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Postpartum Hemorrhage (PPH) (Etiology (4T (Tissue, Trauma, Tone,…
Postpartum Hemorrhage (PPH)
Definition
Blood loss of more than 500 mL following vaginal delivery or more than 1000 mL following cesarean delivery.
Classification
Primary PPH
Within 24 hours of delivery
Secondary PPH
Occur 24 hours after delivery
Etiology
Uterine atony
The failure of uterus to contract and retract following delivery of the baby.
Retained Placenta
Failure to progress during the second stage of labor
Placenta accreta
Lacerations
Instrumental delivery
Large-for-Gestational-Age (LGA) newborn
Hypertensive disorders
Induction of Labor
Augmentation of Labor
4T
Tissue
Trauma
Tone
Thrombosis
Pathophysiology
Workup
Lab Studies
CBC
Coagulation studies
Imaging Studies
Medical Therapy
Resuscitation and management of obstetric hemorrhage and possibly hypovolemic shock
Identification and management of the underlying cause(s) of the hemorrhage
Management of Obstetric Hemorrhage
Fluid Resuscitation
Crystalloid solution
Lactated Ringer's Solution
Normal Saline
Blood Transfusion
Whole Blood
PRBCs
Management of Massive Obstetric Hemorrhage
Resuscitation
Administer Oxygen by mask
Place 2 large-bore (14G) IV lines
Take blood for crossmatch of 6 U PRBCs and obtain a CBC, coagulation screen, urea level, creatinine value, and electrolyte status
Begin immediate rapid fluid replacement with NS or Ringer Lactate Solution
Transfuse with PRBCs as available and appropriate
Defective Blood Coagulation
Organization
Call Experienced Staff (including Obstetrician and Anesthetist)
Allert the blood blank and hematologist
Designate a nurse to record vital signs, urine output, fluids and drugs administered
Place operating theater on standby
Evaluation of Response
Remedy the Cause of Bleeding
