1. Postpartum hemorrhage
Page 244

2. Definition
• Postpartum hemorrhage has been defined as
the loss of 500ml or more blood after the
delivery of the fetus (completion of the
third stage of labor).
• Hemorrhage after the first 24 hours is
designated late postpartum hemorrhage.

3. Sheehan syndrome
• Severe intrapartum or early postpartum
hemorrhage is on rare occasions followed
by sheehan syndrome, which in the classical
case is characterized by failure in
laceration, amenorrhea, atrophy of the
breasts, loss of pubic and axillary hair,
superinvolution of the uterus,
hypothyroidism and adrenal cortical
insufficiency.

4. Sheehan syndrome
• In some but not all instances of sheehan
syndrome, varying degrees of anterior
pituitary necrosis with impaired secretion of
one or more trophic hormones account for
endocrine abnormalities. Some cases imply
impaired hypothalamic function.

5. Etiology
•
•
•
•
Uterine atony(uterine inertia)
Genital tract lacerations
Placenta factors
Impaired coagulation mechanism

6. Clinical manifestation and
diagnosis
• Bleeding
• shock., infection
•
uterine atony
•
genital tract lacerations
•
placenta factors

7. Placenta factors
• Retained placenta fragments
• placenta adherence
• placenta accreta, increta and percreta
– placenta accreta is used to describe any
placental implantation in which there is
abnormally firm adherence to the uterine
wall.Placenta villi are attached to the
myometrium in placenta accreta; actually
invade the myometriumin placenta increta, or
penetrate through the myometrium in placenta
percreta

8. Puerperal Infection
Page 257

9. definition
• Puerperium: is the postpartum period during
which the pelvic organs return to their
prepregnant conditions
• puerperium infection is a general term used
to describe any bacterial infection of the
genital tract after delivery
• puerperium morbidity:

10. Puerperium morbidity
• Temperature 38.0 or higher, the temperature
to occur on any 2 of the first 10days
postpartum, exclusive of the first 24 hours,
and to be taken by mouth by a standard
technique at least four times daily.
– Although it is suggests that all puerperal fevers
are the consequence of pelvic infection,
temperature elevations may be the results of
other causes.

11. Extragenital causes of puerperal fever
•
•
•
•
•
•
Respiratory complications
pyelonephritis
intense breast engorgement
bacterial mastitis
thrombophlebitis
incisional wound abscess

12. Bacteria commonly responsible for
female genital infections
• Aerobes
– Group A, B and D streptococci
– Enterococcus
– Gram-negative bacteria---E. Coli, Klebsiella
– staphylococcus aureus
• Anaerobes
– peptococcus species
– peptostreptococcus species
– bacteroides bivius, B. Fragilis,B. Disiens
– clostridium species
– fusobacterium species
• others------mycoplasma hominis
–

13. Clinical manifestation
• Acute episiotis, vulvovaginitis and cervitis
• metritis(postpartum uterine infection)
– endometritis, endomyometritis,
endoparametritis
– subinvoluted, tenderness, rebound tenderness
– lochia
• adnexal infections: acute salpingitis
• parametrial phlegmen and pelvic abscess
• acute pelvic peritonitis or general peroitonitis
• septic pelvic thrombophlebitis:femoral,saphena
• pyemia and sepsis