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    Post Partum Hemorrhage

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    Md. Lutfor Rahman Khan
    Postpartum hemorrhage is defined as blood loss greater than 500 ml after vaginal delivery or 1000 ml after cesarean section. It can be immediate within 24 hours after birth or delayed up to 6 weeks later. Causes include uterine atony, retained placental fragments, genital tract lacerations, and disorders of coagulation. Management involves massaging the uterus, administering oxytocin and other drugs, IV fluids, monitoring vitals, and blood transfusion if needed. Prevention includes active management of the third stage of labor with oxytocin, controlled cord traction, uterine massage, and examining the placenta for completeness.

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    Post Partum Hemorrhage

    Uploaded by

    Md. Lutfor Rahman Khan
    250 views12 pages
    Postpartum hemorrhage is defined as blood loss greater than 500 ml after vaginal delivery or 1000 ml after cesarean section. It can be immediate within 24 hours after birth or delayed up to 6 weeks later. Causes include uterine atony, retained placental fragments, genital tract lacerations, and disorders of coagulation. Management involves massaging the uterus, administering oxytocin and other drugs, IV fluids, monitoring vitals, and blood transfusion if needed. Prevention includes active management of the third stage of labor with oxytocin, controlled cord traction, uterine massage, and examining the placenta for completeness.

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    Post Partum hemorrhage

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    Postpartum hemorrhage is defined as blood loss greater than 500 ml after vaginal delivery or 1000 ml after cesarean section. It can be immediate within 24 hours after birth or delayed up to 6 weeks later. Causes include uterine atony, retained placental fragments, genital tract lacerations, and disorders of coagulation. Management involves massaging the uterus, administering oxytocin and other drugs, IV fluids, monitoring vitals, and blood transfusion if needed. Prevention includes active management of the third stage of labor with oxytocin, controlled cord traction, uterine massage, and examining the placenta for completeness.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    250 views12 pages

    Post Partum Hemorrhage

    Uploaded by

    Md. Lutfor Rahman Khan
    Postpartum hemorrhage is defined as blood loss greater than 500 ml after vaginal delivery or 1000 ml after cesarean section. It can be immediate within 24 hours after birth or delayed up to 6 weeks later. Causes include uterine atony, retained placental fragments, genital tract lacerations, and disorders of coagulation. Management involves massaging the uterus, administering oxytocin and other drugs, IV fluids, monitoring vitals, and blood transfusion if needed. Prevention includes active management of the third stage of labor with oxytocin, controlled cord traction, uterine massage, and examining the placenta for completeness.

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    Post Partum hemorrhage

    DR. NAZNEEN RASHID


    Definitions
    Blood loss : if, > 500 ml at vaginal delivery
    : if, > 1000 ml at Cesarean Section
    ACOG :10% reduce in hematocrit>Need for blood transfusion
    Severe PPH : > 1000ml loss at vaginal delivery

    • Immediate or Primary PPH: increased vaginal bleeding within first


    24 hours after childbirth
    • Delayed or Secondary PPH: following the first 24 hours after
    childbirth upt0 6 weeks
    Etiology
    1.Early PPH: 2.Late PPH:
    • Endometritis
    • Uterine atony • Retained placental fragments
    • Retained placental fragments • Disorders of coagulation
    • Retained placenta
    • Genital tract laceration
    • Placental adherence
    • Uterine inversion
    Specific management of PPH
    Specific management of PPH
    General management of PPH:
    • Shout for help and assess ABC and start resuscitation
    • Massage fundus to expel blood clot
    • Give 10 unit of oxytocin I/M
    • I/V access with wide bore cannula rapidly infuse N/S or Hartman`s
    solution with 20 unit oxytocin in 1 liter infuse in 15 min and next
    1litre within 30 minutes and then regulate the rate of infusion
    according to response. (pulse settle down <100/min and systolic BP
    >100mmHg)
    • Catheterization, initiate and encourage breast feeding
    Continue….

    • Assess pulse/BP/monitor blood loss/urine output until stable


    • Inj. Ergometrine 02mg IM and Tab. Misoprostol 800-1000 micro gm
    PR
    • Send blood for Hb%, blood grouping and Rh typing and arrange blood
    transfusion
    • Reassure the mother and keep the family informed
    Prevention of PPH by Active Management of Third Stage
    of Labor (AMTSL)
    • After delivery of baby palpate the uterus to make sure no other baby is present

    • If no other baby is present, administer Inj. Oxytocin 10 unit IM within one minute of
    delivery

    • Clamp the cord by artery forceps near woman’s perineum

    • Wait for uterine contraction (2-3 minutes)

    • When there is uterine contraction, apply counter traction to the uterus and firm, steady
    traction to the cord cautiously
    Continue….
    • If the placenta doesn’t descend during 30-40 seconds of CCT, STOP
    CONTROLLED CORD TRACTION. Hold the cord & wait until the uterus is
    well contracted again. When there is another contraction, repeat the procedure

    • Immediately message the uterus after delivery of placenta. And teach the
    mother how to message the uterus

    • Check for completeness of placenta and membranes

    • Monitor the woman at least every 15 minutes during the first 2 hours after
    delivery of placenta for vital signs, uterine contraction and excessive bleeding
    Examination of Placenta
    Examination of placenta
    • Examine the fetal and maternal sides of the placenta and membranes to ensure
    they are complete. A small amount of placental tissue or membranes remaining
    in the woman can prevent uterine contractions and cause PPH.
    • To examine the placenta for completeness;
    • Hold the placenta in the palms of the hands with the maternal side facing
    upward and make sure that all lobules are present and fit together.
    • Hold the cord with one hand, allowing the placenta and membranes to hang
    down. Place the other hand inside the membranes, spreading your fingers to
    ensure that membranes are complete and dispose of the placenta as appropriate.
    Fig 12: Examining Maternal Side
    THANK YOU

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