The utero vaginal canal is to be explored under general anaesthesia after the placenta is expelled. In this true post partum hemorrhage the bleeding occurs subsequent to expulsion of placenta majority.
Child birth For these reasons, various authors have suggested that PPH should be diagnosed with any amount of blood loss that threatens the hemodynamic stability of the woman. Bleeding related to spontaneous abortion may have etiologies and management in common with those for PPH.
Epidemiology ————————————————- Frequency United States and industrialized countries The frequency of PPH is related to the management of the third stage of labor.
Developing countries The increased frequency of PPH in the developing world is more likely reflected by the rates given above for expectant management because of the lack of widespread availability of medications used in the active management of the third stage.
The first is a lack of experienced caregivers who might be able to successfully manage PPH if it occurred. Additionally, the same drugs used for prophylaxis against PPH in active management of the third stage are also the primary agents in the treatment of PPH.
Lack of blood transfusion services, anesthetic services, and operating capabilities also plays a role. Etiology PPH has many potential causes, but the most common, by a wide margin, is uterine atony, ie, failure of the uterus to contract and retract following delivery of the baby.
PPH in a previous pregnancy is a major risk factor and every effort should be made to determine its severity and cause. In a recent andomized trial in the United States, birthweight, labor induction and augmentation, chorioamnionitis, magnesium sulfate use, and previous PPH were all positively associated with increased risk of PPH.
In a study by Blomberg, the risk of atonic uterine hemorrhage rapidly increased with increasing BMI; in women with a BMI over 40, the risk was 5. Overdistension of the uterus, either absolute or relative, is a major risk factor for atony.
Overdistension of the uterus can be caused by multifetal gestation, fetal macrosomia, polyhydramnios, or fetal abnormality eg, severe hydrocephalus ; a uterine structural abnormality; or a failure to deliver the placenta or distension with blood before or after placental delivery.
Poor myometrial contraction can result from fatigue due to prolonged labor or rapid forceful labor, especially if stimulated.
It can also result from the inhibition of contractions by drugs such as halogenated anesthetic agents, nitrates, nonsteroidal anti-inflammatory drugs, magnesium sulfate, beta-sympathomimetics, and nifedipine.
Other causes include placental implantation site in the lower uterine segment, bacterial toxins eg, chorioamnionitis, endomyometritis, septicemiahypoxia due to hypoperfusion or Couvelaire uterus in abruptio placentae, and hypothermia ue to massive resuscitation or prolonged uterine exteriorization.
Recent data suggest that grand multiparity is not an independent risk factor for PPH. Complete detachment and expulsion of the placenta permits continued retraction and optimal occlusion of blood vessels.
Retention of a portion of the placenta is more common if the placenta has developed with a succenturiate or accessory lobe. Following delivery of the placenta and when minimal bleeding is present, the placenta should be inspected for evidence of fetal vessels coursing to the placental edge and abruptly ending at a tear in the membranes.
Such a finding suggests a retained succenturiate lobe. This should be a consideration in all deliveries at very early gestations, whether they are spontaneous or induced. Recent trials suggest that the use of misoprostol for second trimester termination of pregnancy leads to a marked reduction in the rate of retained placenta when compared to techniques using the intrauterine instillation of prostaglandin or hypertonic saline.
In this condition, the placenta has invaded beyond the normal cleavage plane and is abnormally adherent. Significant bleeding from the area where normal attachment and now detachment has occurred may mark partial accreta. Complete accreta in which the entire surface of the placenta is abnormally attached, or more severe invasion placenta increta or percretamay not initially cause severe bleeding, but it may develop as more aggressive efforts are made to remove the placenta.
This condition should be considered possible whenever the placenta is implanted over a previous uterine scar, especially if associated with placenta previa.
All patients with placenta previa should be informed of the risk of severe PPH, including the possible need for transfusion and hysterectomy.
Finally, retained blood may cause uterine distension and prevent effective contraction. Cesarean delivery results in twice the average blood loss of vaginal delivery. Incisions in the poorly contractile lower segment heal well but are more reliant on suturing, vasospasm, and clotting for hemostasis.
Uterine rupture is most common in patients with previous cesarean delivery scars. Routine transvaginal palpation of such scars is no longer recommended. Any uterus that has undergone a procedure resulting in a total or thick partial disruption of the uterine wall should be considered at risk for rupture in a future pregnancy.
This admonition includes fibroidectomy; uteroplasty for congenital abnormality; cornual or cervical ectopic resection; and perforation of the uterus during dilatation, curettage, biopsy, hysteroscopy, laparoscopy, or intrauterine contraceptive device placement.
Trauma may occur following very prolonged or vigorous labor, especially if the patient has relative or absolute cephalopelvic disproportion and the uterus has been stimulated with oxytocin or prostaglandins. Using intrauterine pressure monitoring may lessen this risk. Trauma also may occur following extrauterine or intrauterine manipulation of the fetus.
The highest risk is probably associated with internal version and extraction of a second twin; however, uterine rupture may also occur secondary to external version. Finally, trauma may result secondary to attempts to remove a retained placenta manually or with instrumentation. The uterus should always be controlled with a hand on the abdomen during any such procedure.
Assisted vaginal delivery forceps or vacuum should never be attempted without the cervix being fully dilated. Cervical laceration may occur spontaneously.According to Dawn Postpartum Haemorrhage (PPH) is the term denoting "excessive haemorrhage from the genital tract at any time after the birth of the baby up to the end of puerperium amounting to a degree affecting the general condition of the patient.
Nov 23, · Postpartum haemorrhage (PPH) continues to be a leading cause of maternal deaths, particularly in low-income countries [1, 2]. Almost one-third of maternal deaths worldwide are due to haemorrhage, mostly in the postpartum period [ 3 ]. Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of blood more than ml or 1, ml of blood within the first 24 hours following childbirth.
Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. . Postpartum hemorrhage (PPH) is a significantly life-threatening complication that can occur after both vaginal and caesarean births (Ricci & Kyle, ).
Essay on brain hemorrhage A cerebral hemorrhage (also spelled haemorrhage) is a subtype of intracranial hemorrhage that occurs within the brain tissue itself. It is alternatively called. Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization.
Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than mL after a vaginal birth, more than mL after a cesarean section, and a ten percent. postpartum hemorrhage Essays: Over , postpartum hemorrhage Essays, postpartum hemorrhage Term Papers, postpartum hemorrhage Research Paper, Book Reports.
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