Pph

Post purtum

1. Postpartum Hemorrhage Mahmoud Elsayed Meleis, Md

2. Agenda Definition Risk Factors Prevention Management

3. Definition SUBJECTIVE , any amount of blood loss affecting general condition Clinical findings in PPH (degrees of shock) NOTE: women may become compromised with small amount of blood loss as in Gestational HTN e proteinuria Anemic or dehydrated , small stature Compensation Mild Moderate Severe Blood loss 500-1000 ml 10-15% 1000-1500 15-25% 1500-2000 25-35% 2000-3000 35-45% SBP change None Slight fall (80-100 mmHg ) Marked fall (70-80 mmHg ) Profound fall (50-70 mmHg ) S&S Palpitations Dizziness Tachycardia Weakness Sweating Tachycardia Restlessness Pallor Oliguria Collapse Air hunger Anuria

4. Risk factors ( 4 T )

5. Atonic vs Traumatic PPH Atonic Traumatic Bleeding Gushes of dark clotted blood Continuous & bright red Uterus larger, boggy, deficient contractions Small, hard, well contracted Uterine compression Gushes or clots comes out No effect Exploration of genital tract Bleeding is coming through cervical canal & no lacerations detected Bleeding coming from laceration in genital tract

6. Prevention Routine , prophylactic OXYTOCIN after delivery of shoulder either : 10 units IM & 5 units IV push OR 10 – 20 units / liter IV drip at 100-150 cc/ hr 3 rd stage care: Early cord clamping Controlled cord traction with uterine palpation & inspection of placenta & lower genital tract

7. Management Stepwise approach Bedside test EMPTY BLADDER

8. First Aid management Insert 2 wide bore IV cannula Withdraw 20 mL of blood for cross matching Provide 100 % oxygen & keep airway patent IV crystalloids solution via fast drip (restore circulation) Start ecbolic drugs Monitor vital signs every 5 mins Insert foley catheter Monitor urine output Massage uterine fundus Back

9. Medications used for Rx of PPH Drug Dose/Route Frequency Comment Oxytocin ( Synntocinon ) IV 5 unit Continuous Avoid undiluted rapid IV infusion causing hypotension Methylergonovine ( Methergine ) IM: 0.2 mg Direct injection into uterus Every 2-4 hrs Avoid if ptn in hypertensive Misoprostol ( Cytotec ) 800-1000 mcg rectally Back MAINTAIN uterine compression & massage while administration of above drugs