Primary Post Partum Hemorrhage-Causes-Management and Treatment

Primary Post Partum Hemorrhage-Causes-Management and Treatment

Primary post partum hemorrhage (PPH) refers to blood loss of greater than 500ml during the 3rd stage of labour or within 24 hours of delivery.

Causes of PPH

1. 80 % of PPH cases are associated with uterine atony.

2. Upper or lower genital tract trauma.

3. Uterine Inversion

4. Retained Placental Tissue.

5. DIC. Disseminated intravascular coagulation.

Some important points:

Normally placenta comes out within 30 minutes after delivery. If it stays in the uterus for abnormally longer period of time it is called retained placenta.

1. Retained placenta is found in 2% of deliveries.

2. Frequency of retained placenta is markedly increased in case of pre-mature deliveries ( < 26 weeks of gestation ).

3. At term, in 90 % of cases placenta is delivered with 15 minutes of delivery.

4. If Third stage of labour exceed 30 minutes there is 10 folds increase in the risk of hemorrhage.

Management:

1. If there is uterine atony, give uterotonic agents via umbilical vein.

2. If bleeding persist inspite of uterine contraction look for genital tract trauma and repair it.

3. Explore the uterus for retained products of conception.

4. Blood grouping, cross matching and blood coagulation tests should be done.

5. If bleeding still persist stepwise devascularization is done.

6. Hysterectomy is the last procedure of choice.

see also:

Uterine Rupture

Uterine Inversion

Retained placenta and Complications of third stage of labour