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Postpartum Haemorrhage PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Postpartum Haemorrhage”.

This medical PowerPoint presentation is about postpartum hemorrhage (PPH), which is defined as excessive bleeding, typically greater than 500 ml, occurring within 24 hours after childbirth. PPH is one of the leading causes of maternal mortality worldwide, and it can occur due to a number of different factors, including uterine atony, retained placenta, trauma, and coagulation disorders.

Uterine atony is the most common cause of PPH and refers to the failure of the uterus to contract properly after delivery. Other causes of PPH may include tears or lacerations in the birth canal or cervix, retained placental tissue, coagulation disorders, and uterine inversion.

Immediate management of PPH involves uterine massage to stimulate contractions, administering medications such as oxytocin, and evaluating for the presence of retained placental tissue. If these initial measures fail, other interventions such as balloon tamponade, uterine artery embolization, or surgical procedures may be necessary.

Prevention of PPH includes appropriate management of labor and delivery, including active management of the third stage of labor (delivery of the placenta), appropriate use of oxytocin, and early recognition and treatment of risk factors such as uterine atony or coagulation disorders.

It is important to seek immediate medical attention if excessive bleeding occurs after childbirth, as PPH can be life-threatening if not promptly diagnosed and managed.

Tags : Postpartum Haemorrhage, maternal mortality, tears or lacerations in the birth canal or cervix, Obstetrics and Gynecology, Obstetrics and Gynecology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 3074 | Downloads : 3

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Slide 1-

Postpartum Haemorrhage King Khalid University Hospital Department of Obstetrics & Gynecology Course 482
Slide 2-

Definition Any blood loss than has potential to produce or produces hemodynamic instability About 5% of all deliveries Incidence
Slide 3-

Definition >500ml after completion of the third stage, 5% women loose >1000ml at vag delivery >1000ml after C/S >1400ml for elective Cesarean-hyst >3000-3500ml for emergent Cesarean-hyst
Slide 4-

woman with normal pregnancy-induced hypervolemia increases blood-volume by 30-60% = 1-2L therfore, tolerates similar amount of blood loss at delivery hemorrhage after 24hrs = late PPH
Slide 5-

Hemostasis at placental site At term, 600ml/min of blood flows through intervillous space Most important factor for control of bleeding from placenta site = contraction and retraction of myometrium to compress the vessels severed with placental separation Incomplete separation will prevent appropriate contraction
Slide 6-

Etiology of Postpartum Haemorrhage
Slide 7-

Predisposing factors- Intrapartum Operative delivery Prolonged or rapid labour Induction or agumentation Choriomnionitis Shoulder dystocia Internal podalic version coagulopathy
Slide 8-

Predisposing Factors- Antepartum Previous PPH or manual removal Abruption/previa Fetal demise Gestational hypertension Over distended uterus Bleeding disorder
Slide 9-

Postpartum causes Lacerations or episiotomy Retained placental/ placental abnormalities Uterine rupture / inversion Coagulopathy
Slide 10-

Prevention Be prepared Active management of third stage Prophylactic oxytocin 10 U IM 5 U IV bolus 10-20 U/L N/S IV @ 100-150 ml/hr Early cord clamping and cutting Gentle cord traction with surapubic countertraction
Slide 11-

Remember! Blood loss is often underestimated Ongoing trickling can lead to significant blood loss Blood loss is generally well tolerated to a point
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Management- talk to and assess patient Get HELP! Large bore IV access Crystalloid-lots! CBC/cross-match and type Foley catheter
Slide 13-

Diagnosis ? Assess in the fundus Inspect the lower genital tract Explore the uterus Retained placental fragments Uterine rupture Uterine inversion Assess coagulation
Slide 14-

Management- Assess the fundus Simultaneous with ABC’s Atony is the leading case of PPH Bimanual massage Rules out uterine inversion May feel lower tract injury Evacuate clot from vagina and/ or cervix May consider manual exploration at this time
Slide 15-

Management- Bimanual Massage
Slide 16-

Management- Manual Exploration Manual exploration will: Rule out the uterine inversion Palpate cervical injury Remove retained placenta or clot from uterus Rule out uterine rupture or dehiscence
Slide 17-

Replacement of Inverted Uterus
Slide 18-

Management- Oxytocin 5 units IV bolus 20 units per L N/S IV wide open 10 units intramyometrial given transabdominally
Slide 19-

Replacement of Inverted Uterus
Slide 20-

Replacement of Inverted Uterus
Slide 21-

Management- Additional Uterotonics Ergometrine (caution in hypertension) .25 mg IM 0r .125 mg IV Maximum dose 1.25 mg Hemabate (asthma is a relative contraindication) 15 methyl-prostaglandin F2 alfa O.25mg IM or intramyometrial Maximum dose 2 mg (Q 15 min- total 8 doses) Cytotec (misoprostol) PG E1 800-1000 mcg pr
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Slide 23-

Management- Bleeding with Firm Uterus Explore the lower genital tract Requirements Appropriate analgesia Good exposure and lighting Appropriate surgical repair May temporize with packing
Slide 24-

Management – ABC’s ENSURE THAT YOU ARE ALWAYS AHEAD WITH YOUR RESUSCITATION!!!! Consider need for Foley catheter, CVP, arterial line, etc. Consider need for more expert help
Slide 25-

Management- Evolution Panic Panic Hysterectomy Pitocin Prostaglandins Happiness
Slide 26-

MANAGEMENT OF PPH
Slide 27-

Management- Continued Uterine Bleeding Consider coagulopathy Correct coagulopathy FFP, cryoprecipitate, platelets If coagulation is normal Consider embolization Prepare for O.R.
Slide 28-

Surgical Approaches Uterine vessel ligation Internal iliac vessel ligation Hysterectomy
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Slide 31-

Conclusions Be prepared Practice prevention Assess the loss Assess the maternal status Resuscitate vigorously and appropriately Diagnose the cause Treat the cause
Slide 32-

Summary: Remember 4 Ts Tone Tissue Trauma Thrombin
Slide 33-

Summary: remember 4 Ts “TONE” Rule out Uterine Atony Palpate fundus. Massage uterus. Oxytocin Methergine Hemabate
Slide 34-

Summary: remember 4 Ts “Tissue” R/O retained placenta Inspect placenta for missing cotyledons. Explore uterus. Treat abnormal implantation.
Slide 35-

Summary: remember 4 Ts “TRAUMA” R/O cervical or vaginal lacerations. Obtain good exposure. Inspect cervix and vagina. Worry about slow bleeders. Treat hematomas.
Slide 36-

Summary: remember 4 Ts “THROMBIN” Check labs if suspicious.
Slide 37-

CONSUMPTIVE COAGULOPATHY (DIC) A complication of an identifiable, underlying pathological process against which treatment must be directed to the cause
Slide 38-

Pregnancy Hypercoagulability  coagulation factors I (fibrinogen), VII, IX, X  plasminogen;  plasmin activity  fibrinopeptide A, b-thromboglobulin, platelet factor 4, fibrinogen
Slide 39-

Pathological Activation of Coagulation mechanisms Extrinsic pathway activation by thromboplastin from tissue destruction Intrinsic pathway activation by collagen and other tissue components Direct activation of factor X by proteases Induction of procoagulant activity in lymphocytes, neutrophils or platelets by stimulation with bacterial toxins
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Slide 41-

Significance of Consumptive Coagulopathy Bleeding Circulatory obstructionorgan hypoperfusion and ischemic tissue damage Renal failure, ARDS Microangiopathic hemolysis
Slide 42-

Causes Abruptio placentae (most common cause in obstetrics) Sever Hemorrhage (Postpartum hge) Fetal Death and Delayed Delivery >2wks Amniotic Fluid Embolus Septicemia
Slide 43-

Treatment Identify and treat source of coagulopathy Correct coagulopathy FFP, cryoprecipitate, platelets
Slide 44-

Fetal Death and Delayed Delivery Spontaneous labour usually in 2 weeks post fetal death Maternal coagulation problems < 1 month post fetal death If retained longer, 25% develop coagulopathy Consumptive coagulopathy mediated by thromboplastin from dead fetus tx: correct coagulation defects and delivery
Slide 45-

Amniotic Fluid Embolus Complex condition characterized by abrupt onset of hypotension, hypoxia and consumptive coagulopathy 1 in 8000 to 1 in 30 000 pregnancies “anaphylactoid syndrome of pregnancy”
Slide 46-

Amniotic Fluid Embolus Pathophysiology: brief pulmonary and systemic hypertensiontransient, profound oxygen desaturation (neurological injury in survivors)  secondary phase: lung injury and coagulopathy Diagnosis is clinical
Slide 47-

Amniotic Fluid Embolus Management: supportive
Slide 48-

Amniotic Fluid Embolus Prognosis: 60% maternal mortality; profound neurological impairment is the rule in survivors fetal: outcome poor; related to arrest-to-delivery time interval; 70% neonatal survival; with half of survivors having neurological impairment
Slide 49-

Septicemia Due to septic abortion, antepartum pyelonephritis, puerperal infection Endotoxin activates extrinsic clotting mechanism through TNF (tumor necrosis factor) Treat cause
Slide 50-

Abortion Coagulation defects from: Sepsis (Clostridium perfringens highest at Parkland) during instrumental termination of pregnancy Thromboplastin released from placenta, fetus, decidua or all three (prolonged retention of dead fetus)
Slide 51-

Thank You ! ! !