Postpartum Hemorrhage (PPH)
Postpartum Hemorrhage (PPH):
• Loss of blood more than 500 ml within the first 24 hours after delivery is called PPH.
Type of PPH :
• Third stage hemorrhage : before expulsion placenta
• Primary PPH : After expulsion of placenta without 24 hrs
• Secondary PPH : After 24 to 6 weeks.
• Causes (Four T’s)
• Tone : Atnocity of the uterus (Uterine atony)
• Traumatic injury
• Tissues : Retained tissues
• Thrombin : Blood coagulation disorders
• Sign and symptoms : Decreased BP, increased heart rate and uncontrolled bleeding.
Management :
• Bimaunal message of the uterus
• Start NS/RL with oxytocin (1 L 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 done under general anesthesia if placenta does not separate.
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Writer: (Vandita Singh, Lucknow)