Post partum hemorrhage

Postpartum hemorrhage ( PPH)

definition- Any amount of blood loss which adversely affect the general condition of mother.

According WHO

1. Vaginal delivery blood loss excess of  500 ml from genital track. (Q) 
2. Caesarean delivery blood loss of >1000ml (Q)
3. Caesarean delivery with hysterectomy blood loss of 1500ml or more (Q)
4. A drop in hemotocrit of 10% (Q)

 

PPH  TYPE 

1. Early PPH / primary PPH – during first 24 hr. postpartum
2. Late PPH / secondary PPH – after 24 hr and upto 6wk postpartum

Causes -4T 

1. tone – atonic uterus (m/c causes 90%) (Q- AIIMS  M/C causes primary PPH  )

• Grand multipara
• Anaemia
• Prolonged labour
• oxytocic use
• Anaesthesia
• Fibeoid
• Overdistension
• Precipitted labour

2. Tissue – retained placenta  (Q- AIIMS  M/C causes secondary  PPH  )

Ex –1. placenta accretta (adherent) 2. placenta Succenturiata 

3. Trauma

• Apisiotomy
• Cervical laccration
• Uterine rupture

4. Thrombin – coagulopathy & bleeding disorder

• DIC, hypo fibrin
• Abruptio
• IUD
• Severe preeclepsia with HELLP syndrome
• Sepsis ( infction)

Other causes- local trauma, carcinoma of cervix, uterine polyps etc.

 

Management

• Manually compress and massage the uterus – controls most cases of hemorrhage due to atony
• Start large bore iv & infuse isotonic crystalloids
• Crossmatching & arranging for blood
• If uterus is boggy, suspect atony Give additional dilute oxytocin (Q)
• NOTE - Oxytocin should never given as undilluted bolus because serious hypotension can result (Q)
• Methergine – contraindication- HTN (Q)
• PG F2a – contraindication- asthma (Q)
• Misoprostol (Q) contraindication –scarred uterus
• decrease uterine pulse pressure (Q)

Technique for fundal massage

• One hand remains cupped against the uterus at the level of the symphysis pubis to support the uterus.
• The other hand is cupped to massage and gently compress the fundus toward the lower uterine segment.

fundal massage

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Nursing Officer

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