Presented by: Ms.

MANI B SDMINS

Definition
Quantitative Definition: It is related to the amount of blood loss in excess of 500ml following birth of the baby. Clinical Definition: any amount of bleeding from or into the genital tract following the birth of the baby upto the end of the puerperium which adversely affects the general condition of the patient evidenced by raised pulse and falling blood pressure is called Post partum haemorrhage.

Types of PPH
1. Primary PPH
Third stage hemorrhage True PPH

2. Secondary PPH

Causes
Atonic Uterus
Traumatic coagulopathy

Clinical Manifestation
Copious, continuous or intermittent gushes. No external bleeding - but distended uterus is observed due to accumulation of bleeding. In ATONIC PPH soft & flabby uterus. In TRAUMATIC PPH firmly contracted. pulse rate & blood pressure. Altered LOC. Maternal collapse.

Investigations
Hemoglobin, haematocrit Urine output monitoring
Central venous pressure monitoring

Management
Schematic Diagram
Immediate Measures
Call for help Start I.V. line Send blood cross matching Rapid infusion of NS till blood arranged

Feel the uterus by palpation

Atonic Uterus

Uterus hard & contracted (traumatic)

Uterus remains ATONIC

Exploration of tear sites

Surgical methods

Haemostatic sutures

Hysterectomy

Complications
Hemorrhagic shock Acute renal failure Puerperal sepsis Failure to establish lactation

Subinvolution
Iron deficiency anemia