Module 3

Postpartum haemorrhage
Learning outcomes

 Define PPH
 Explain the types of PPH
 Point out various factors that need consideration
in PPH
 Describe the prevention guidelines for PPH
 Clarify the diagnosis and clinical mamifestations
 Discuss the management protocol
Definition

 Isexcessive vaginal bleeding of 500ml or

more post delivery until 42 days after
giving birth
 Can be classified as
 Primary PPH(bleeding takes place within
24 hours post-delivery)
 Secondary PPH (bleeding after 24 hours-42
days post-delivery)
Primary PPH types

 Atomic PPH
 Traumatic PPH
 Uterine rupture, usually catastrophic
Various factors need to be considered;

 APH and intrapartum blood loss

 Hb levels and haematocrit
 Cardiovascular competency or compromise
 Woman’s physical condition and body weight
 Other factors such as coagulation defects
 Contextual factors, such as staff, skills and
equipment available
Major types of primary PPH

 Atonicpostpartum haemorrhage
 Traumatic postpartum haemorrhage
Atonic postpartum haemorrhage

 Occurs within first 24 hours post-delivery

 Characterised by clear blood gushing from
the vagina, with relaxed uterus
 It occur as result of:
 An overstretched uterus in a grand
multipara woman,multiple pregnancy or
polyhydramnios or/uterus that is tired after
Atonic postpartum haemorrhage

 a prolonged or obstructed labour

 Abnormalities of the uterus such as myomata and
bicornuate uterus
 Congenital factors such as blood coagulation defect
conditions
 Retained products of conception and placental pathology
 Obstetric interventions such as IOL, anaesthesia and
Caesarean section
 Low Hb
 Full bladder
Traumatic postpartum haemorrhage

 Well Contracted uterus, with clots coming from vagina

 Bleeding is not active
 Predisposing factors include
• Forceps delivery
• Vacuum/ventouse extraction
• Large baby
• Precipitate labour
Prevention guidelines

 Good antenatal care with improved

nutritional status of pregnant women
 Routine supplementation of iron, folic acid
and vitamin C
 All women at risk should deliver hospital
 Women with previous history of PPH or
retained placenta
Prevention guidelines

 Earlydetection of PPH by routine

monitoring after delivery and C/S
 Allwomen at risk for PPH should routinely
have IV line during labour
 Ensure an empty bladder
 Execute AMTSL for all women
Prevention guidelines

 Carry out routine management of fourth stage of

labour with strict observation of uterus and blood
loss
 Putting baby to breast can be helpful in mild
cases
 An IV infusion with 20 IU of oxytocin in 1 000 ml
Ringers’s lactate is continued for 24 hours post-
delivery or until stable
Diagnosis

 500 ml of blood loss

 Depends on woman ‘s Hb level
 Low
HB may be fatal irrespective of the
amount of blood lost
Clinical manifestations

 APH with current pregnancy

 Low HB
 Cardiac conditions
 Pre-eclampsia
Following progression of condition(grade
I & II)

 Vasodilatation
 Tachycardia
 Increasein diastolic BP
 Decrease in urine output
 Nausea and vomitting
Progressive state (1500-2 000 ml; grade
III)

 Overwhelming compensatory response

 Severe dysrhythmia and myocardial
ischaemia
 Hypotension, late sign of shock
Refractory stage

 Failing of compensatory mechanisms

 Shutting down of kidneys
 Tissue necrosis caused by low BP
 Pituitary
gland necrosis (Shehaan’s
syndrome)
 Air hunger