Nahida Chakhtoura MD Epidemiology Postpartum hemorrhage PPH leading cause of maternal mortality worldwide Prevalence rate 6 Africa has highest prevalence rate 105 In ID: 358284
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Slide1
Post-Partum Hemorrhage
Nahida Chakhtoura, M.D.Slide2
Epidemiology
Postpartum hemorrhage (PPH): leading
cause of maternal mortality worldwide
Prevalence rate: 6%
Africa
has
highest
prevalence
rate: 10.5%
In
Africa and
Asia PPH
accounts for more than 30% of all maternal deaths
Maternal death rates
attributable to PPH vary considerably between developed and developing countries, suggesting that deaths from PPH are
preventableSlide3
Etiology
Uterine
Atony
Placenta: retained placenta, placental tissue or membrane, incomplete separation
Full bladder
Antepartum hemorrhage: placenta
previa or placental abruptionOverstretched uterus: high parity, multiple pregnancy, polyhydramnios, macrosomia, fibroidsSlide4
Etiology
Uterine
Atony
Prolonged active phase
Medical factors: anemia, coagulopathy
Others: severe pre-
eclampsia and eclampsia, precipitate labor, induction/ augmentation, IUFD, h/o PPH, c/s, gen. anesthesia, chorioamnionitis or endometritis Slide5
Etiology
Genital Trauma
Perineum
Vaginal walls
Cervix
U
terusRisk FactorsMistimed episiotomyInduced laborPrecipitate laborC/SForceps DeliveryProlonged labor
Previous uterine surgery
Anemia
Delay in
TxSlide6Slide7
Management
PrioritiesCall for Help!
Rapid assessment of patient’s condition
Identify source of bleeding
Stop the bleeding
Stabilize/resuscitate
Prevent further bleedingSlide8
Management
Atonic PPH
Massage the uterus to promote contraction and expel clots
Oxytocin 10 IU IM
Assess EBL
T
ype and cross, CBC, coagulation profile
Start IVF: if shock
1L NS or LR in 15min
up to 3L
Foley catheter
Check placenta and membranes. If placenta cannot be delivered, manually extract
Examine cervix, vagina, and perineumSlide9
Management
If bleeding persists…Oxytocin 20 units in 1L of IVF @ 60 drops per min
Add other IV access
Continue uterine massage
Assess clotting status and transfuse if necessary
Consider transferring to higher level
Uterine or utero-ovarian ligation; hypogastric artery ligationUterine balloonB-lynch sutureHysterectomyDocument properlySlide10
Management
Traumatic PPH
Lithotomy
position
Identify site of bleeding and repairSlide11
Continuing Management
Close monitoring over next 24-48hrsUterine tone
VS; Ins and Outs
Blood loss
Serial CBCSlide12
Management
Developing CountriesActive management of laborUterine massage
Draining the bladder
10 U oxytocin IM
Misoprostol
Uterine packing
HysterectomySlide13
Thank You!
Fausto Astudillo-Davalos, M.D.
Mabel
Marotta
Danielle Kramer
Nahida Chakhtoura, M.D.