1. Dr.Suresh Babu Chaduvula
Professor
Dept. of Obstetrics & Gynecology
College of Medicine, Abha, KKU, Saudi Arabia

2.  Definition:
 More
than 500 ml of blood loss following
normal vaginal delivery of the fetus or
1000ml following Cesarean section.
 Clinically the amount of blood loss from or
into the genital tract which will adversely
affect the general condition of the patient
 Hemorrhage leading to fall in hematocrit by
10 %.
 Incidence – 1- 4 %

3.  1]
Primary 2] Secondary
 Primary – bleeding occurs following delivery
of the baby up to 24 hours
 Primary is two types:
 A] Third Stage hemorrhage
 B] True Post Partum hemorrhage

4.  Third
Stage hemorrhage:
 Bleeding occurs before the expulsion of
placenta
 Example- Placenta accreta,increta and
percreta & retained placenta
 True Postpartum hemorrhage:
 Occurs after the expulsion of placenta

5.  Secondary
or Delayed or Late Postpartum
hemorrhage:
 Bleeding occurs following delivery of the
baby after 24 hours up to 6 weeks.

6. Tone
Tissue
Trauma
Thrombin

7.  Causes:
 1]
Atonic
 2] Traumaic
 3] Mixed
 4] Retained Placenta
 4] Coagulopathy

9.  Contributes
for 80 % of PPH
 Commonest cause of PPH
 Cause – Faulty retraction of the uterus
 Etiology:
 1] Grand Multipara
 2] Over- distension of uterus – Multiple
pregnancy, Hydramnios, big baby
 3] Anemia

10.  4]
Prolonged Labor
 5] Anaesthesia – Halothane. Ether,

Cyclopropane
 6] Uterine fibroid
 7] Precipitate labor
 8] Malformations of uterus – septate
uterus, bicornuate uterus
 9] Ante partum hemorrhage
 10] Initiation & augmentation of delivery
with oxytocin

13.  1]
Cervix – lacerations
 2] Vaginal laceration
 3] Perineum injury
 4] Paraurethral injury
 5] Uterine rupture
Retained Placenta
Placenta accreta, increta and percreta
Succentuirate placenta.

15. Blood coagulation Disorders:
 Abruptio
Placenta, Jaundice, Thrombocytopenic
purpura, HELLP syndrome
 Combination
of Atonic and Traumatic:

16.  Vaginal
bleeding may be revealed or
concealed
 Alteration
in pulse, Blood pressure and Pulse
pressure
 Flabby
uterus in atonic uterus

18.  UTEROTONIC
DRUGS

Routine oxytocic administration in the third
stage of labour can reduce the risk of PPH by
more than 40%

The routine prophylaxis with oxytocics results
in a reduced need to use these drugs
therapeutically

Management of the third stage of labour should
therefore include the administration of
oxytocin after the delivery of the anterior
shoulder.

19.  Early
recognition of PPH is a very important
factor in management.
 An
established plan of action for the
management of PPH is of great value when
the preventative measures have failed.

28. Description of technique

29.  Tone
 Tissue
 Trauma
 Thrombin

30.  “TONE”
 Rule
out Uterine
Atony
 Palpate
fundus.
 Massage uterus.
 Oxytocin
 Methergine
 Hemabate

31.  “Tissue”
 Inspect
placenta for
missing cotyledons.
 R/O retained placenta
 Explore uterus.
 Treat abnormal
implantation.

32.  “TRAUMA”
 R/O
cervical or
vaginal lacerations.
 Obtain
good
exposure.
 Inspect cervix and
vagina.
 Worry about slow
bleeders.
 Treat hematomas.

33.  “THROMBIN”
 Replacement
with
blood or Fresh frozen
plasma or Platelet
rich pasma.

34. THANK YOU