Professional Documents
Culture Documents
Objectives
Definition
Etiology
Risk Factors
Prevention
Management
Puddles on the floor
Revealed bleeding.
Postpartum Hemorrhage
Traditional Definition
blood loss of > 500 mL following vaginal delivery
blood loss of > 1000 mL following cesarean
delivery
Functional Definition
any blood loss that has the potential to produce or
produces hemodynamic instability
Incidence
about 5% of all deliveries
Postpartum Hemorrhage
Etiology of Postpartum
Hemorrhage
Tone - uterine atony
Tissue - retained tissue/clots
Trauma - laceration, rupture,
inversion
Thrombin - coagulopathy
Postpartum Hemorrhage
Rusch balloons
Condom catheters
Gauze
Surgical Procedures
Angiographic embolization
Hysterectomy
Rupture of the Uterus
Primary occurring in a previously intact
or unscarred uterus
Secondary reexisting myometrial inci-
sion, injury, or anomaly
Complete when all layers of the uterine
wall are separated
Incomplete when the uterine muscle is
separated but the visceral peritoneum is
intact
Diagnosis
Hypovolemic shock
Diaphragmatic irritation with pain referred
to the chest
Nonreassuring fetal heart rate
Cessation of contractions
Loss of station
Breech extraction
Prevention
be prepared
active management of the third stage
prophylactic oxytocin with delivery or with
delivery of anterior shoulder
10 U IM or 5 U IV bolus
20 U/L N/S IV run rapidly
early cord clamping and cutting
gentle cord traction with suprapubic
countertraction
Postpartum Hemorrhage
A = airway
A B CB
C
=
=
breathing
circulation
Postpartum Hemorrhage
Management - ABCs
talk to and observe patient
large bore IV access (16
gauge)
crystalloid - lots!
CBC
cross-match and type
get HELP!
AIRWAY
Eddy Rahardjo
Estimasi BB : ... 60 kg
Estimasi Blood Volume : ... 70 ml/kg x 60 = 4200 ml
Estimasi Blood Loss : .... % EBV = ..... ml
-- 15% EBV
NORMO -- 30% EBV
VOLEMIA -- 50% EBV
Management - Oxytocin
5 units IV bolus
20 units per L N/S IV wide open
10 units intramyometrial given
transabdominally
Postpartum Hemorrhage
Management -ManualExploration
if no response to bimanual massage
and oxytocin then proceed to
exploration
manual exploration will:
rule out uterine inversion
palpate cervical injury
remove retained placenta or clot from
uterus
rule out uterine rupture or dehiscence
Postpartum Hemorrhage
if coagulation is normal:
prepare for O.R. (may consider embolization)
Tidak
Perdarahan berlanjut
Histerektomi
Postpartum Hemorrhage
Management - ABC s
Conclusions
be prepared
practice prevention
assess the loss
assess maternal status
resuscitate vigorously and
appropriately
diagnose the cause
treat the cause
Postpartum Hemorrhage
Management - Evolution
Panic
Panic
Hysterectomy
Pitocin
Prostaglandins
Happiness
Postpartum
Hemorrhage
Thank You