Hemorharge Post Partum

Yuma S
 HPP
Definisi:
Perdarahan > 500 cc pada pasca persalinan
Pervaginam atau > 1000 cc pada SC

Klasifikasi berdasarkan waktu

1. Early HPP  < 24 jam
2. Late HPP  > 24 jam
 HPP
Causes of Early Postpartum Hemorrhage
-Uterine atonia
-Retained plac fragments
-Lower genital tract laceration
-Uterine rupture
-Uterine inversion
-Plac accreta
-Hereditary coagulopathy
 HPP
Causes of Late or Secondary Postpartum
Hemorrhage
• Infection
• Retained placental fragments
• Subinvolution of the placental site
• Inherited or acquired coagulopathy
 HPP
Etiologi:
1. Atonia uteri
2. Sisa plasenta
3. Robekan jalan lahir
4. Infeksi
5. Ggn pembekuan darah
6. Inversio uteri
 HPP
Penyebab tersering dari atonia:
1. Regangan berlebih dari rahim spt pada
hidramnion, kembar dll
2. Grande multipara (anak lebih dari 5)
3. Partus presipitatus
4. Intraamniotik infeksi
5. Protracted labor
6. Prolonged induction of labor
7. Penggunaan anestesi halogen
General Principles in the Management of
Postpartum Hemorrhage
• Establish etiology
• Call for assistance
• Notification of blood bank for emergency need
for packed red blood cells, platelets, and other
clotting factors
• Establish venous access (preferably two large-
bore intravenous lines)
• Replace blood volume
• Correction of coagulopathy
• Monitor pulse, blood pressure, and urine output
(Foley catheter)
 HPP
Surgical Techniques for the Management
of Postpartum Hemorrhage
• Uterine compression sutures ( B-Lynch )
• Uterine artery ligation
• Internal iliac (a.hypogastricâ) artery
ligation
• Hysterectomy (supracervical or total)
 HPP
Indications for Emergency Peripartum
Hysterectomy
• Uterine atony
• Placenta accreta
• Placenta previa
• Uterine laceration
• Uterine rupture
• Uterine leiomyomata
Terima kasih