Bleeding after Delivery (Post-Partum Hemorrhage)
Quantitative Amount of blood loss excess of 500 ml following birth of the baby.
Clinical definition :
Any amount of bleeding or from or into the genital tract following birth of the baby up to the end of puerperium which adversely affect the general condition of the pt evidenced by rise in pulse rate & falling blood pressure is called PPH (Post-Partum Hemorrhage) .
Incidence– 1% among hospital deliveries.
1) Primary –
Hemorrhage occurs within 24 hrs following the birth of the baby. Again two types.
a) 3rd stage hemorrhage – Bleeding occur before expulsion of placenta.
b) True post- Partum Hemorrhage- Bleeding occur subsequent to expulsion of placenta.
Secondary:- Bleeding occurs beyond 24hrs and within perineum called delayed or late puerperal hemorrhage.
Causes of Primary Post-Partum Hemorrhage (PPH)
4) Blood coagulopathy.
Atonic – 80% is the atonic cause. Following are the condition where uterine contraction & retraction interferes.
1) Over distension of uterus- Multiple pregnancy, large baby, hydramnios.
2) Ante partum haemorrhage.
3) Prolonged labour
4) Malnutrition and anaemia
5) Persistent uterine distension – Retention of partially separated placenta interfere with retraction.
6) Malformation of uterus:- e.g., when placenta in planted in the uterine septum of septate uterus.
7) Uterine fibroid.
8) Mismanaged third stage of labour-
i) Too rapid delivery of the baby
ii) Premature attempt to expel the placenta before it is separated.
iii) Kneading & fidding the uterus
iv) Bladder not evacuated.
9) Constriction ring – Hour glass contraction formed in the upper segment.
10) Precipitate labour
20% Usulally involve Cx, vagina, Episiotomy wound, perineum. (Revealed)
Concealed- Vulvo-vaginal & broad ligament haematoma.
Mixed- Combination of atonic and traumatic causes.
Blood coagulopathy- accuried or congenital.
Due to diminished procoagulands or increased fibrinolytic activity. The conditions where coagulopathy can develop-
a. Abruption placenta
b. Jaundice in pregnancy
c. Pre-Eclanpsia – Eclampsia.