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Postpartum Hemorrhage(PPH)

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Postpartum Hemorrhage(PPH) Major causes of death for pregnancy women maternal mortality) Postpartum hemorrhage 28%) heart diseases ... – PowerPoint PPT presentation

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Title: Postpartum Hemorrhage(PPH)


1
Postpartum Hemorrhage(PPH)
  • ????
  • ???

2
Major causes of death for pregnancy
women(maternal mortality)
  • Postpartum hemorrhage(28)
  • heart diseases
  • pregnancy-induced hypertension
  • (or Amniotic fluid embolism )
  • infection

3
Definition of PPH
  • be defined as a blood loss exceeding 500ml after
    delivery of the infant
  • PPH occurs in 24 hour of delivery
  • the late PPH occurs after 24 hour of delivery
    to 6 weeks

4
Major causes
  • Uterine atony (90)
  • lacerations of the genital tract(6)
  • retained placenta(3-4)
  • coagulation defects (blood dyscrasia)
  • (4T tone, tissue,trauma,thrombin)

5
1. Uterine atony
  • Local factors
  • overdistention of the uterine (hydramnios,
    multiple pregnancy, macrosomia )
  • condition that interfere with contraction(leiomyom
    as)
  • complications(PIH,anaemia, placenta praevia

6
  • Systemic factors
  • nervous
  • drugs(magnesium sulfate,sedative)
  • abnormal labor(prolonged,precipitous)
  • History of previous PPH
  • Preeclampsia, abnormal placentation,

7
pathology
  • Contraction constricting the spiral arteries
  • preventing the excessive bleeding from the
    placenta implantation site
  • the uterine atony give rise to PPH when no
    contraction occur

8
Prevention and therapeutic of uterine atony
  • Administration of medicine
  • promotes contraction of the uterine corpus
  • decreases the likelihood of uterine atony
  • Oxytocin agents
  • Methegine
  • prostaglandin

9
  • Mechanical stimulation of uterine contraction
  • Massage of uterus through the abdomen and
    bimanual compression
  • intrauterine packing

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Surgical methods
  • If massage and agents are unsuccessful
  • Ligation of the uterine arteries
  • ligation of the hypogastric arteries
  • selective arterial embolization
  • hysterectomy
  • taking into account the degree of
    hemorrhage,the overall status of patient,her
    future childbearing desires

14
2. Lacerations of the genital tract
  • Causes
  • Instrumented delivery (forceps)
  • manipulative delivery(breech extraction,precipitou
    s labor, macrosomia)
  • Types
  • perineum laceration
  • vaginal laceration
  • cervical laceration

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perineum and vaginal laceration
  • The first degree tear
  • involves only skin and a minor part of the
    perineal body
  • the second degree tear
  • involves the perineal body and vagina
  • the third degree tear
  • involves the anal sphincter and anal canal

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management
  • Vaginal examination soon after delivery
  • repair
  • cervical laceration gt2cm in length and be
    actively bleeding
  • laceration of vaginal and perineum

21
3. Retained placenta
  • Separation and explosion of placenta is caused by
    strong uterine contraction
  • Placenta tissue remaining in the uterus
  • prevent adequate contraction and predispose to
    excessive bleeding

22
  • causes
  • adherence of placenta (previous cesarean
    delivery,prior uterine curettage)
  • succenturiate placenta
  • placenta accreta (into the decidua)
  • placenta increta(into the myometrium)
  • placenta pericreta(through the myometrium to the
    peritoneal)

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Prevention and treatment
  • The placenta should be examined to see that it is
    complete or not
  • part of placenta is missing, removed digitally
  • not separated, manual removal of placenta is done
  • hysterectomy is required for placenta
    increta(percreta,accreta)
  • uterine contraction drugs

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4. Coagulation defects
  • Acquired abnormality in blood clotting
  • abruptio placenta,
  • amniotic fluid embolism
  • severe preclampsia
  • congenital abnormality in blood clotting
  • thrombocytopenia
  • severe hepatic diseases
  • leukemia

28
disseminated intravascular coagulopathy(DIC)
  • if bleeding persists in spite of all other
    treatment described, DIC should be suspected
  • the blood passing from the genital tract is not
    clotting
  • shock reduction of effective circulation
  • inadequate perfusion of all
    tissues
  • oxygen depletion
  • depression of functions

29
  • Record
  • pulse
  • blood pressure
  • maternal heart rate
  • central venous pressure
  • urine output

30
  • Lab tests
  • Hb,
  • BT(bleeding time), CT( clotting time),
  • platelets count
  • fibrinogen
  • prothrombin time and patial thromboplastin time
  • FDP
  • womens group and cross-matching

31
  • Treatment
  • the key is correcting the coagulation defect
  • resuscitation must be started as soon as
    possible
  • infusion of crystalloid(saline) and Dextran is
    started firstly while arranging the blood
    transfusion
  • blood transfusion is essential
  • infusion of platelets, fresh frozen plasma, FDP ,
    clotting factors,

32
  • Potential complications of PPH
  • Postpartum infection
  • Anemia
  • Transfusion hepatitis,
  • Sheehans syndrome
  • Ashermans syndrome
  • The best management of PPH is prevention

33
Key words
  • the definitio n of HHP
  • The causes of HHP
  • treatment methods of Uterine atony
  • the types of retained placenta
  • the degrees of the perineal and vaginal
    laceration
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