POST PARTUM HAEMORRHAGY - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

POST PARTUM HAEMORRHAGY

Description:

pph – PowerPoint PPT presentation

Number of Views:0
Date added: 17 March 2020
Slides: 26
Provided by: AMISSI
Tags: okay

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: POST PARTUM HAEMORRHAGY


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

Dr AMISSI Longane MD.
2
Purpose of presentation
  • At the end of this presentation, participants
    must be able to
  • 1. Define the PPH
  • 2. know the causes of PPH and management.

3
Definition of PPH
  • Blood loss gt 500 ml at vaginal delivery
  • gt 1000 ml at Cesarean
  • ACOG( American College of Obstetricians  Gynecolo
    gists ) 10 drop in hematocrit
  • Need for blood transfusion
  • Severe PPH gt 1000 ml loss at vaginal delivery
  • Any amount of blood loss causes
  • S/O Hypovolemic Hemorrhagic Shock
  • - Tachycardia - Hypotension - Reduced urine
    out put

4
Why it is important?
  • PPH remained one of the top
  • 3 obstetric causes of direct maternal deaths.

5
Why it is important?
6
Why it is important?
  • Incidence 4 after vaginal delivery
  • 6,5 after CS delivery

7
We have 4 problems
  • Problem 1 almost 50 of deliveries lose gt500 ml
    of blood.
  • Problem 2 estimated blood loss is often less
    than half the actual blood loss.
  • Problem 3 Most of the serious causes of PPH
    have origins prior to the end of the 3rd Stage of
    labor.
  • Problem 4 PPH, as defined, is technically
    misdiagnosed and clinically irrelevant.

8
Measuring Blood Loss in PPH THE BRASS-V
DRAPE
9
Advantages of Brass-V
  • Simple and practical
  • Low cost ( Plastic)
  • Accurate
  • Objective
  • Can be used in a wide
  • range of settings
  • Provides a hygienic delivery surface

10
CAUSES OF PPH
  • 1. TONE
  • 2. TRAUMA
  • 3. TISSUE RETENSION
  • THROMBIN
  • FOUR T (4T)
  • BUT MOST IMPORTANT IS

11
1.ToneUterine Atony90of causes
  • - Uterine over distension
  • Polyhydramnios, Multiple gestations, Macrosomia
  • Prolonged labor uterine fatigue
  • Precipitory labor
  • High parity
  • Chorioamnionitis
  • Retained product of conception
  • Halogenated anesthetic

12
2.TRAUMA Obstetric OR OPERATIVE 7 of
causes
  • Obstetric Trauma
  • - Uterine Rupture
  • - Lacerations of the Birth Canal
  • - Operative Trauma
  • Cesarean sections
  • Episiotomies
  • Forceps, Vacuums, Rotations

13
3.Tissue retention Abnormal placentation
  • - Placenta Praevia
  • - Abruption Placenta
  • - Accreta, increta, percreta placenta
  • - Vasa previa

14
4.Thrombin Coagulation Defects
  • - Sepsis
  • - Amniotic Fluid Embolism
  • - Abruption Placenta associated with
  • coagulopathy
  • - Dilutional Coagulopathy
  • - Inherited Clotting Disorders
  • - Anticoagulant Therapy
  • - HELLP Syndrome

15
4.Thrombin Coagulation Defects
  • HELLP Syndrome(Hemolysis, Elevated Liver
    Enzymes, Low Platelet Count)

16
Management of PPH
  • Postpartum hemorrhage prevention measures

17
Thrombin Coagulation Defects 2-3 of causes
  • - Sepsis
  • - Amniotic Fluid Embolism
  • - Abruptio Placentae associated
  • coagulopathy
  • - HELLP Syndrome
  • - Dilutional Coagulopathy
  • - Inherited Clotting Disorders
  • - Anticoagulant Therapy

18
  • Goals of Therapy (CALL FOR HELP)
  • Maintain the following
  • Systolic pressure gt90mm Hg
  • Urine output gt0.5 mL/kg/hr
  • Normal mental status
  • Eliminate the source of hemorrhage
  • Avoid overload volume replacement that can
    contribute to pulmonary edema

19
Management Protocol
  • Examine the uterus to rule out atony
  • Examine the vagina and cervix to rule out
    lacerations repair if present
  • Explore the uterus and perform curettage to rule
    out retained placenta

20
On recognition of Hemorrhage
  • Initiate volume replacement with lactated ringers
    or normal saline.
  • Alert blood bank and surgical team.
  • Control the blood loss.
  • Initiate decisive therapy.
  • Monitor for complications.

21
MANAGEMENT of Uterine atony
  • Explore uterus for retained placental tissue.
  • Uterine massage
  • 3.Firm bimanual compression

22
management of uterine atony Cont
  • 4- uterotonic agents
  • Oxytocin infusion, 40 units in 1 liter of D5 RL
  • Methergine 0.2 mg IM
  • 15-methyl prostglandin F2a, 0.25 to 0.50 mg
    intramuscularly may be repeated
  • , PGE1 200 mug, or PGE2 20 mg are second line
    drugs in appropriate patients

23
Management of uterine atony Cont
  • Use of BAKRY Ballon (UBT uterine ballon
    tamponade)

24
Management of other causes
  • 2. TRAUMA
  • 3. TISSUE RETENSION
  • 4. THROMBIN

25
SHUKRAN THANKS
About PowerShow.com