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产后出血Postpartum Hemorrhage(PPH)
产后出血
林建华
Major causes of death for pregnancy women
(maternal mortality)
Postpartum hemorrhage(28%)
heart diseases
pregnancy-induced hypertension
(or Amniotic fluid embolism )
infection
Definition of PPH
be defined as a blood loss exceeding 500ml after delivery of the infant
PPH: occurs in 24 hour of delivery
the late PPH: occurs after 24 hour of delivery to 6 weeks
Major causes
Uterine atony (90%)
lacerations of the genital tract(6%)
retained placenta(3%-4%)
coagulation defects (blood dyscrasia)
(4T: tone, tissue,trauma,thrombin)
1. Uterine atony
Local factors
overdistention of the uterine (hydramnios, multiple pregnancy, macrosomia )
condition that interfere with contraction(leiomyomas)
complications(PIH,anaemia, placenta praevia
Systemic factors:
nervous
drugs(magnesium sulfate,sedative)
abnormal labor(prolonged,precipitous)
History of previous PPH
Preeclampsia, abnormal placentation,
pathology
Contraction constricting the spiral arteries
preventing the excessive bleeding from the placenta implantation site
the uterine atony give rise to PPH when no contraction occur
Prevention and therapeutic of uterine atony
Administration of medicine:
promotes contraction of the uterine corpus
decreases the likelihood of uterine atony
Oxytocin agents
Methegine
prostaglandin
Mechanical stimulation of uterine contraction:
Massage of uterus through the abdomen and bimanual compression
intrauterine packing
Surgical methods
If massage and agents are unsuccessful:
Ligation of the uterine arteries
ligation of the hypogastric arteries
selective arterial embolization
hysterectomy
taking into account the degree of hemorrhage,the overall status of patient,her future childbearing desires
2. Lacerations of the genital tract
Causes:
Instrumented delivery (forceps)
manipulative delivery(breech extraction,precipitous labor, macrosomia)
Types:
perineum laceration
vaginal laceration
cervical laceration
perineum and vaginal laceration
The first degree tear:
involves only skin and a minor part of the perineal body
the second degree tear:
involves the perineal body and vagina
the third degree tear:
involves the anal sphincter and anal canal
management
Vaginal examination soon after delivery
repair:
cervical laceration >2cm in length and be actively bleeding
laceration of vaginal and perineum
3. Retained placenta
Separation and explosion of placenta is caused by strong uterine contraction
Placenta tissue remaining in the uterus
prevent adequate contraction and predispose to excessive bleeding
causes:
adherence of placenta (previous cesarean delivery,prior uterine curettage)
succenturiate placenta
placenta accreta (into the decidua)
placenta increta(into the myometrium)
placenta pericreta(through the myometrium to the peritoneal)
Prevention and treatment
The placenta should be examined to see that it is complete or not
part of placenta is missing, removed digitally
not separated, manual removal of placenta is done
hysterectomy is required for placenta increta(percreta,accreta)
uterine contraction drugs
4. Coagulation defects
Acquired abnormality in blood clotting:
abruptio placenta,
amniotic fluid embolism
severe preclampsia
congenital abnormality in blood clotting:
thrombocytopenia
severe hepatic diseases
leukemia
disseminated intravascular coagulopathy(DIC)
if bleeding persists in spite of all other treatment described, DIC should be suspected
the blood passing from the genital tract is not clotting
shock: reduction of effective circulation
inadequate perfusion of all tissues
oxygen depletion
depression of functions
Record:
pulse
blood pressure
maternal heart rate
central venous pressure
urine output
Lab tests:
Hb,
BT(bleeding time), CT( clotting time),
platelets count
fibrinogen
prothrombin time and patial thromboplastin time
FDP
women''s group and cross-matching
Treatment:
the key is correcting the coagulation defect
resuscitation must be started as soon as possible
infusion of crystalloid(saline) and Dextran is started firstly while arranging the blood transfusion
blood transfusion is essential
infusion of platelets, fresh frozen plasma, FDP , clotting factors,
Potential complications of PPH:
Postpartum infection
Anemia
Transfusion hepatitis,
Sheehan''s syndrome
Asherman''s syndrome
The best management of PPH is prevention
Key words
the definitio n of HHP
The causes of HHP
treatment methods of Uterine atony
the types of retained placenta
the degrees of the perineal and vaginal laceration
394969
·上一篇：结膜下巩膜破裂致交感性眼炎一例
·下一篇：一种简单有效的控制产后出血的方法
产后出血
林建华
Major causes of death for pregnancy women
(maternal mortality)
Postpartum hemorrhage(28%)
heart diseases
pregnancy-induced hypertension
(or Amniotic fluid embolism )
infection
Definition of PPH
be defined as a blood loss exceeding 500ml after delivery of the infant
PPH: occurs in 24 hour of delivery
the late PPH: occurs after 24 hour of delivery to 6 weeks
Major causes
Uterine atony (90%)
lacerations of the genital tract(6%)
retained placenta(3%-4%)
coagulation defects (blood dyscrasia)
(4T: tone, tissue,trauma,thrombin)
1. Uterine atony
Local factors
overdistention of the uterine (hydramnios, multiple pregnancy, macrosomia )
condition that interfere with contraction(leiomyomas)
complications(PIH,anaemia, placenta praevia
Systemic factors:
nervous
drugs(magnesium sulfate,sedative)
abnormal labor(prolonged,precipitous)
History of previous PPH
Preeclampsia, abnormal placentation,
pathology
Contraction constricting the spiral arteries
preventing the excessive bleeding from the placenta implantation site
the uterine atony give rise to PPH when no contraction occur
Prevention and therapeutic of uterine atony
Administration of medicine:
promotes contraction of the uterine corpus
decreases the likelihood of uterine atony
Oxytocin agents
Methegine
prostaglandin
Mechanical stimulation of uterine contraction:
Massage of uterus through the abdomen and bimanual compression
intrauterine packing
Surgical methods
If massage and agents are unsuccessful:
Ligation of the uterine arteries
ligation of the hypogastric arteries
selective arterial embolization
hysterectomy
taking into account the degree of hemorrhage,the overall status of patient,her future childbearing desires
2. Lacerations of the genital tract
Causes:
Instrumented delivery (forceps)
manipulative delivery(breech extraction,precipitous labor, macrosomia)
Types:
perineum laceration
vaginal laceration
cervical laceration
perineum and vaginal laceration
The first degree tear:
involves only skin and a minor part of the perineal body
the second degree tear:
involves the perineal body and vagina
the third degree tear:
involves the anal sphincter and anal canal
management
Vaginal examination soon after delivery
repair:
cervical laceration >2cm in length and be actively bleeding
laceration of vaginal and perineum
3. Retained placenta
Separation and explosion of placenta is caused by strong uterine contraction
Placenta tissue remaining in the uterus
prevent adequate contraction and predispose to excessive bleeding
causes:
adherence of placenta (previous cesarean delivery,prior uterine curettage)
succenturiate placenta
placenta accreta (into the decidua)
placenta increta(into the myometrium)
placenta pericreta(through the myometrium to the peritoneal)
Prevention and treatment
The placenta should be examined to see that it is complete or not
part of placenta is missing, removed digitally
not separated, manual removal of placenta is done
hysterectomy is required for placenta increta(percreta,accreta)
uterine contraction drugs
4. Coagulation defects
Acquired abnormality in blood clotting:
abruptio placenta,
amniotic fluid embolism
severe preclampsia
congenital abnormality in blood clotting:
thrombocytopenia
severe hepatic diseases
leukemia
disseminated intravascular coagulopathy(DIC)
if bleeding persists in spite of all other treatment described, DIC should be suspected
the blood passing from the genital tract is not clotting
shock: reduction of effective circulation
inadequate perfusion of all tissues
oxygen depletion
depression of functions
Record:
pulse
blood pressure
maternal heart rate
central venous pressure
urine output
Lab tests:
Hb,
BT(bleeding time), CT( clotting time),
platelets count
fibrinogen
prothrombin time and patial thromboplastin time
FDP
women''s group and cross-matching
Treatment:
the key is correcting the coagulation defect
resuscitation must be started as soon as possible
infusion of crystalloid(saline) and Dextran is started firstly while arranging the blood transfusion
blood transfusion is essential
infusion of platelets, fresh frozen plasma, FDP , clotting factors,
Potential complications of PPH:
Postpartum infection
Anemia
Transfusion hepatitis,
Sheehan''s syndrome
Asherman''s syndrome
The best management of PPH is prevention
Key words
the definitio n of HHP
The causes of HHP
treatment methods of Uterine atony
the types of retained placenta
the degrees of the perineal and vaginal laceration
394969
·上一篇：结膜下巩膜破裂致交感性眼炎一例
·下一篇：一种简单有效的控制产后出血的方法
