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.