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Postpartum Hemorrhage

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Postpartum Hemorrhage Dr HONG Shunjia 2nd Affiliated hospital, Sun Yat-sen University E-Mail:hongshunjia_at_yahoo.com Postpartum Hemorrhage Definition Incidence Etiology ... – PowerPoint PPT presentation

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Title: Postpartum Hemorrhage


1
Postpartum Hemorrhage
  • Dr HONG Shunjia
  • 2nd Affiliated hospital,
  • Sun Yat-sen University
  • E-Mailhongshunjia_at_yahoo.com

2
Postpartum Hemorrhage
  • Definition
  • Incidence
  • Etiology
  • Diagnosis
  • Prevention
  • Management
  • Chapter 28, Current obstetric Gynecologic
    Diagnosis Treatment 9th ed

3
Definition What is it?
  • gt500ml
  • During the 1st 24 hours after delivery of baby
  • Btw 24 hours and 6 weeks(Late postpartum
    hemorrhage, abnormal puerperium)

4
Incidence How important is it?
  • 2-3 of all delivery
  • The leading (1st) cause of maternal mortality
    (maternal death)
  • Underestimated

5
Etiology Why does it happen?
  • Uterine atony
  • the myometrium cannot contract
  • Retained placental tissue
  • Obstetric laceration
  • Coagulation defects

6
Etiology uterine atony
Nervousness, Drugs Sedatives, anesthetics,
tocolytics Weakness Chronic disease
General conditions
Prolong delivery, Complications Placenta previa,
Placental Abruption,
Pre-eclampsia, Anemia, infection,
Obstetric factors
Multiple pregnancy, polyhydroaminos,
Macrosomia Scared uterus, multi-parity Malformatio
n or fibroid
Uterine factors
7
Etiology Retained placental tissue
  • Retained placenta
  • Placenta accreta or placenta increta
  • Retained placental parts

8
Etiology Obstetric laceration
  • Risk factors Operative delivery, macrosomia,
    precipitate delivery
  • Either revealed or concealed

9
Etiology Coagulation defects
  • Primary secondary
  • Obs Complications placental abruption, fetal
    death, AFE, pre-eclampsia
  • General thrombocytopenia, aplastic anemia

10
Diagnosis
  • Clinical manifestations Bleeding Shock
  • Estimation of blood loss
  • Differentiating the etiology

11
Prevention
  • Antenatal care
  • Adequate management of labor
  • Postpartum monitoring

12
Management etiology-specific
  • Identify the source of bleeding
  • Replacement of blood loss
  • Prevention of infection

13
Management uterine atony
  • Massage of uterus
  • Oxytocics
  • Bimanual compression uterine packing
  • Surgery ligation of uterine A. or I. I A
  • Radiographic embolization
  • hysterectomy

14
Management Retained placental tissue
  • Manual removal of the placenta
  • Curettage
  • Hysterectomy

15
Management Obstetric laceration
  • Manual removal of the placenta if needed
  • Systematic inspection of the whole birth canal
  • Hemostatic repair of laceration

16
Management coagulation defects
  • Other etiology excluded first
  • Transfusion of fresh blood
  • Replacement of Platelet, fibrinogen, coagulation
    factor, etc
  • Treatment of DIC

17
Management anti-shock
  • Replacement of volumne
  • Red cell replacement
  • Blood components
  • Prevention of infection
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