Description
Severe bleeding after giving birth is known as postpartum hemorrhage (PPH). This condition is hazardous and terrible. PPH typically manifests within 24 hours of delivery, however it can also appear up to 12 weeks after delivery. Early detection and prompt treatment of bleeding result in better outcomes.
Postpartum hemorrhage is defined as bleeding that is severe enough to result in symptoms of excessive blood loss or a significant change in heart rate or blood pressure following birth, regardless of whether it was a vaginal delivery or a Cesarean section, or C-section.
Résumé
- Postpartum hemorrhage (PPH) anticipation is crucial, even without apparent risk factors. While overdistended uterus (polyamnios, macrosomia, multiple pregnancies) and multiparity are known risks, a significant portion of PPH cases occur in low-risk patients. Vigilant monitoring of uterine retraction and vaginal bleeding during the first golden hour after delivery is essential for early detection.
- Immediate steps after PPH include accurate blood loss estimation and establishing IV access. Blood samples should be sent for cross-matching, and a bedside clot test can help assess clotting. Uterotonic drugs like oxytocin, carboprost, and methylergonovine (if no contraindications) should be administered. Manual uterine compression should be performed if the uterus is not well-retracted.
- The management approach depends on the cause of PPH. Atonic PPH is addressed with uterotonics and compression techniques. Traumatic PPH necessitates identifying and repairing cervical or vaginal tears. Retained placental fragments require removal, preferably under ultrasound guidance using blunt curettage to prevent uterine perforation.
- For uncontrolled bleeding, escalating interventions include balloon tamponade, compression sutures (B-Lynch), and uterine artery ligation. In severe cases, consider internal iliac artery ligation or hysterectomy. Prompt referral to a higher-level facility is necessary if the current center lacks resources or expertise.
- Varicose veins in the cervix during PPH present a unique challenge. Wide sutures taken away from the varicosities may help. Alternatives include uterine artery embolization or ligation. Cervical inflation with pressure may temporarily reduce bleeding.
- Placenta previa poses a high PPH risk due to impaired lower segment retraction. Management involves identifying and addressing adherent placenta. Morbidly adherent placenta (MAP) requires specialized care, potentially involving leaving the placenta in situ and administering methotrexate or referring to a center with expertise in managing MAP.
Exemple de certificat
À propos des intervenants
Dr . Krishna Kumari
Gynecologist, Apollo Hospital
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