Beruflich Dokumente
Kultur Dokumente
Postpartum
haemorrhage
Dr. Mohammed Abdalla
Egypt, Domiat General Hospital
Hemorrhage is the
underlying causative factor
in at least 25% of
maternal deaths in
industrialized and
underdeveloped countries
Maternal physiology is well prepared for
hemorrhage:
increase in blood volume .
hypercoagulable state.
posterior division
important collateral to the pelvis.
Iliolumbar
lateral sacral
superior gluteal
PHYSIOLOGY OF
COAGULATION
PHYSIOLOGY OF COAGULATION
requires no extravascular
component for initiation and
begins with Factor XII, which
is activated by contact with
injured epithelium.
Extrinsic Pathway
tone,
tissue,
trauma,
thrombin
Etiology of PPH
Uterine atony
Multiple gestation,
high parity,
prolonged labor
chorioamnionitis,
augmented labor,
tocolytic agents
Etiology of PPH
Retained uterine
contents
Products of conception,
blood clots
Etiology of PPH
Placental abnormalities
Planned Unplanned
•Vaginal/cervical tear,
•Cesarean section,
•surgical trauma
•episiotomy
Etiology of PPH
Coagulation disorders
Congenital Acquired
DIC,
Von Willebrand's disease
dilutional coagulopathy,
heparin
Women in whom these factors have been
identified should beadvised to deliver in a
specialist obstetric unit( ( GRADE B
odds ratio
Risk Factor for PPH
•Multiple pregnancy 5
•Pre-eclampsia/gestational hypertension 4
The following factors, becoming apparent
during labour and delivery are associated
(with an increased risk of PPH. (GRADE B
odds ratio for
Risk factor PPH
(ALL GRADE C)
In the event of a woman coming to
delivery while receiving therapeutic
heparin,
•GRADE C
UH and LMWH in prophylactic dosage are
not felt to present a haemorrhagic hazard.
However, in overdosage there can be
bleeding problems and protamine
sulphate is less effective at reversing the
effects of these agents (particularly
LMWH) than of therapeutic heparin
administered by infusion.
GRADE C
Antenatal assessment
history
The existence of some of the
obstetric risk factors may be
known early in pregnancy from
history and examination.
Antenatal assessment
anemia
Detection of anemia more than
physiologic anemia of pregnancy
is important, because anemia at
delivery increases the likelihood of
a woman requiring blood
transfusion.
Antenatal assessment
Coagulation studies
COMMUNICATE.
RESUSCITATE.
MONITOR / INVESTIGATE.
STOP THE BLEEDING.
COMMUNICATE
call 6
• Call experienced midwife
• Call obstetric registrar & alert consultant
• Call anaesthetic registrar , alert consultant
• Alert haematologist
• Alert Blood Transfusion Service
• Call porters for delivery of specimens / blood
RESUSCITATE
• IV access with 14 G cannula X 2
• Head down tilt
• Oxygen by mask, 8 litres / min
• Transfuse
•Crystalloid (eg Hartmann’s)
•Colloid (eg Gelofusine)
•once 3.5 litres infused, GIVE ‘O NEG’ If no cross-
matched blood available OR give uncross-matched
own-group blood, as available