus after childbirth. This can prevent the uterus from contracting properly, leading to persistent bleeding. Blood Clotting Disorders (Thromtin) Certain medical conditions, like hemophilia or von Willebrand disease, affect the blood's ability to clot. In such cases, the postpartum bleeding may be prolonged and require specialized treatment.

6. Signs and Symptoms of Postpartum Hemorrhage Excessive Vaginal Bleeding Heavy or profuse bleeding from the vagina, often soaking through one or more pads in an hour Rapid Heart Rate An abnormally fast heart rate (tachycardia) as the body attempts to compensate for blood loss. Low Blood Pressure A drop in blood pressure, leading to symptoms such as dizziness, lightheartedness, or fainting. Large Blood Clots Passing large blood clots, typically larger than a golf ball. Uncontrolled Bleeding Continued and uncontrolled bleeding despite uterine massage or other interventions. Pale or Cold Skin The skin may become pale, cool to the touch, or clammy as a result of decreased blood circulation.

7. Signs and Symptoms of Postpartum Haemorrhage (Contd..) Weakness or Fatigue Excessive bleeding can lead to a feeling of weakness or extreme tiredness. Confusion or Altered Mental State In severe cases, a woman may become confused or disoriented due to decreased oxygen and blood supply to the brain. Swelling and Pain in the Perineal Area Pain and swelling in the perineum or vaginal area can be indicative of trauma-related bleeding. Decreased Urine Output A notable reduction in urine production may occur as the body tries to conserve fluid in response to blood loss.

8. Diagnosis of Postpartum Hemorrhage 1 Clinical Assessment The healthcare provider evaluates the mother's overall clinical condition, including her medical history, and assesses any visible signs of excessive bleeding. 2 Vital Signs Monitoring Vital signs like blood pressure and heart rate are closely monitored for changes, which can indicate hemorrhage. 3 Uterine Examination The provider checks the firmness of the uterus to identify conditions like uterine atony. 4 Blood Loss Estimation An estimation of blood loss is made by measuring soaked pads or using other appropriate methods. 5 Blood Tests Hemoglobin and hematocrit levels are tested to assess the extent of blood loss. 6 Ultrasound and Further Tests In specific cases, ultrasound and other diagnostic tests may be employed to identify the cause and extent of bleeding, such as retained placental tissue or trauma.

9. Treatment of Postpartum Hemmorhage Maneuvers uterine massage +/- bimanual compression Medications Oxytocin (10-40 U in 1000 ml as continuous infusion) -TXA - (1g over 10 minutes) Cytotec (600-1000 mg rectally, oral, or sublingual) Carboprost (IM.25 mg, contraindicated in asthma) -Methylergonovine (IM.2 mg, contraindicated in CAD, HTN, preeclampsia) Surgical/Invasive including Bakri Balloon, vascular ligation, TAH