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HEAMORRHAGE
PRESENTATION OUTLINE
Introduction
Classification
Definition
Incidence
Causes
Risk factors
Pathogenesis of blood loss
Complications
Secondary postpartum
haemorrhage
Introduction
• Major cause of maternal haemorrhage
• Principal unfavorable factors
High frequency of anaemia
Absence and lack of access to adequate
obstetrics care
Strong social pressures-cultural & religious
beliefs
Poor transportation and gross infrastructural
inadequacies
Delay effective treatment –blood transfusion
• 2 types- Primary and secondary post
partum haemorrage
DEFINITION
• 5-8% Generally
• Developing countries??
• In U.P.T.H 2003 annual report-3.9%
• Primary-0.2%
• Secondary-1.3%
CAUSES
Uterine Atony -50%
Grand multiparity,
Uterine overdistension,
Prolonged labour,
Uterine leimyomas,
oxytocin use in labour,
Previous hx-Intrinsic myometrial dysfunction
Operative delivery
Excessive manipulation of the uterus,
General anaesthesia(halogenated cpds)
• Coagulation Defects
Acquired causes include:
DIC 2* retained dead fetus,
Amniotic fluid embolism,severe preeclampsia
and eclampsia,dilutional coagulopathy,sepsis.
others include von willebrands dz,autoimmune
thrombocytopenia & leukaemia
Risk factors
• Past obstetric hx of coagulopathy,
haemorhage or blood transfusion
• Anaemia during labour
• Grandmultiparity
• Multiple gestation &Macrosomia
• Oxytocin induction & Augumentaion
• Severe preeclampsia &Eclampsia
• Vaginal delivery after C/S
• General anaesthesia
• Precipitate labour
Pathogenesis of blood loss And its
Consequences
• Increase in blood volume by up to 1.5
liters
• Increase in coagulation factors- fibrinogen
• Suppression of the fibrinolytic system
• Constriction of interlacing myometrial
fibers
Haemorrhage triggers off circulatory, neural and
endocrine mechanism.
• Circulatory adaptations and its clinical relevance
– Acute loss of 10% circulatory volume-Tachycardia
- 25% loss - vasoconstrction,weak rapid and
thready peripheral pulse, & cold skin but normal
blood pressure.
>25%-Hypotension
30-35% loss - Shock: SBP 70-80mmHg,
tarchycardia worsens, sweating and oligouria
Further loss leads to ppt fall in CO -fainting and
restlessness.
complications
• Shock
- Acute renal failure
- Ischaemic necrosis of the anterior
pituitary(Sheehan Syndrome)
- DIC
-ARDS
- Anaemia
• Complications of treatment
2. Blood transfusion related mortality and
morbidity
3. Genital tract infections
4. Subfertility-Asherman’s syndrome
5. Sterility
Secondary post partum
haemorrhage
• Secondary postpartum haemorrhage is
any fresh bleeding from the genital
tract after the first 24 hours of delivery
up to 6weeks post delivery.
• Causes
2. Retained placental fragments
3. Uterine subinvolution
Faulty placental implantation
Implantation in the lower segment
Persistent infection on placental
bed