Postpartum Hemorrhage
🩸 Postpartum Hemorrhage (PPH)
Definition
Postpartum Hemorrhage is excessive bleeding after childbirth defined as:
- >500 mL blood loss after vaginal delivery
- >1000 mL after cesarean section
🔴 Severe PPH: ≥1000 mL with signs of hypovolemic shock
Types of PPH
|
Type |
Timing |
|
Primary (Early) |
Within 24 hours of delivery |
|
Secondary (Late) |
Between 24 hours and 6 weeks postpartum |
Causes of PPH “4 Ts”
|
Cause |
Description |
Frequency |
|
Tone |
Uterine atony (failure of the uterus to contract) |
~70% |
|
Trauma |
Lacerations of cervix, vagina, perineum; uterine rupture |
~20% |
|
Tissue |
Retained placental tissue or clots |
~10% |
|
Thrombin |
Coagulation disorders (e.g., DIC, preeclampsia) |
<1% |
Risk Factors
- Prolonged or rapid labor
- Overdistended uterus (twins, polyhydramnios)
- Uterine atony or fibroids
- Instrumental delivery (forceps, vacuum)
- Previous PPH
- Placenta previa or accreta
- Preeclampsia or eclampsia
Clinical Features
- Excessive vaginal bleeding
- Pallor, dizziness, tachycardia, hypotension
- Boggy or soft uterus (if atonic)
- Failure of uterus to contract
- Signs of shock (in severe cases)
Diagnosis
- Visual estimation of blood loss (often underestimates)
- Palpation of uterus
- Vitals: Blood pressure, heart rate
- Labs:
- CBC, coagulation profile
- Crossmatch blood
- Fibrinogen, INR/PTT
Management
- ABCs
- IV fluids
- Call for help
- E: Early detection
- M: Massage of uterus
- Oxytocin 10 IU
- Tranexamic Acid 1g
- Balloon temponade
- Uterine Artery ligation
- B-Lynch suture
- Hysterectomy
This is the common cause of SheeHan’s Syndrome
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