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Postpartum hemorrhage: Clinical
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But in rare situations, it happens later than 24 hours after delivery, and that’s where it’s called late, or secondary postpartum hemorrhage.
Stage 2 is when 1000 to 1500 milliliters have been lost. Systolic blood pressure drops to 80 to 100 mmHg, tachycardia is obvious, and there may be weakness and sweating.
Stage 3 is when 1500 to 2000 milliliters have been lost. Systolic blood pressure drops between 70 and 80 mmHg, and there may be restlessness, pallor and low urine output.
Finally, stage 4 is when more than 2000 milliliters have been lost, systolic blood pressure is less than 70 mmHg, and symptoms may include cardiovascular and respiratory collapse, loss of consciousness and and anuria.
Now, before elucidating the cause, some immediate measures should be taken in order to compensate the blood loss. These follow an A-B-C pattern.
A stands for airway, so you’ll want to protect the airway, especially when there’s loss of consciousness.
C stands for circulation - meaning measuring vital signs and establishing the degree of hypovolemia, inserting two large caliber peripheral IV catheters - of at least 14 gauge or even larger-gauge -, and starting fluid resuscitation immediately, with 500 milliliters of normal saline or lactated Ringer’s solution given over 30 minutes.
Postpartum hemorrhage is defined as blood loss of more than 500 mL for a vaginal delivery, or more than 1000 mL for cesarean delivery, within the first 24 hours following childbirth. Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breath rate.
Risk factors for PPH include prolonged labor, a large baby, placenta complications, an infection, or underlying medical conditions. Treatment for PPH depends on the cause and can range from uterine massage to a blood transfusion. Prevention strategies include proper prenatal care, labor monitoring, and active management of the third stage of labor.
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