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Abstract
One of the Millennium Development Goals set by the United Nations in 2000 is to reduce
maternal mortality by three-quarters by 2015. If this is to be achieved, maternal deaths related
to postpartum haemorrhage (PPH) must be significantly reduced. PPH is generally defined as
blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is
blood loss greater than or equal to 1000 ml within 24 hours. Excessive bleeding affects
approximately 5 to 15 percent of women after giving birth. The etiologies of early PPH are
most easily understood as abnormalities of one or more of four basic processes. Bleeding
will occur if for some reason the uterus is not able to contract well enough to arrest the
bleeding at the placental site. Retained products of conception or blood clots, or genital tract
trauma may cause large blood losses postpartum, especially if not promptly identified.
Coagulation abnormalities can cause excessive blood loss alone or when combined with one
of the other processes. As a memory aid these processes can be thought of as the four Ts;
Tone, Tissue, Trauma and Thrombin. Effective team management of PPH involves
recognition, communication, resuscitation, monitoring and investigation and directed
treatment. Once a PPH has been recognised these components should be conducted
simultaneously for optimal patient care.
Keywords: postpartum hemorrhage, management
Perubahan Tidak ada slight fall marked fall (70- profound fall
Tekanan darah (80-100 mmH g) 80 mmH g) (50-70 mmH g)
(Tekanan Sistole)
TABEL 2
FAKTOR RISIKO PPH
- acquired in
pregnancy - bruising
- ITP - elevated BP
- thrombocytopenia dengan pre-eclampsia - fetal demise
- D IC - fever, W BC
- pre-eclampsia - antepartum haemorrhage
- dead fetus in utero - sudden collapse
- severe infection
- abruption
- amniotic fluid embolus
Delivery
INITIAL 30
Obstetric team Anesthesiology team
MANAGEMENT OF PPH
min
Manual removal of placentaif not yet delivered Monitor
Communica
crystalloids
Visual assessment of the lower genital tract Sutures Uterine massage
Anesthesia for manual explora on of the uterus
Oxytocin
Failure of 5-10 IU slow IV or IM (Max: 40 IU) An bio c therapy
ini al management
- 2nd peripheral
Verify venous
blood group andline
IAS 16 g
validity
30 SULPROSTONE
Ini al lab work: CBC, platelets, PT, AC, Fibrinogen +/- Hemocue
min* In-dwelling urinary catheteriza
Order reserva on of units of packed red blood cells
on
- Fluid resuscita on
+/-
(crystalloids/colloids)
intra-uterine balloon tamponnade
Failure of Sulprostone -Transfusion of packed red blood
Hemodinamically unstable
SEVERE OR cells
Hemodinamically stable -Hypothermia preven on
and/or Massive hemorrhage
PERSISTENT POST PARTUM HEMORRHAGE -+/- laboratory results
and +/- Tranexamic acid
and/or Emboliza on
Emboliza on rapidly available
unavailable +/- Fresh frozen
rFVIIa
salpingectomy/oophorectomy
Referensi