![]() ![]() Active management of PPH reduces the risk of secondary coagulation disorder s.To ascertain the various causes of delayed postpartum hemorrhage and to test whether subinvolution of the placental bed is associated with other pregnancy disorders for which defective maternal-fetal interaction has been implicated pathogenetically. – Coagulation disorders may be the cause and the result of PPH. packed red blood cells or whole blood + fresh frozen plasma.fresh whole blood (blood freshly collected, for less than 4 hours, and that has not been refrigerated), or.– In the event of coagulation disorders, transfuse: – In rare cases, it is impossible to remove the placenta manually because there is no cleavage plane between the placenta and the uterine wall (placenta accreta). – Give routine antibiotic prophylaxis (Chapter 9, Section 9.1.2). Do not proceed without anaesthesia unless anaesthesia cannot be performed immediately. ![]() – Perform manual placenta removal and manual uterine exploration under anaesthesia. – Immediate manual removal if the placenta has not yet delivered and/or routine uterine exploration to remove any clots or placental debris (allows good uterine retraction) and to verify that there was no uterine rupture (for vaginal deliveries with a scarred uterus, in particular). – An episiotomy can bleed: temporarily stop arterial bleeding with a clamp and suture as quickly as possible. – Cervical or vaginal tears: Section 8.5. – Uterine rupture: Chapter 3, Section 3.3. If the following causes are identified, additional specific management is required. − If necessary, perform one of the additional compression measures below.Īpply pressure to the abdominal aorta (just above the umbilicus) until the femoral pulse is no longer palpable, for example, the time it takes to insert an intrauterine balloon or start laparotomy (Figure 8.2).īimanual uterine compression (Figure 8.3 and Figure 8.4).įigure 8.3 - Uterine compression between fingers in the vagina and a hand on the abdomenįigure 8.4 - Uterine compression between the fist and a hand on the abdomen − Start transfusion as quickly as possible. − Perform initial management as quickly as possible and do not wait 30 minutes to perform further obstetric management (intrauterine balloon tamponade, surgical procedures). In the event of 150 ml of blood loss per minute or shock: Subtotal hysterectomy is preferable, as it limits the operative time.Ĩ.2.3 Management of immediate massive haemorrhage Radical surgical treatment: hysterectomy with adnexal preservation.Section 9, Chapter 51: Therapy for Non-atonic Bleeding, C. For more information on B-Lynch suture: A Comprehensive Textbook of Postpartum Hemorrhage 2 nd Edition. Uterine compression suture (B-Lynch or other type suture) a Citation a. Stepwise ligation of the uterine blood supply (round ligaments, utero-ovarian arteries, uterine arteries) − If bleeding continues, perform the following: − Additional measures if necessary ( Section 8.2.3). ![]() If an intrauterine balloon is inserted in a BEmONC facility, it is imperative to transfer the patient to a CEmONC facility in order to have surgical resources on hand should they be necessary. − In the event of persistent atony: insert an intrauterine balloon (c) Citation c. Transfuse fresh whole blood or packed red blood cells or whole blood + fresh frozen plasma in the event of massive haemorrhage and/or coagulation disorders. – Retained placenta (10% of cases): the entire placenta or a fragment of the placenta remains in the uterus. – Obstetric trauma (20% of cases): uterine rupture, particularly in case of vaginal delivery in women with a scarred uterus but also in women without uterine scarring cervical and vaginal lacerations uterine inversion. It can be the cause or an aggravating factor of the PPH. Factors for uterine atony include: overstretching (polyhydramnios, multiple pregnancy, foetal macrosomia), prolonged labour and infection (chorioamniotitis). The uterus gets larger, extends, and becomes soft. – Uterine atony (70% of cases): the placenta has been expelled, but the uterus fails to retract. The volume exceeds the normal 500 ml third stage blood loss.Ĭlose delivery room monitoring is crucial for 2 hours post-partum, in order to rapidly identify and treat postpartum haemorrhage (PPH).īlood loss is often underestimated (up to 50%).ĭelay in treatment can lead to coagulation disorders, with a risk of massive, diffuse bleeding. Early postpartum haemorrhage is defined as bleeding that occurs within 24 hours (usually immediately) after delivery of the placenta. ![]()
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