Post partum hemorrhage

POST PARTUM HEMORRHAGE

Indication

1. Definition

2. cause of PPH

3. Frequency factor

4. symptom / sign

5. Diagnosis

6. Management 

        Definition :

- PPH is  an excessive bleeding after delivery > 500ml by vaginal delivery and > 1000ml by cesarean section

- PPH is 2 division :

       . Immediate PPH : duration < 24H

       . Delay PPH         : duration >  24H

Cause of bleeding

}Inertia uterin / atonic uterin

}Cervical / Vaginal / Perineal tears

}Retained placenta

}Retained placenta fragment

}Rupture uterine

}Inverted uterine

}coagulopathy 

Frequency factor

}Overdistend uterine

}Placenta abruption / placenta previa

}Multiple pregnancy

}Prolong labour

}Uterine fibrome

}Having many previous births

}Preeclapsia

Symptom / sign

}Sudden bleeding < 24h

}Uterine  is not contraction

}Retained placenta fragment after placenta delivery

}Retained placenta

}Hypotention

}Tachycardia

}Somnolent

}shock

Diagnosis

}Clinical signs and examination

}Paraclinic : CBC , blood group , PT , PTT

             . ultrasound

Managment

1 . Inertia / atonic uterin :

     - Foley catheter

     - massage uterin and breast- feeding

     - use oxytocin 20 IU in Lactate ringer( 500ml): 40drop/mn add oxytocin 10IU IM

     - if shock is treament shock

     - To stop  bleeding have 2 technique :

         . Compression bimanual hand on uterin

         . Compression abdominal aort and palpation femoral pulse 

2. Retained placenta / placenta fragment :

     - urinary catheter

     - massage uterin and breast- feeding

     - manual romoval of placenta / exploration

     - currhatag

     - MVA

     -use oxytocin( 20IU ) in lactate ringer ( 1000ml) at 60 drop/mn until uterin contraction , be continue 40 drop/mn

    - oxytocin 10iu (im)

     - use misoprotol ( cytotec ) : 3-5 tablet  intrarectum

     -blood tranfusion ( severe bleeding )

     -sugery ( placenta  adherence )

3. Cervical / vaginal / perineal tears : repair cervical / vaginal / perineal tears

4. Inverted uterin :

      - reduction par taxis

      - surgery 

ANTIBIOTHÉRAPIE

Antibiotiques à large spectre pour 5 à 7 jours

couvrant les entérocoques, streptocoques et les anaérobies:

Ceftriaxone 1g + Métronidazole 500 mg + Gentamycine 80 mg en 2 prises par jour

Ou

 Ampicilline 2g + Métronidazole 500 mg + Gentamycine 80 mg en 2 prises par jour