Complications of

3 Stage of labour
rd

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1. Retained placenta
2. Post partum haemorrhage
PPH-with placenta retained
-without retained placenta
1. Tear and lacerations in genital tract
2. Uterine inversion
3. Amniotic fluid embolism
4. Uterine rupture
5. Post partum collapse
6. Coagulation disorder (DIC)
Retained placenta
 Placenta is not expelled 30 min after the delivery of
foetus
Feb 6, 2013 2
Causes of retained placenta
(1) Uterine atony
-fully bladder
-grandmultip
-prolonged labour
-precipitate labour
-prolonged Anaesthesia
-over distension of Ut –Twins
(2) Constriction ring
-hourglass constriction of Ut
-localized constriction just above LUS due to –
intrauterine manipulation
-prolonged labour

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(3) Morbid adhesion of placenta
types acreta
increta
percreta

Sign and symptom -bleeding PV slight/heavy or no

bleeding
-shock
-Ut. Flabby-usually
Management
1. I/V line
2. Bld G&M –reserve bld
--if necessary – give bld
3. Resuscitation of shock
4. Catheterization-aseptic
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5. Look for signs of pla: seperation
If (+)  controlled cord traction & deliver the
placenta
If (-) –I/V Ergometrine /synto CCT
If still (-) Manual Removal under anesthesia in OT
-follow the cord
-find the edge
-abd. hand guard the Ut
-remove the pla:
-give oxytocis
-check the Pla:
-antibiotics

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Postpartum Haemorrhage
Def: -loss of 500ml or more of blood from genital tract after
delivery
1) PPH with retained placenta
2) PPH without retained placenta
Incidence 2% of all deliveries
Types P• PPH –bleeding within 24hr after delivery
S• PPH –bleeding 24hr after the delivery
Causes of Primary PPH
(1) Ut atony -full bladder
-prolonged labour
-GM
-over distension of Ut
-APH -Abruptio
-placenta praevia
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-fibroid
 (2) Trauma in the genital tract
a) spontaneous
b) interferences -forceps
-vacuum
-Op-LSCS
-perinetal tears -vg
-Cx
-Ut. rupture
(3) Coagulation disorders
DIC – Abruptio
(4) Ut inversion
Complications—
1) shock if anaemia >worse
2) mat. death
3) post partum anaemia
4) renal failure
5) post partum pituitary necrosis
Sheehan’s syndrome
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Prevention
(1) Antenatal Care
-correct anaemia-prevent anaemia
-high risk patient
-past H/O PPH
-Twins, hydramnios
-G.M Myoma
Delivery in hospital
(1) During labour -prevent prolong labour
-partogram
-Active M of 3rd stage
Management - two principles
-Bleeding must be arrested
-Blood vol. must be restored

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 P’ PPH ē retained placenta
(M) – same as retained placenta
It placenta is already delivered ē PPH
Check BP, pulse, Color
-consciousness
-Ut. Contraction
-free fluid in abdomen
-Ut height –hard or soft
-placenta –complete or not to check
Put up I/V line-drip
-reserve blood G&M
-give blood if necessary CVP line
-if shock –(T) the shock
-empty bladder-catheterization
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If Ut is soft –I/V Ergometrine 0.5mg
-I/V syntocinon 5-10unit
-PG
-Continue synto 40 unit in drip
-rub the ut per abd-ut fundus
-If still bleeds -Bimanual compression
-Fist in ant fornix vaginally
-Abd hand in post fornix- compress the Ut between 2 hands
Aortic Compression
Bleeding(+) Laparotomy
-TAH
-Internal Iliac artery ligation
-antibiotics
intake out put chart for renal failure

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 2’ PPH >24hr after delivery incidence 5-10%
Causes-retained pieces of placenta
-seperation of infected slough in Cx or
Vg tear, LSCS wd.
-infected fibroid
(T) Evacuation
-antibiotics
Blood transfusion

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Uterine inversion
Ut is turned inside out partially or totally
Types -1st degree Fundus inside the Ut
-2nd degree fundus in vag.
-3rd degree whole Ut outside the introitus
Clinical features –profound shock-painshock
-PPH
-appearance of fundus at vulva
-pain
-Ut fundus not felt per abd

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 (T) Immediate replacement
-(T) of shock
-I/V line
-Bld transfusion
-manual reposition
-O sullivain’s hydrostatic pressure method
-3 feet above the patient- put N/S into the vaginal
Genital tract injury
1st perineal tear –skin + small area of P. body
2nd perineal tear-P. body + Vg
3rd perineal tear –anal sphincter & mucosa

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 1st + 2nd –Immediate repair –LA
3rd tear –OT-under Anaesthesia
-anal mucosal 1st
-sphincter
-vg., P. body + skin
Post OP-wound care –keep clean & dry
-oral liquid followed by semisolid + solid
-catheter
-antibiotics

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Postpartum obstetric shock
Causes - 1)Amniotic fluid embolism
2)pulmonary embolism
3)A/C ht failure-cardio myopathy
-vulvular heart disease
4)pneumonitis-Mendelson’s syndrome
5)pneumothorax
6)CVA
7)Eclampsia
8)hypoglycaemia
9)septicaemia
10)asso ē GA, prolonged labour, trauma,
electrolyte imbalance, Mat. Infection
(T) – (T) the cause.

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 Coagulation disorder
DIC
Abruptio placenta
Amniotic fluid embolism
Puerperal sepsis
Prolonged & massive haemorrhage
DVT

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 The end

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