pph.ppt
- 1. Postpartal Haemorrhage (PPH) Why is this topic important? PPH is the main reason for maternal death, both - In Europa/USA - Africa If you can recognise and handle PPH properly, you will safe lives, if you can`t you will loose women
- 2. Postpartal Haemorrhage (PPH) Definition: Any blood loss from the birth channel exceeding 500 ml. Any amount sufficient to cause cardiovassicular compromise. - Primary PPH within 24 h - Secundary PPH after 24 h to 6 weeks after birth.
- 3. PPH Causes: Primary PPH Secundary PPH: • Tonus • Tears • Tissue • Subinvolutio uteri, infection • Retention T T T
- 4. PPH Causes: • Tonus – Uterine Atony • Tears – Perineal, vaginal, cervical, uterine • Tissue – Placental retention, uterine eversion
- 6. Uterine Atony PPH Increased uterine bleeding due to inability to contract properly.
- 7. PPH: Uterine Atony • Excessive bleeding • Soft, enlarged uterus, • HOF ▲ • BP, Pulse ▼ • Impaired coagulation Symptoms
- 8. PPH: Uterine Atony Secundary PPH: • Excessive uterine distension • Multiparity • Prolonged labour, uterine inertia • Labour augmented wit Synto • General anaesthesia • Placenta praevia (lower segment) • Placental abruption Risk factors, Etiology
- 9. PPH Uterine Atony • Tears • Tissue • Coagualtion DD
- 10. PPH: Uterine Atony Therapy • Call for help (1) • Stop bleeding, insert cath. (1) • iv Line, put up drips, give drugs (2) • Cross match, FBC (2) • Monitoring BP, pulse, respiration (3)
- 11. • 1Amp Oxytocin® (5-10 IE) i.v. • 0.5 mg Ergometrine i.v. (repeat) • Drip 40-80IE Oxytocin® (4-8 Amp) and 1 mg Ergometrine® in 1000ml Ringer, NaCl • 1mg Misoprostol (Cytotec® ): 5 Tbl. à 200ug rectally • Consider PGF2 (Hemabate) PPH: Uterine Atony Drugs
- 12. Bimanuelle Kompression des atonen Uterus PPH: Uterine Atony Manual Compression
- 13. Tamponade des atonen Uterus PPH: Uterine Atony Package of Uterus
- 14. PPH: Uterine Atony Surgical Therapy If conservative Tx not effective, don`t loose time • Compressing sutures • Tornique • Ligation of uterine artery • pp hysterectomy
- 15. Funduskompressionsnähte nach von Castelberg (Schnarwyler 1996) PPH: Uterine Atony Surgical Therapy, compressing sutures
- 18. PPH: Uterine Atony Surgical Therapy B-Lynch Sutures
- 19. PPH: Uterine Atony Surgical Therapy Other fency sutures
- 20. PPH: Uterine Atony Surgical Therapy Torniquet
- 21. PPH: Uterine Atony 1911: Momburgsche Blutleere
- 22. PPH, Uterine Atony: Postpartal Hysteretomy Postpartal Hysterectomy: Consider prior hysterectomy • Tornique • Lig. ut artery • Compression sutures
- 24. PPH: inversio uteri definition: Eversion of uterus Causes: • Fundal placenta • Uterine atony • placenta accreta • cord traction Very rare
- 25. PPH: inversio uteri Management • General anaesthesia • catheter • Drip, close monitoring • If available give tocolytic drugs • Manual reposition • After reposition, oxitocin, ergometrine
- 28. PPH, retained Placenta: Retention of Placenta, incomplete Placenta: Definition: Retention or incomplete P. after 30 min Causes: Acreta Increta Percreta
- 29. PPH, retained Placenta: Symptoms: • Bleeding > 500ml • Impaired circulation • Uterine atony • Growing HOF
- 30. PPH, retained Placenta: Treatment: Active Management • Dont`wait • Give Oxytocin Bolus (5IE i.v.) • catheter • Rub uterus ( massage) • suction • Cord traction / Credé
- 31. PPH, retained Placenta: Tx surgical: • Give anaesthesia • Monitoring, drip • Cross match, FBC • Manual removal of Placenta • Post intervention: Oxytocin, ergometrin, misoprostol Close patient monitoring vitals, urine out put> 30mlslhr.
- 32. PPH, retained placenta: Surgical Tx: Abdominal hand inner hand
- 33. Tears Grade I-IV: PPH, TEARS:
- 34. Suturing in SpA PPH, TEARS: sphincter ani
- 35. Laceration of the Cervix RF: - Forceps - Vacuum PPH TEARS:
- 36. PPH: Conclusion: PPH is the most dangerous condition after delivery • can be fatal even if recognised and treated • active management is mandatory and life saving • always have the next step in mind • don`t wait for problems, treat problems before they get fatal • prepare yourself and the labour ward for PPH
- 37. PPH: Conclusion: Remember TTT • Tonus • Tissue • Tears Remember Drugs • Oxytocin • Ergometrine • Misoprostol Be prepared for surgery • compr. Sutures, Ligation, Hysterectomy
- 38. PPH: Cases: Case 1 25 yo IG/IP 40 week of gestation, admitted with ruptured membranes, labour - normal first stage of labour - prolonged second stage of labour - fetal distress - vacuumdelivery - delivery of placenta within 15 min - Massive PPH, uterus well contracted - BP 90/50 mmHg, Puls 110 BPM Assesment, Plan
- 39. PPH: Cases: Case 2 35 yo IXG/IP 42 weeks of gestation, polyhydramnion - normal first and second stage of labour -delivery of placenta normal - massive PPH, HOF 5 cm above umbilicus Assesment, Plan
- 40. PPH: Cases: Case 3 30 yo, IIIG/IIIP, 37 weeks of gestation - Hx of two incomplete abortion with evacuation - uncomplicated delivery - placenta 1 h pp with strong cord traction - massive PPH, HOF umbilicus Assesment, Plan
- 41. PPH: Cases: Case 4 32 yo IG/IP 40 weeks of gestation - Hx of excessive menstrual bleeding, Hx of recurrent epistaxis - normal delivery, incl. placenta - massive PPH - uterus well contracted Assesment, Plan