Postpartum haemorrhage is the loss of blood following
a delivery resulting in a hypouolemia or otherwise causing the patient to
become symptomatic due to blood loss.
a delivery resulting in a hypouolemia or otherwise causing the patient to
become symptomatic due to blood loss.
Some practitioners measure PPH by a blood loss greater
than 500ml of blood following vagina delivery or 1000ml of blood following caesarean
section. It is the most common cause of perinatal maternal death in developing
world and the major cause of maternal morbidity worldwide. Post partum
haemorrhage can be classified into primary and secondary haemorrhage base on
its severity.
than 500ml of blood following vagina delivery or 1000ml of blood following caesarean
section. It is the most common cause of perinatal maternal death in developing
world and the major cause of maternal morbidity worldwide. Post partum
haemorrhage can be classified into primary and secondary haemorrhage base on
its severity.
Primary Postpartum
Haemorrhage
Haemorrhage
Primary postpartum haemorrhage is the most common form
of major obstetric haemorrhage. The traditional definition of primary PPH is
the lost of 500ml or more of blood from the genital track within 24hours of the
birth of the baby. Primary PPH can be minor (500ml – 1000ml) or major (more
than 1000ml). Major could be divided into moderate (1000ml – 2000ml) or severe
(more than 2000ml) the recommendation in this guideline applies to women
experiencing primary PPH of 500ml or more.
of major obstetric haemorrhage. The traditional definition of primary PPH is
the lost of 500ml or more of blood from the genital track within 24hours of the
birth of the baby. Primary PPH can be minor (500ml – 1000ml) or major (more
than 1000ml). Major could be divided into moderate (1000ml – 2000ml) or severe
(more than 2000ml) the recommendation in this guideline applies to women
experiencing primary PPH of 500ml or more.
Secondary Postpartum
Haemorrhage
Haemorrhage
Secondary PPH is defined as abnormal or excessive
bleeding from the birth canal between 24 hours and 12 weeks postnatally that is
excessive bleeding once the woman has returned home after delivery.
bleeding from the birth canal between 24 hours and 12 weeks postnatally that is
excessive bleeding once the woman has returned home after delivery.
Signs and Symptoms of
Postpartum Haemorrhage
Postpartum Haemorrhage
Symptoms vary but may include;
1.
Fever
Fever
2.
Abdominal pain
Abdominal pain
3.
Offensive smelling lochia
Offensive smelling lochia
4.
Abnormal vaginal bleeding
Abnormal vaginal bleeding
5.
Abnormal vaginal discharge
Abnormal vaginal discharge
6.
General malaise
General malaise
Prevention and Management of
PPH
PPH
1.
Identification of the factors which place women at
risk for PPH
Identification of the factors which place women at
risk for PPH
2.
Management of the third stage of labour.
Management of the third stage of labour.
3.
Massaging of the uterus and expelling clots.
Massaging of the uterus and expelling clots.
4.
Applying manual compression to the uterus.
Applying manual compression to the uterus.
5.
Applying manual compression to the aorta
Applying manual compression to the aorta
6.
Suturing perinael tears
Suturing perinael tears
7.
Suturing of episiotomy
Suturing of episiotomy
8.
Repair of cervical and high vaginal tears.
Repair of cervical and high vaginal tears.
9.
Manual removal of the placenta.
Manual removal of the placenta.
Causes of Postpartum
Haemorrhage And Their Incidence
Haemorrhage And Their Incidence
(1) Uterine atony 70%
(2) Trauma 20%
(3) Retained tissue 10%
(4) Coagulpathy 1%
Other causes of PPH are uterine atony, trauma,
retained placenta, and coagulpathy, commonly referred to as the four Ts
retained placenta, and coagulpathy, commonly referred to as the four Ts
(1) Tone uterine atony; This is the inability of the uterus to contract
and may lead to continuous bleeding, retained placenta tissue and infection may
contribute to uterine atony. Uterine atony is the most common cause of postpartum
haemorrhage.
and may lead to continuous bleeding, retained placenta tissue and infection may
contribute to uterine atony. Uterine atony is the most common cause of postpartum
haemorrhage.
(2) Trauma: Trauma from the delivery may tear tissue and
vessels leading to significant postpartum bleeding.
vessels leading to significant postpartum bleeding.
(3) Tissue: Retention of tissue from the placenta or fetus
may lead to bleeding.
may lead to bleeding.
(4) Thrombia: A bleeding disorder occurs when there is a
failure of clothing such as disease known as coagupathies.
failure of clothing such as disease known as coagupathies.
Risk Factors
1.
Antepartum haemorrhage
Antepartum haemorrhage
2.
Placenta praeuia
Placenta praeuia
3.
Suspected or proven placenta abruptio
Suspected or proven placenta abruptio
4.
Multiple pregnancy
Multiple pregnancy
5.
Pre-eclampsia
Pre-eclampsia
6.
Grand multiparity
Grand multiparity
Complication
1.
Hypouolaemic shock
Hypouolaemic shock
2.
Acute kidney injury
Acute kidney injury
3.
Acute (adult) respiratory distress syndrome
Acute (adult) respiratory distress syndrome
4.
Death
Death
