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PRESENTATION
Post Partum Hemorrhage PRESENTATION According to WHO it is define as the amount of blood loss in excess of 500ml following birth of baby Any amount of bleeding from or into the genital tract following birth up to the end of the puerperium, which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure is called post partum hemorrhage The average blood loss following vaginal delivery, cesarean delivery and cesarean hysterectomy is 500 ml, 1000 ml and 1500 ml respectively. Depending upon the amount of blood loss, PPH can be 1. Minor PP {estimated blood loss of up to 1000 mls.) Py Major PP (estimated blood loss over 1000 mis.) 3. Severe PPH (estimated blood loss over 2000 mls.) Types 1. Primary PP H within 24hrs following birth of baby) a. Third stage hemorrhage ivetore expuision of placenta) b. True post partum haemorrhage subsequent to expulsion of placenta) 2. Secondary PP H beyond 24 hrs & within puerperium) . Also k/a delayed or late puerperal hemorrhage ATONIC UTERUS(80%) * Commonest cause of PPH * As long as placenta remains unseparated ; bleeding is unlikely. * with separation of the placenta , the uterine sinuses torn, which cannot be compressed effectively due to the imperfect contraction and retraction of uterus and bleeding continues. Predisposing factors 1.Grand multipara * Inadequate retraction and frequent adherent contribute to it. 2. Overdistension of the uterus -multiple pregnancy -hydramnios -big baby(>4kg) 3.Malnutrition and anemia(<9g/dl) 7.\nitiation and agumentation of delivery by oxytocin -if oxytocin is contine for at least one hour following delivery. 8.Malformation of uterus -implantation of the placenta inuterine septum of septate uterus or in cornual region of bicornute uterus. 9.Uterine fibroid 10.Mismanaged third stage of labour -too rapid delivery of the baby preventing the uterine wall to adapt to the diminising content -premature attempt to deliver the placenta before it separate -pulling the cord -manual separation of placenta increase blood loss during cesarean delivery 11.Placenta -morbidly adherent (accreta,percreta) -partially or compeletly seprated 12.precipitate labor TRAUMATIC * Trauma to genital tract due to -operative delivery -episitomy -cesarean section RETAINED TISSUE -bits of placenta -blood clots THROMBIN -blood coagulation disorder ; acquired or congenital -blood coagulopathy; diminised procoagulant or increase fibrinolytic activity Management of PPH Medical management ** Communication ** Resuscitation ** Monitoring ** Arrest the bleeding 2. Resuscitation e Access airway, breathing and circulation * Give oxygen 10-15L/min via mask ¢ Two wide bore cannula is inserted and crystalloid is infused «Send blood for full count, group, cross matching, coagulation screen and ask for 2 unit of blood 
