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Title:

Postpartum Hemorrhage

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Title: Postpartum Hemorrhage Author: JOKE Last modified by: JOKE Created Date: 4/29/2010 12:19:37 PM Document presentation format: On-screen Show Other titles – PowerPoint PPT presentation

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Date added: 25 September 2019
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Title: Postpartum Hemorrhage


1
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2
Postpartum Hemorrhage
  • ??.???? ??????????????????
  • ??.??????
  • 30 ?????? 2553

3
Definition of PPH
  • blood loss greater than 500 mL during a vaginal
    delivery or greater than 1,000 mL with a cesarean
    delivery

4
Definition of PPH
  • ??????????????????????????????????????????????????
    ????????
  • ???????????????????????????????????????? 50

5
Definition of PPH
  • ??????????????????????????????????????
  • ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    ???????
  • ??????????????????????? ??????
  • ???????? ??????? ??????
  • ??????????????????????????? ??????
  • ????????????? ???????????????? ???????????????????

6
??????????????????????????????????????????????????
????????????
?????????????????? ?????????????????? ???????????? (?????????????) ?????????????????
?????? ????????? ???????????? (?????????????) ?????????????????
10-15 500-1000 ???? ?????? ????? ?????????
15-25 1000-1500 ??????????? 80-100 ??????? ????????? ?????????
25-35 1500-2000 70-80 ????????????? ??? ??????????????
35-45 2000-3000 50-70 ?????? ???????? ????????????
7
Postpartum hemorrhage
  • Early postpartum hemorrhage (lt24 hours post
    delivery)
  • Late postpartum hemorrhage (gt24 hours to 6 weeks
    post delivery)

8
Early postpartum hemorrhage (lt24 hours
postdelivery)
  • Uterine atony (Tone)
  • Retained placenta (Tissue)
  • Genital tract trauma (Trauma)
  • Coagulopathy (Thrombosis)

9
Late postpartum hemorrhage (gt24 hours to 6 weeks
postdelivery)
  • Infection
  • Retained placental fragments
  • Coagulopathy

10
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11
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12
(No Transcript)
13
?????????????????????????????????????
  • ?????????????
  • ???????????????????????????????????????????
  • ????????????????????????????

14
?????????????????????????????????????
  • ????????
  • ??????????????????????????????? ???? ??????????
    ???????????????????? ?????????????????????????????
    ????? ?
  • ??????????????????????????????????????????
    (???????? ???????????)
  • ??????????????????????????????????? (????
    ????????????? 18)

15
?????????????????????????????????????
  • ????????????????????
  • Active management
  • Oxytocin
  • Early cord clamping
  • Controlled cord traction

16
????????????????????
  • ??? oxytocin ???????????????? (????????????????)
  • 10 ????? IM
  • ?????????? IV 100-150 ??./??. ?????????? 10-20
    ?????/???? ??????????????????????? 1-2 ???????

17
????????????????????
  • Controlled cord traction

18
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19
????????????????????
  • ????????????????
  • ????????????????????????????????
    ????????????????????????????? 15 ???? ?? 2
    ?????????? ??????????????????????
  • ??????????????? (????????????????
    ???????????????????)

20
(No Transcript)
21
???????????????????????????????????
  • ?????????? 1 ?????????????????????????
  • ?????????? 2 ?????????????????????????
  • ?????????? 3 ??????????????????????????????????
  • ?????????? 4 ????????????????????????

22
?????????? 1 ?????????????????????????
  • ??????????????????
  • ?????????????????????????????? (??????????????????
    18) / ???????????
  • ??????????
  • ??????????????????? ????????????????
  • ????????????????
  • ???????????????? (4Ts)
  • ??????????????????? (tone)
  • ????????? (tissue)
  • ??????????????????????????????????????? (trauma)
  • ?????????????????? (thrombin)
  • ????????????????????????
  • CBC
  • ??????????????????
  • ????????? / ????????

23
?????????? 2 ?????????????????????????
  • 1.  ???????????????????????? (Tone)
  • ????????????
  • ?????????????????????? ???????? oxytocin
    ???????????? ???/???? methylergonovine
    ???????????????????????? ?????????????????????????
    ??????????????
  • Bimanual compression

24
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25
?????????? 2 ?????????????????????????
  • 2. ?????????/?????????? (Tissue)
  • ??????
  • ???????? ???????????? ????????????????????
    ??????????? curette ??????? (?????????????????????
    ?????????????????????????)

26
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27
?????????? 2 ?????????????????????????
  • 3. ?????????????????? / ?????????? (Trauma)
  • ????????????????????? ????????????????????????????
    ???? ??????????????????? broard ligament
    ?????????????????????????
  • ???????? ????????????????? ???????????????????????
    ???????? ? ??
  • ??????????????? ??????????????

28
(No Transcript)
29
?????????? 2 ?????????????????????????
  • 4. ????????????????????????? (Thrombin)
  • ????? / ???????????????????????
  • ????????????????

30
?????????? 3 ??????????????????????????????????
  • 1.???????????????
  • ???????????????????? /  ????????????
  • ???????????????????????????????
    (???????????????????????? ??????????????????????
    ????????????????????????????????????????????)

31
?????????? 3 ??????????????????????????????????
  • 2. ????????????????
  • ?????????????????? (??????????)
  • ???????????????????????????????????????
  • ???????? / ???????? / ???????????????

32
?????????? 3 ??????????????????????????????????
  • 3. ???????????????? 3.1 ??????????????????????
    (???????????????????????) (??????????????????????)
  • ????????????????????? / ??????????????????????????
    ?????? (?????)
  • B-Lynch sutures (????????)
  • Uterine temponade / embolization (????????)
  • ??????????????????? internal iliac arteries
    (???????????????????????)
  • Recombinant Factor VIIa (????????
    ??????????????? ?????????????)
  • 3.2 ???????? (total ???? subtotal)
    ???????????????? ??????? 3.1 ???????? ?????????

33
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34
(No Transcript)
35
(No Transcript)
36
?????????? 4 ????????????????????????
  • ????? Abdominal packing / umbrella packing
  • ???????? Arterial embolization / Recombinant
    Factor VIIa (??????????????????????) 

37
??????????????????????????? (?????????????? PPH)
  • Oxytocin 
  • IV 10-40 ??????????????? ???? Lactated Ringers
    1 ???? ???????????? 
  • IM 10 ?????
  • Methergin
  • IM ???? IV ??? ? 0.2 ??. ????????? 2-4 ??.
    ?????????????????????????????

38
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