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Published byAlbert Picot Modified over 8 years ago
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Nahida Chakhtoura, M.D.
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Postpartum hemorrhage (PPH): leading cause of maternal mortality worldwide Prevalence rate: 6% Africa has highest prevalence rate: 10.5% In Africa and Asia PPH accounts for more than 30% of all maternal deaths Maternal death rates attributable to PPH vary considerably between developed and developing countries, suggesting that deaths from PPH are preventable
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Uterine Atony Placenta: retained placenta, placental tissue or membrane, incomplete separation Full bladder Antepartum hemorrhage: placenta previa or placental abruption Overstretched uterus: high parity, multiple pregnancy, polyhydramnios, macrosomia, fibroids
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Uterine Atony Prolonged active phase Medical factors: anemia, coagulopathy Others: severe pre-eclampsia and eclampsia, precipitate labor, induction/ augmentation, IUFD, h/o PPH, c/s, gen. anesthesia, chorioamnionitis or endometritis
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Genital Trauma Perineum Vaginal walls Cervix Uterus Risk Factors Mistimed episiotomy Induced labor Precipitate labor C/S Forceps Delivery Prolonged labor Previous uterine surgery Anemia Delay in Tx
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Priorities Call for Help! Rapid assessment of patient’s condition Identify source of bleeding Stop the bleeding Stabilize/resuscitate Prevent further bleeding
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Atonic PPH Massage the uterus to promote contraction and expel clots Oxytocin 10 IU IM Assess EBL Type and cross, CBC, coagulation profile Start IVF: if shock 1L NS or LR in 15min up to 3L Foley catheter Check placenta and membranes. If placenta cannot be delivered, manually extract Examine cervix, vagina, and perineum
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If bleeding persists… Oxytocin 20 units in 1L of IVF @ 60 drops per min Add other IV access Continue uterine massage Assess clotting status and transfuse if necessary Consider transferring to higher level Uterine or utero-ovarian ligation; hypogastric artery ligation Uterine balloon B-lynch suture Hysterectomy Document properly
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Traumatic PPH Lithotomy position Identify site of bleeding and repair
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Close monitoring over next 24-48hrs Uterine tone VS; Ins and Outs Blood loss Serial CBC
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Developing Countries Active management of labor Uterine massage Draining the bladder 10 U oxytocin IM Misoprostol Uterine packing Hysterectomy
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Fausto Astudillo-Davalos, M.D. Mabel Marotta Danielle Kramer Nahida Chakhtoura, M.D.
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