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Postpartum Hemorrhage(PPH)

Postpartum Hemorrhage(PPH). 产后出血 林建华. Major causes of death for pregnancy women （ maternal mortality). Postpartum hemorrhage （ 28%) heart diseases pregnancy-induced hypertension (or Amniotic fluid embolism ) infection. Definition of PPH.

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Postpartum Hemorrhage(PPH)

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  1. Postpartum Hemorrhage(PPH) 产后出血 林建华

  2. Major causes of death for pregnancy women（maternal mortality) • Postpartum hemorrhage（28%) • heart diseases • pregnancy-induced hypertension • (or Amniotic fluid embolism ) • infection

  3. Definition of PPH • be defined as a blood loss exceeding 500ml after delivery of the infant • PPH: occurs in 24 hour of delivery • the late PPH: occurs after 24 hour of delivery to 6 weeks

  4. Major causes • Uterine atony (90%) • lacerations of the genital tract(6%) • retained placenta(3%-4%) • coagulation defects (blood dyscrasia) • (4T: tone, tissue,trauma,thrombin)

  5. 1. Uterine atony Local factors • overdistention of the uterine (hydramnios, multiple pregnancy, macrosomia ) • condition that interfere with contraction(leiomyomas) • complications(PIH,anaemia, placenta praevia

  6. Systemic factors: • nervous • drugs(magnesium sulfate,sedative) • abnormal labor(prolonged,precipitous) • History of previous PPH • Preeclampsia, abnormal placentation,

  7. pathology • Contraction constricting the spiral arteries • preventing the excessive bleeding from the placenta implantation site • the uterine atony give rise to PPH when no contraction occur

  8. Prevention and therapeutic of uterine atony • Administration of medicine: • promotes contraction of the uterine corpus • decreases the likelihood of uterine atony • Oxytocin agents • Methegine • prostaglandin

  9. Mechanical stimulation of uterine contraction: • Massageof uterus through the abdomen and bimanual compression • intrauterine packing

  10. Surgical methods • If massage and agents are unsuccessful: • Ligation of the uterine arteries • ligation of the hypogastric arteries • selective arterial embolization • hysterectomy taking into account the degree of hemorrhage,the overall status of patient,her future childbearing desires

  11. 2. Lacerations of the genital tract Causes: • Instrumented delivery (forceps) • manipulative delivery(breech extraction,precipitous labor, macrosomia) Types: • perineum laceration • vaginal laceration • cervical laceration

  12. perineum and vaginal laceration • The first degree tear: involves only skin and a minor part of the perineal body • the second degree tear: involves the perineal body and vagina • the third degree tear: involves the anal sphincter and anal canal

  13. management • Vaginal examination soon after delivery repair: • cervical laceration >2cm in length and be actively bleeding • laceration of vaginal and perineum

  14. 3. Retained placenta • Separation and explosion of placenta is caused by strong uterine contraction • Placenta tissue remaining in the uterus prevent adequate contraction and predispose to excessive bleeding

  15. causes: • adherence of placenta (previous cesarean delivery,prior uterine curettage) • succenturiate placenta • placenta accreta (into the decidua) • placenta increta(into the myometrium) • placenta pericreta(through the myometrium to the peritoneal)

  16. Prevention and treatment • The placenta should be examined to see that it is complete or not • part of placenta is missing, removed digitally • not separated, manual removal of placenta is done • hysterectomy is required for placenta increta(percreta,accreta) • uterine contraction drugs

  17. 4. Coagulation defects Acquired abnormality in blood clotting: • abruptio placenta, • amniotic fluid embolism • severe preclampsia congenital abnormality in blood clotting: • thrombocytopenia • severe hepatic diseases • leukemia

  18. disseminated intravascular coagulopathy(DIC) • if bleeding persists in spite of all other treatment described, DIC should be suspected • the blood passing from the genital tract is not clotting • shock: reduction of effective circulation inadequate perfusion of all tissues oxygen depletion depression of functions

  19. Record: • pulse • blood pressure • maternal heart rate • central venous pressure • urine output

  20. Lab tests: • Hb, • BT(bleeding time), CT( clotting time), • platelets count • fibrinogen • prothrombin time and patial thromboplastin time • FDP • women’s group and cross-matching

  21. Treatment: • the key is correcting the coagulation defect • resuscitation must be started as soon as possible • infusion of crystalloid(saline) and Dextran is started firstly while arranging the blood transfusion • blood transfusion is essential • infusion of platelets, fresh frozen plasma, FDP , clotting factors,

  22. Potential complications of PPH: • Postpartum infection • Anemia • Transfusion hepatitis, • Sheehan’s syndrome • Asherman’s syndrome • The best management of PPH is prevention

  23. Key words • the definitio n of HHP • The causes of HHP • treatment methods of Uterine atony • the types of retained placenta • the degrees of the perineal and vaginal laceration

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