PPH (Postpartum Hemorrhage) and PPH types
Loss of blood more than 50 ml within first 24 hours after delivery is called PPH.
Third stage Hemorrhage: before explusion of placenta
Primary PPH: after explusion of placenta within 24 hrs
Secondary PPH: After 24 hours to 6 weeks.
Causes: (Four T’s)
Tone: Atomicity of uterus
Traumatic injury
Tissues: Retained tissues
Thrombin: Blood coagulation disorders
Signs and symptoms: Decreased BP, increase heart rate and uncontrolled bleeding.
Risk factors
▸ Prolonged third stage of labor
▸ Multiple delivery
▸ Placenta previal
•Pacental abruption
▸ Episiotomy
▸ Fetal macrosomia
▸ History of postpartum hemorrhage.
▸ Placenta previa
▸ Placental abruptio
▸ Pregnancy induced hypertension
► Infection
Management:
Bimanual message of the uterus
Start NS/RL with oxytocin (1L with 20 units) at 60 drops) minute
Administer oxytocin 10 units Im/methergine 0.2 mg IV
Catheterize the bladder
Apply fundal pressure and control cord traction to separate the placenta
Manual removal of placenta is to be under general anesthesia if placenta does not separate.