Postpartum Hemorrhage

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Postpartum Hemorrhage

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

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Postpartum Hemorrhage

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

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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)

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Incidence How important is it?

• 2-3 of all delivery
• The leading (1st) cause of maternal mortality
  (maternal death)
• Underestimated

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Etiology Why does it happen?

• Uterine atony
• the myometrium cannot contract
• Retained placental tissue
• Obstetric laceration
• Coagulation defects

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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
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Etiology Retained placental tissue

• Retained placenta
• Placenta accreta or placenta increta
• Retained placental parts

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Etiology Obstetric laceration

• Risk factors Operative delivery, macrosomia,
  precipitate delivery
• Either revealed or concealed

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Etiology Coagulation defects

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

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Diagnosis

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

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Prevention

• Antenatal care
• Adequate management of labor
• Postpartum monitoring

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Management etiology-specific

• Identify the source of bleeding
• Replacement of blood loss
• Prevention of infection

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Management uterine atony

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

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Management Retained placental tissue

• Manual removal of the placenta
• Curettage
• Hysterectomy

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Management Obstetric laceration

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

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Management coagulation defects

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

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Management anti-shock

• Replacement of volumne
• Red cell replacement
• Blood components
• Prevention of infection