Post partum hemorrhage slideshare

Uterine atony (or uterine tone) refers to a soft and weak uterus after childbirth. It happens when your uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth. This can lead to life-threatening blood loss after delivery. Immediate medical treatment is required. Overview What is uterine atony? Uterine atony (atony of the uterus) occurs when your During pregnancy, your baby grows in your uterus and gets blood, oxygen and nutrients from the placenta. Blood vessels and arteries supply blood to your baby through the Uterine atony can also occur during a Atony of the uterus requires immediate medical intervention. Most people have a full recovery when it's treated promptly. What happens if your uterus doesn't contract after birth? When muscles in your uterus don't contract What are the risk factors for uterine atony? Uterine atony has several risk factors. These factors can prevent your uterus from contracting after delivery: • This is your first baby or you’ve had more than five babies. • You’re having • Your baby is larger than average ( • You’re • You have too much amniotic fluid ( • You have obesity. • You have Healthcare providers also believe if the following factors are present during labor, your uterus may not contract after delivery: • You’ve had a very long labor or very fast labor. • You’ve had a difficult labor. • Your • You have • You've had general • You have an enlarged uterus. You’re at high risk for uterine atony if you ...

Postpartum hemorrhage, the loss of more than 500 mL of blood after delivery, occurs in up to 18 percent of births and is the most common maternal morbidity in developed countries. Although risk factors and preventive strategies are clearly documented, not all cases are expected or avoidable. Uterine atony is responsible for most cases and can be managed with uterine massage in conjunction with oxytocin, prostaglandins, and ergot alkaloids. Retained placenta is a less common cause and requires examination of the placenta, exploration of the uterine cavity, and manual removal of retained tissue. Rarely, an invasive placenta causes postpartum hemorrhage and may require surgical management. Traumatic causes include lacerations, uterine rupture, and uterine inversion. Coagulopathies require clotting factor replacement for the identified deficiency. Early recognition, systematic evaluation and treatment, and prompt fluid resuscitation minimize the potentially serious outcomes associated with postpartum hemorrhage. Clinical recommendation Evidence rating References Active management of the third stage of labor decreases postpartum blood loss and the risk of postpartum hemorrhage (number needed to treat=12). A , Active management of the third stage of labor does not increase the risk of retained placenta. A , , Oxytocin (Pitocin) is the first choice for prevention of postpartum hemorrhage because it is as effective or more effective than ergot alkaloids or prostaglandins and has f...

Postpartum Hemorrhage Lecture Notes • OFTHE MEDICAL MANAGEMENT OF POSTPARTUM HEMORRHAGEPOSTPARTUM HEMORRHAGE Chukwuma I. Onyeije, M.D.,Chukwuma I. Onyeije, M.D., Atlanta Perinatal AssociatesAtlanta Perinatal Associates 2 •Provide a definition of PPH •Review the risk factors for PPH •Understand the nature and importance of rapid diagnosis and treatment OBJECTIVES • digital copy of this lecture is also located at: http://onyeije.net/present 4 Mary 24 year old G2P2 Underwent a routine cesarean section at 7.30 pm Pre-operative Hb was 13 g/dl. Blood loss of 500cc. 5 Mary 4 hours post-partum Pulse at 100-120 otherwise stable. BP: 70-90 / 50-60 Analgesia and Hydration provided. 5 hours postpartum: Seizure with obtundation. Hemoglobin: 7 g/dl, 6 6 Hours post partum: Elevated cardiac enzymes DIC Myocardial Infarction & Liver failure 9 Hours postpartum: Failed arterial embolization 10 Hours postpartum Uterine packing done. 11 Hours Postpartum: Hysterectomy 2 Days Postpartum: Flatline EKG 7 ‘‘‘‘She died inShe died in childbirth’’childbirth’’ 8 Hemorrhage has probably killed more women than any other complication of pregnancy in the history of mankind. • year 10 90% of deaths from Postpartum hemorrhage are preventable. 11 WE HAVE THE TOOLS GOOD NEWS 12 Those caring for pregnant women must be prepared to aggressively treat this complication when it occurs. 13 WhatWhat can becan be done?done? 14 THE STEPS TO PPH: POSTPARTUM HEMORRHAGE: PREDICT HANDLE PREPARE • PPH: POSTPARTUM HEMORRHAGE...

Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Oxytocin is more effective than misoprostol for prevention and treatment of uterine atony and has fewer adverse effects. Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration. Appropriate management of postpartum hemorrhage requires prompt diagnosis and treatment. The Four T's mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]). Rapid team-based care minimizes morbidity and mortality associated with postpartum hemorrhage, regardless of cause. Massive transfusion protocols allow for rapid and appropriate response to hemorrhages exceeding 1,500 mL of blood loss. The National Partnership for Maternal Safety has developed an obstetric hemorrhage consensus bundle of 13 patient- and systems-level recommendations to reduce morbidity and mortality from postpartum hemorrhage. Clinical recommendation Evidence rating References Routinely use active management of the third stage of labor, preferably with oxytocin (Pitocin). This practice will decreas...

• Articles & Issues • Current Issue • Previous Issues • Published Ahead-of-Print • Online Only • Collections • Addiction Medicine • Art of Medicine • Cardiology • CME • Infectious Disease • Pediatrics • Research • Surgery • Women's Health • View All • CME • CME Post-tests • CME from AAPA • Blog • Multimedia • Podcasts • Videos • Authors & Info • Submit A Manuscript • Info for Authors & Reviewers • About the Journal • Editorial Board • The PA Profession • Roadmap to Better Writing • Advertising • Open Access • Subscription Services • Reprints • Rights and Permissions • Author Permissions • AAPA • About AAPA • CME Calendar • CME Posttests • Annual Conference • AAPA Salary Report • PA Competencies • AAPA Publications Elyse J. Watkins is an associate professor in the PA and DMSc programs at the University of Lynchburg in Lynchburg, Va., and a lecturer in the PA program at Florida State University in Tallahassee, Fla. At the time this article was written, Kelley Stem was a student in the PA program at Florida State University. She now practices at North Florida Women's Care in Tallahassee. The authors have disclosed no potential conflicts of interest, financial or otherwise. Earn Category I CME Credit by reading both CME articles in this issue, reviewing the post-test, then taking the online test at Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and incidence in the United States, although lower than in some resource-limited countries,...

The treatment of patients with PPH has 2 major components: (1) resuscitation and management of obstetric hemorrhage and, possibly, hypovolemic shock and (2) identification and management of the underlying cause(s) of the hemorrhage. For the purpose of discussion, these components are discussed separately; however, remember that successful management of PPH requires that both components be simultaneously and systematically addressed. The diagnosis of PPH is established by observing the amount of bleeding and the patient’s clinical status. The amount of blood lost and the patient’s level of consciousness and vital signs are continually assessed. Once the diagnosis is made, immediately notify appropriate staff members. The magnitude and underlying cause of the bleeding to some degree dictate which specialized personnel are called, but a minimum of 1 obstetrician and 1 anesthetist is necessary. Skilled midwives or nurses can be indispensable. Notifying blood transfusion services is essential because the timely availability of blood products is likely to be critical. As in a cardiac arrest, designate an experienced person to document critical information and times. Ensure the availability of an operating room. The speed with which PPH occurs, becomes life-threatening, and can be successfully managed with relatively simple interventions sometimes makes it difficult to decide when to institute the full protocol. A randomized double-blind, placebo-controlled trial by the WOMAN Tri...

• Overdistension (excessive stretching) or excessive enlargement of the uterus from various causes, including multiple gestation (giving birth to more than one baby at a time) and polyhydramnios (large amount of amniotic fluid) • Prolonged labor • Rapid labor • The use of oxytocin (a hormone used to produce contractions) • The use of general anesthesia or other drugs during labor • Fetal macrosomia (a fetus that is larger than usual) • High parity (having many prior births) • Intra-amniotic infection, or chorioamnionitis (infection of the fetal membranes and amniotic fluid) • Agents that relax the uterus (such as drugs used for pain management during labor) • Being more than 35 years old • Obesity • A delivery involving forceps or vacuum assistance • Orthostatic/postural hypotension: dizziness from low blood pressure that commonly occurs when a person gets up after sitting or lying down • Anemia: low red blood cell count • Hypovolemic shock: a serious, potentially life-threatening complication of uterine atony, involving low blood volume from the loss of blood or other fluids • Evanson, A., Anderson, J., Fontaine, P. Am Fam Physician. 2017 Apr 1;95(7):442-449. • Driessen M, Bouvier-Colle M-H, Dupont C, Khoshnood B, Rudigoz R-C, Deneux-Tharaux C. Obstetrics & Gynecology. 2011;117(1):21-31. doi:10.1097/AOG.0b013e318202c845 • Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita ATN. American Journal of Obstetrics and Gynecology. 2013;209(1):51.e1-51.e6. doi:10.1016/j...