2. PRIMARY PPH
• Loss of MORE than or
EQUAL to 500mL blood
from the genital tract
within 24 hours of
delivery
• Loss of MORE than or
EQUAL to 500mL blood
from the genital tract
between 24 hours and
12 weeks post delivery
SECONDARY PPH
•Postpartum Haemorrhage (PPH)
Classification
3. •Aetiology
5 “T”s
Uterine atony
Retained placenta and/or membranes
Clotting disorder
Uterine inversion
Tone
Tissue
Trauma
Thrombin
Injury to vagina, perineum ad uterine tears
at Caesarean section
Traction
5. • Can be predict.
• Predisposing conditions:
• Multiparity(Fibrosis of uterine
muscle)
• Over distension of uterus(eg:
Macrosomia,polyhydramnios)
• Prolong labour (uterine inertia)
• Fibroid
• Placenta previa
• Oxytocin induce labour
•Uterine Atony
Uterus fails to contract following delivery of placenta.
13. • Caused by traction on the
umbilical cord before
placenta has separated.
• Associated factors:
-Fundal placenta
-Short cord
-Morbidly adherent placenta
• Cardiovascular collapse &
shock.
•Acute Inversion of Uterus
Uterus is pulled ‘inside out’ and the fundus at the introitus.
Third Degree Uterine Inversion
14. •Uterine Inversion
Stages/Classification
• First Degree (Incomplete)-inverted fundus
reached the external os.
• Second Degree (Complete)-whole body of the
uterus is inverted and protrudes into the
vagina
• Third Degree – prolapse of inverted uterus,
cervix and vagina outside the vulva
15. • (A)The protruding fundus is
grasped with fingers directed
toward the posterior fornix.
• (B, C) The uterus is returned to
position by pushing it through
the pelvis and into the abdomen
with steady pressure towards
the umbilicus.
• Acute inversion of uterus-
reduced manually or O’Sullivan
(hydrostatic pressure) or
surgery.
•Johnson’s Method
16. • Circulatory collapse ► shock,
organ failure, stroke,death
• Sheehan’s syndrome –
damage to pituitary –
pituitary necrosis
• Puerperal anaemia
• Fear of further pregnancies
•Complications of PPH
17. • ABC,fluid resuscitation
• Feel abdomen-uterus poorly
contracted
• Rub the fundus gently –see
wether uterus contract and
bleeding arrested
• Set up IV line & IV infusion of 40
units of syntocinon/B.C*/
intramyometrial injection of
ergometrine or PG
• Send blood for group and cross
matching
• Examine placenta to see if it is
complete-If uncompleted, sent
to OT for manual exploration
• If complete-Examine vagina and
cervix in lithotomy position for
laceration
•Management
Diagnosis & management occur simultaneously
Bimanual Compression*
18. • No laceration?-Examination
under anaesthesia(allow
further measures eg:uterine
tamponade,radioloical
occlusion)
• Exploratory Laporotomy(iliac
artery ligation,sutures)
• Hysterectomy
• B lynch -sutures are placed in
double loop that surround the
uterus & aim to squeeze
whole uterus by tightening
them
•Management
B lynch suture
Uterine Balloons
19. PRIMARY PPH
• Loss of MORE than or
EQUAL to 500mL blood
from the genital tract
within 24 hours of
delivery
• Loss of MORE than or
EQUAL to 500mL blood
from the genital tract
between 24 hours and
12 weeks post delivery
SECONDARY PPH
•Postpartum Haemorrhage (PPH)
Classification
20. • It is usually the result of:
• Retained product of conception
• Uterine infection
Rare cause of massive bleeding.
•Secondary PPH
Management
•Broad spectrum antibiotic
•Gentle evacuation of uterus
Clinical Sign
•Crampy abdominal pain
•Delayed uterine involution
•Signs of infection