Post Partum Haemorrhage (Pph)
Post Partum Haemorrhage (PPH)
Introduction: Post partum haemorrhage (PPH) is an obstetrical emergency that can follow vaginal or cesarean delivery. It is a major cause of maternal morbidity and one of the top three causes of maternal mortality in both high and low per capital income countries, although the absolute risk of death in much lower in high income countries (1 in 100,000 versus 1 in 1000 births in low income countries). Furthermore, hemorrhage is the leading cause of admission of the intensive care unit and the most preventable cause of maternal mortality. The average blood loss following vaginal delivery, caesarean delivery and caesarean hysterectomy is 500 ml, 1000ml and 1500 ml respectively. Depending upon the amount of blood loss, post partum hemorrhage (PPH) can be- ➢ Minor (1L) ➢ Severe (10g/dl) so that the patient can withstand some amount of the blood loss. • High risk patients who are likely to develop post partum hemorrhage (such as twins, hydramnios, grand multipara, APH, history of previous PPH, severe anemia) are to be screened & delivered in a well equipped hospital. • Blood groping should be one for all women so that no time is wasted during emergency. • Placental localization must be done in all women with previous caesarean delivery by USG or MRI to detect placenta accreta or percreta. • Women with morbid adherent placenta are at high risk of PPH. Such a case should be delivered by a senior obstetrician. A availability of blood & or blood products must be ensured before hand.
Intranatal: • Active management of the third stage, for all women in labour should be a routine as it reduces PPH by 60%. • Women delivered by caesarean section, oxytocin 5 IU slow IV is to be given to reduce blood loss. • Exploration of the utero-vaginal canal for evidence of trauma following difficult labour or instrumental delivery. • Observation for about 2 hours often delivery to make sure that
Introduction: Post partum haemorrhage (PPH) is an obstetrical emergency that can follow vaginal or cesarean delivery. It is a major cause of maternal morbidity and one of the top three causes of maternal mortality in both high and low per capital income countries, although the absolute risk of death in much lower in high income countries (1 in 100,000 versus 1 in 1000 births in low income countries). Furthermore, hemorrhage is the leading cause of admission of the intensive care unit and the most preventable cause of maternal mortality. The average blood loss following vaginal delivery, caesarean delivery and caesarean hysterectomy is 500 ml, 1000ml and 1500 ml respectively. Depending upon the amount of blood loss, post partum hemorrhage (PPH) can be- ➢ Minor (1L) ➢ Severe (10g/dl) so that the patient can withstand some amount of the blood loss. • High risk patients who are likely to develop post partum hemorrhage (such as twins, hydramnios, grand multipara, APH, history of previous PPH, severe anemia) are to be screened & delivered in a well equipped hospital. • Blood groping should be one for all women so that no time is wasted during emergency. • Placental localization must be done in all women with previous caesarean delivery by USG or MRI to detect placenta accreta or percreta. • Women with morbid adherent placenta are at high risk of PPH. Such a case should be delivered by a senior obstetrician. A availability of blood & or blood products must be ensured before hand.
Intranatal: • Active management of the third stage, for all women in labour should be a routine as it reduces PPH by 60%. • Women delivered by caesarean section, oxytocin 5 IU slow IV is to be given to reduce blood loss. • Exploration of the utero-vaginal canal for evidence of trauma following difficult labour or instrumental delivery. • Observation for about 2 hours often delivery to make sure that