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POSTPARTUM

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

• Primary Postpartum haemorrhage is


defined as blood loss from the genital
tract of 500mls or any amount likely to
compromise the patient’s
heamodynamic status in the first 24
hours after delivery of the baby.
INCIDENCE

• 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)

• Obstetric Lacerations -20%


Episiotomies,
Genital tract lacerations,
Haematomas
Uterine rupture
• Retained placental Tissue - 5-10%
Occurs in placental accreta, manual removal of
placenta, mismanaged 3rd stage of labour,
succenturiate placenta

• 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

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