Definition

Postpartum hemorrhage has been defined as

the loss of 500ml or more blood after the de
livery of the fetus (completion of the third st
age of labor).
Hemorrhage after the first 24 hours is desig
nated late postpartum hemorrhage.

Sheehan syndrome
Severe intrapartum or early postpartum hem
orrhage is on rare occasions followed by sh
eehan syndrome, which in the classical case
is characterized by failure in laceration, ame
norrhea, atrophy of the breasts, loss of pubi
c and axillary hair, superinvolution of the ut
erus, hypothyroidism and adrenal cortical in
sufficiency.

Sheehan syndrome
In some but not all instances of sheehan syn
drome, varying degrees of anterior pituitary
necrosis with impaired secretion of one or
more trophic hormones account for endocri
ne abnormalities. Some cases imply impaire
d hypothalamic function.

Etiology

Uterine atony(uterine inertia)

Genital tract lacerations
Placenta factors
Impaired coagulation mechanism

Clinical manifestation and diagno

sis
Bleeding
shock., infection

uterine atony

genital tract lacerations

placenta factors

Placenta factors
Retained placenta fragments
placenta adherence
placenta accreta, increta and percreta
placenta accreta is used to describe any placent
al implantation in which there is abnormally fir
m adherence to the uterine wall.Placenta villi ar
e attached to the myometrium in placenta accret
a; actually invade the myometriumin placenta i
ncreta, or penetrate through the myometrium in
placenta percreta

Puerperal Infection
Page 257

definition
Puerperium: is the postpartum period during
which the pelvic organs return to their prepr
egnant conditions
puerperium infection is a general term used
to describe any bacterial infection of the ge
nital tract after delivery
puerperium morbidity:

Puerperium morbidity
Temperature 38.0 or higher, the temperature
to occur on any 2 of the first 10days postpar
tum, exclusive of the first 24 hours, and to b
e taken by mouth by a standard technique at
least four times daily.
Although it is suggests that all puerperal fevers
are the consequence of pelvic infection, temper
ature elevations may be the results of other caus
es.

Extragenital causes of puerperal fever

Respiratory complications
pyelonephritis
intense breast engorgement
bacterial mastitis
thrombophlebitis
incisional wound abscess

Bacteria commonly responsible for femal

e genital infections
Aerobes
Group A, B and D streptococci
Enterococcus
Gram-negative bacteria---E. Coli, Klebsiella
staphylococcus aureus
Anaerobes
peptococcus species
peptostreptococcus species
bacteroides bivius, B. Fragilis,B. Disiens
clostridium species
fusobacterium species
others------mycoplasma hominis
chlamydia trochomatis

Clinical manifestation
Acute episiotis, vulvovaginitis and cervitis
metritis(postpartum uterine infection)
endometritis, endomyometritis, endoparametriti
s
subinvoluted, tenderness, rebound tenderness
lochia
adnexal infections: acute salpingitis
parametrial phlegmen and pelvic abscess
acute pelvic peritonitis or general peroitonitis
septic pelvic thrombophlebitis:femoral,saphena
pyemia and sepsis