Post partum haemorrhage ppt

Postpartum Hemorrhage Lecture Notes • OFTHE MEDICAL MANAGEMENT OF POSTPARTUM HEMORRHAGEPOSTPARTUM HEMORRHAGE Chukwuma I. Onyeije, M.D.,Chukwuma I. Onyeije, M.D., Atlanta Perinatal AssociatesAtlanta Perinatal Associates 2 •Provide a definition of PPH •Review the risk factors for PPH •Understand the nature and importance of rapid diagnosis and treatment OBJECTIVES • digital copy of this lecture is also located at: http://onyeije.net/present 4 Mary 24 year old G2P2 Underwent a routine cesarean section at 7.30 pm Pre-operative Hb was 13 g/dl. Blood loss of 500cc. 5 Mary 4 hours post-partum Pulse at 100-120 otherwise stable. BP: 70-90 / 50-60 Analgesia and Hydration provided. 5 hours postpartum: Seizure with obtundation. Hemoglobin: 7 g/dl, 6 6 Hours post partum: Elevated cardiac enzymes DIC Myocardial Infarction & Liver failure 9 Hours postpartum: Failed arterial embolization 10 Hours postpartum Uterine packing done. 11 Hours Postpartum: Hysterectomy 2 Days Postpartum: Flatline EKG 7 ‘‘‘‘She died inShe died in childbirth’’childbirth’’ 8 Hemorrhage has probably killed more women than any other complication of pregnancy in the history of mankind. • year 10 90% of deaths from Postpartum hemorrhage are preventable. 11 WE HAVE THE TOOLS GOOD NEWS 12 Those caring for pregnant women must be prepared to aggressively treat this complication when it occurs. 13 WhatWhat can becan be done?done? 14 THE STEPS TO PPH: POSTPARTUM HEMORRHAGE: PREDICT HANDLE PREPARE • PPH: POSTPARTUM HEMORRHAGE...

UTERINE ATONY **The myometrium fails to contract and the uterus fills with blood because of the lack of pressure on the open vessels of the placental site The myometrium fails to contract and the uterus fills with blood because of the lack of pressure on the open blood vessels of the placental site. POST PARTUM HEMORRHAGE *LACERATIONS*  PREDISPOSING FACTORS 1. Spontaneous or Precipitous delivery 2. Size, Presentation, and Position of baby 3. Contracted Pelvis 4. Vulvar, cervical, perineal, uretheral area and vaginal varices  Signs and Symptoms 1. Bright red bleeding where there is a steady trickle of blood and the uterus remains firm. 2. Hypovolemia

Though laypeople in the U.S. may think of maternal death as something occurring in another century or on other continents, those practicing in the nation's field of obstetrics know that it's not. In fact, approximately 700 women nationwide die yearly from complications due to pregnancy, childbirth or post-delivery, according to the Centers for Disease Control and Prevention (CDC). The No. 1 direct cause of maternal mortality globally is postpartum hemorrhage (PPH), according to a 2014 publication in the Lancet Global Health. Additionally, PPH necessitating blood transfusion is the No. 1 cause of maternal morbidity, reports Dr. Creanga and colleagues in a 2014 issue of Journal of Women's Health. "One of the biggest things obstetricians are concerned about is hemorrhage," says Consistent with recent efforts by the CDC and the American College of Obstetricians and Gynecologists (ACOG), Mayo Clinic Obstetrics and Gynecology strives to play a role in decreasing maternal morbidity and mortality by continuously improving PPH monitoring, prevention and treatment. The majority of PPH— about 98% — occurs immediately post-delivery, though some patients present with delayed PPH, according to Dr. Torbenson. PPH measurement evolution For years, U.S. obstetricians used a qualitative, estimate-based approach to blood loss measurement, says Dr. Torbenson. "The provider would note, 'That looks like about 300 cc of blood, or around 500 cc of blood,' " she says. However, the obstetrics commun...

Definition • Vaginal bleeding in excess of 500ml or any amount sufficient enough to cause cardiovascular compromise. • Primary and secondary PPH • FACT Estimated amounts of blood loss are notoriously low, often half the actual loss. The lower the Hb level the poorer is the woman’s tolerance of blood volume loss.