Postpartum hemorrhage

955,504views

test

00:00 / 00:00

Postpartum hemorrhage

OBGYN

OBGYN

Anatomy of the female reproductive organs of the pelvis
Anatomy of the pelvic cavity
Anatomy of the pelvic girdle
Nerves and lymphatics of the pelvis
Arteries and veins of the pelvis
Anatomy of the urinary organs of the pelvis
Anatomy of the female urogenital triangle
Anatomy of the perineum
Anatomy clinical correlates: Female pelvis and perineum
Estrogens and antiestrogens
Progestins and antiprogestins
Androgens and antiandrogens
Puberty and Tanner staging
Disorders of sexual development and sex hormones: Pathology review
Disorders of sex chromosomes: Pathology review
Menstrual cycle
Amenorrhea
Amenorrhea: Pathology review
Amenorrhea: Clinical
Hypoprolactinemia
Polycystic ovary syndrome
Virilization: Clinical
Abnormal uterine bleeding: Clinical
Abdominal pain: Clinical
Pelvic inflammatory disease
Ovarian cyst
Ovarian torsion
Uterine fibroid
Endometriosis
Endometritis
Uterine disorders: Pathology review
Vulvovaginitis: Clinical
Vaginal and vulvar disorders: Pathology review
Urethritis
Female sexual interest and arousal disorder
Orgasmic dysfunction
Genito-pelvic pain and penetration disorder
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
HIV and AIDS: Pathology review
Sexually transmitted infections: Clinical
Premature ovarian failure
Menopause
Urinary incontinence: Pathology review
Ovarian cysts, cancer, and other adnexal masses: Clinical
Ovarian cysts and tumors: Pathology review
Vulvar cancer: Clinical
Vaginal cancer: Clinical
Cervical cancer
Cervical cancer: Pathology review
Cervical cancer: Clinical
Endometrial hyperplasia
Endometrial cancer
Endometrial hyperplasia and cancer: Clinical
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Germ cell ovarian tumor
Krukenberg tumor
Benign breast conditions: Pathology review
Fibrocystic breast changes
Breast cancer
Breast cancer: Pathology review
Intraductal papilloma
Phyllodes tumor
Paget disease of the breast
Aromatase inhibitors
Contraception: Clinical
Infertility: Clinical
Pregnancy
Development of twins
Ectopic pregnancy
Miscarriage
Routine prenatal care: Clinical
Hyperemesis gravidarum
Preeclampsia & eclampsia
Gestational hypertension
Hypertensive disorders of pregnancy: Clinical
Gestational diabetes
Gestational trophoblastic disease
Gestational trophoblastic disease: Clinical
Oligohydramnios
Potter sequence
Polyhydramnios
Intrauterine growth restriction
Cervical incompetence
Placenta previa
Placenta accreta
Placental abruption
Antepartum hemorrhage: Clinical
Chorioamnionitis
Choriocarcinoma
Complications during pregnancy: Pathology review
Premature rupture of membranes: Clinical
Preterm labor
Stages of labor
Uterine stimulants and relaxants
Vaginal versus cesarean delivery: Clinical
Abnormal labor: Clinical
Postpartum hemorrhage
Postpartum hemorrhage: Clinical
Breastfeeding
Mastitis
Congenital TORCH infections: Pathology review
Neonatal conjunctivitis
Congenital toxoplasmosis
Congenital cytomegalovirus (NORD)
Congenital syphilis
Neonatal herpes simplex
Congenital rubella syndrome
Neonatal sepsis
Neonatal meningitis
Fetal hydantoin syndrome
Fetal alcohol syndrome
Chlamydia pneumoniae

Assessments

Flashcards

0 / 9 complete

Flashcards

Postpartum hemorrhage

0 of 9 complete

External References

First Aid

2024

2023

2022

2021

Coagulopathy

postpartum hemorrhage p. NaN

Postpartum hemorrhage p. NaN

Transcript

Watch video only

Postpartum hemorrhage is a significant loss of blood after giving birth, and it’s the number one reason for maternal morbidity and maternal death around the world.

Specifically it’s defined as losing more than 500ml of blood after a vaginal delivery or more than 1000ml after a cesarean section delivery.

Of course, deliveries can be messy and it’s impossible to measure the precise amount of blood that’s lost, and there’s the possibility of internal bleeding.

So additional criteria to consider for postpartum hemorrhage include a decrease of 10% or more in hematocrit from baseline, as well as changes in the mother’s heart rate, blood pressure, and oxygen saturations —all of which suggest a significant blood loss.

Significant bleeding in the first 24 hours after delivery is called primary postpartum hemorrhage, and after that it’s called secondary, or late, postpartum hemorrhage.

The most common causes of postpartum hemorrhage can be lumped into four groups which can easily be remembered as the “4 Ts”: Tone, Trauma, Tissue, and Thrombin.

Tone refers to a lack of uterine tone, also known as uterine atony—basically a soft, spongy, boggy uterus, and this is the main cause of postpartum hemorrhage, generally resulting in a slow and steady loss of blood.

Now, the uterus is a muscular organ wrapped by three layers of smooth muscle called the myometrium, which contracts during labor to dilate and efface the cervix and ultimately push out the fetus and placenta.

After delivery, the myometrium continues to contract and this squeezes down on the placental arteries at the point where they are attached to the uterine wall, which clamps them shut, and therefore reduces uterine bleeding.

The contractions continue for a few weeks after the delivery.

With uterine atony, though, the uterus fails to contract after birth, and those placental arteries don’t clamp down, which leads to excessive bleeding and postpartum hemorrhage.

Uterine atony can be caused by several things, repeated distention of the uterus as a result of multiple pregnancies, overstretching from twins or triplets, or any condition that causes too much uterine stretching can interfere with efficient uterine contractions and lead to diminished tone and eventual uterine atony.

Uterine atony can also occur when the uterine muscles fatigue during the delivery process because of a prolonged labor.

It can also happen when a woman is unable to empty her bladder, since a full bladder can push against the uterus and interfere with uterine contractions.

Finally, some commonly used obstetric medications like anesthetics (especially halothane), as well as magnesium sulfate, nifedipine, and terbutaline can all interfere with uterine contractions and increase the risk of uterine atony.

Uterine atony can be treated by fundal massage, or massaging the fundus—the upper section of the uterus which is typically near the umbilicus right after birth.

Fundal massage causes the smooth muscle in the wall uterine wall to contract and harden.

If a full bladder seems to be interfering with contractions, then a woman can urinate or have a catheter placed if she can’t void by herself.

Medications to help firm up the uterus can also be given, and if necessary, the bleeding may be stopped surgically.

Summary

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.