PPH Management E-MOTIVE Approach Dr Arikod..pdf

PPH Response Bundle.
Lets Kick Out PPH.
Mother should not die while bringing a new life

1. PPH
E-MOTIVE
ArikodDanielDr.
Sr. Namyalo Cecillia

2. Definitions
•PPH:-Bleeding of
–
–
–
≥ 500 mls after vaginal delivery
≥ 1000 mls after caesarean section
≥ 1500mls after caesarean hysterectomy
OR
•Any amount that causes deterioration
condition
ofthematernal
–
–
–
–
1
0
systolic BP,<90mmHg,
pulse rate>100bpm,
urine output<30mls/hr
altered level ofconsciousness
PPH-with 24hrs of birth vs•
•
2
0PPH->24hrs to 6weeks
Principlesofmanagemtarethesamethesame

3. 45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
4%
5%6%8% 2%1%2%2%2%2%2%2%2%2%3%
18/19 [N= 447 ]19/20 [N=779]20/21[N=811]21/22 [N=1096]
99
5
4
5
4
3
≥ 4%
1
7%6%8%7%
3
1 2 2%
3
1
0
9%
12%
6% 6%
9%
8%6%5% 5%

4. Predisposing factors (4TS)
•Note: Every pregnant woman is
at risk of PPH without
necessarily having an
identifiable risk factor,
•Uterine atony
✓Retained placental fragments
and
membranes
✓Prolonged labour
✓Over-distended uterus (e.g.,
polyhydramnios or multiple
pregnancy, big baby)
•Coagulation disorders
✓Intrauterine foetal death
✓Preeclampsia and
eclampsia
✓ Uterine infections
(chorioamnionitis)
✓Use of anticoagulants
✓ Amniotic fluid embolism

5. •Trauma
✓Trauma to the genital tract
(vaginal,
cervical or uterine)
✓Ruptured uterus
✓Precipitate labor
✓Caesarean section
✓Assisted vaginal delivery
•Tissue
✓ retained placenta
✓ placenta accreta
✓ retained membranes
✓ blood clots

7. TheE-MOTIVEBundle
improvesdetectionandinitial managementofPPH
aimsto standardizeandspeed up care
allessentialinterventionsareadministeredpromptly

8. Bundle Consists of;
•E- Early detection
•M- Uterine Massage
•O- Oxytocic drugs
•T- Trenaxamic acid
•IV- Fluids
•E- Examination and Escalation

9. E-MOTIVE
Early Detection
Objective:
•Accuratemeasurementofblood
loss
usesanunder-buttockscalibrated
drape
•
Importance:
•Visualestimationisoften
inaccurate
thusunderestimationanddelayed
response
•

10. E-MOTIVE

11. E-MOTIVE
Uncontracteduterus
Uterine Massage
Objective:
vStimulateuterinecontractions
reducebleeding
Technique:
to
Technique of massaging
vFirmlymassagetheuterusthrough
theabdominalwalluntilitisfirm
andcontracted
vevery15minuntil2hours
Contracteduterus

12. E-MOTIVE
Oxytocic Drugs
Objective:
•Induce uterine contractions
pharmacologically
Drugs Used:
Oxytocin is the first-line drug,followedby
alternatives such as misoprostol if
necessary
10iu-im then 20iu in 1ltr N/S
misoprostol-800μg subligual

13. E-MOTIVE
Tranexamic Acid
Objective:
•Reducebleedingby
bloodclots
Administration:
•Givenintravenously
•administeredassoon
diagnosed
•1g:10mls:10minutes
stabilizing
asPPHis

14. E-MOTIVE
Intravenous Fluids
Objective:
•Maintainbloodvolumeandpreventshock.
Administration:
•RapidinfusionofIVfluidstostabilize
•Give3mLoffluidfor1mLofbloodloss.
•5%Dextroseandcolloidsaretobeavoided
transfuse
•if loss > 40%of the patient's blood volume(2-
3L)

15. E-MOTIVE
Examination and Escalation
Objective:
•Identify &manage any remaining
bleeding.
Procedure:
•Thoroughexaminationofthegenitaltractfor
trauma,retainedtissue,orotherissues,with
escalationtosurgicalinterventionsif
needed.
causesof

16. exploreforthecause
manageordopre-referralmanagement

17. Atony
uncontracted
uterus
uterine massenge
well
contracted
uterus
bimanuel compression
uterine tamponade
Non-pneumatic anti-shock
garment

18. tears
ContinueIVfluids
Havegoodlightingforinspection
packthevagina
examinethevulva,ifnoperinealtearsthen
Usesterilespeculumtovisualizethevaginalwalland
examine
ifnotears,removethevaginalpackandexaminethe
cervix
whattodoifidentifedtears
•
•
•
•
•
•
•
1.perinealtears
•
•
1stand2nddegree:repearfromlaborsuit
3rdand4thdegree:applytworingforcepsandrepearintheatre.
2.Cervicaltear:applyringforceps,andrepairintheatre.
ifyoudontreachtheapexofcervicaltear;diagnoseuterine
rupture:dolaporatomy-makeintra-opdecisions.3.

19. •Retained placenta (1 hour
after childbirth)
Attempt controlled cord traction (CCT)
If CCTfails, perform a gentle vaginal examination
and if the placenta is felt protruding through the
cervix, grasp with the fingers and steadily withdraw
fromtheuteruswhiletheotherhandsupportsit
throughtheabdominalwall.
Iftheplacentacannotbedelivered,manualremoval
oftheplacentaisperformed under general
anaesthesia if available.
Give oxytocin after removal
Broad spectrum antibiotics
Continue monitoring vital signs and PV bleeding
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21. THANKYOU