Bleeding after Delivery (Post-Partum Hemorrhage) Part 1 Here

Diagnosis Of Post-Partum Hemorrhage

Vaginal bleeding is present- copious or slow.

Some time conceald – as vulvo vaginal or broad ligament haematoma.

When uterus contracted, PPH is traumatic.

When uterus flabby, become hard on massaging, PPH is due to atomicity

 Prevention

Pose partum haemorrhage cannol always be prevented. The incidence & magnitude can be reduced substantially.

If following guide lines are followed.

Antenatal

1) Improvement of the health status to raise the Hb level near to normal so the pt can with stand blood loss.

2.) High risk pt- e.g. Twin, hydramnios. grand multipara, severe anaemia – to be screened & delivered in equipped hospital.

3) Blood grouping & typing – done in vulnerable group so that no time is loss during emergency.

Intranatal

1) Hasty delivery of the baby is to be avoided.

2) Active management of 3rd stage.

3) Examination of placenta & membrane should be routine. so as to detect at the earliest any missing part.

4) Exploration of uterovaginal canal – after difficult labour or instrumental delivery.

Management of Post-Partum Hemorrhage

Management of 3rd stage bleeding.

Principles-

1) to be empty the uterus & to make it contract.

– to replace the blood.

– to ensue effective haemostasis in traumatic bleeding.

• Massage the fundus make it hard.
• Inj. Erogonetine 0.25 mg i/v
• Sedation.
• To start 5% Dextrose saline & arrange for blood transfusion.
• Catheterise the bladder.

Management of True Post-Partum Hemorrhage

Principles-

• To diagnose cause of bleeding, atonic or traumatic.
• To take prompt & effective measures to control bleeding.
• To correct hypovolaemia.

Steps of Management
To feel the uterus by abdominal palpation

Uterus & flabby

• Massage the uterus
• Inj. Ergonetrine 0.25 mg i.v
• Sedation
• To start 5% D/Saline/arrange for blood
• To Examine the Expelled placenta
• To catheterise the bladder.

Secondary Post-Partum Hemorrhage

Bleeding usually occurs between 8th to 10th day of delivery.

Causes –

• Retained bits of cotyledon or membranes.
• Separation of slough of cervico – vaginal laceration following infection.
• Subinvolution of the placental site – delayed healing process.
• Sloughing of C/S wound –from exposed bleeding vessel  or granulation tissue.

Diagnosis

1. Bleeding bright red.

2. Amount – varying amount small to copious.

3. Anaemia

4. Evidence of sepsis

Internal  Examination –

1. Sub involution of uterus

2. Patulous cervial  os.

Investigation –  USG is useful to diagnosis.

Management

Principles – 

To assess the amount of blood loss & to replace the lost blood.

To find out cause & to take appropriate step to rectify it.

Conservative treatment-

Blood transfusion.

To adminster Inj. Ergometrine.

To administer antibiotics as a routine.

Active treatment

Commonest cause Retained bit – Explore the uterus under GA (D&C). RProduct is sent for histopathological Exam.

Sloughing wound of cervico- vaginal canal or C/S – needs antibiotic & some time haemostatic sutures.