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Postpartum Hemorrhage, Anggraini Barus
1808260110 - Coggle Diagram
Postpartum Hemorrhage
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Diagnostic Approach
Retained Placenta
Clinical findings
- Retained placenta and membranes
Investigations
- Examination under anaesthesia
Trauma
Clinical findings
- Bleeding from trauma area
- Extension of uterine angles
- Tears during CS
- Uterine rupture
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Uterine atony
Clinical findings
- Uterus feels relaxed
- Boggy & soft
Investigations
- Full blood count
- Coagulation profile
- Urea & electrolytes
- Abdominal USG (Uterine rupture or intraperitoneal bleeding)
Coagulapathy
Clinical findings
- Continuing bleeding
- Contracted uterus
Investigations
- Full blood count
- Urea and electrolytes
- Coagulotion profile
Definition, etiology & classification
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Classification
Early postpartum hemorrhage
: <24 hours of delivery,
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Definition
defined as greater than 500 mL estimated blood loss in a vaginal delivery or greater than 1000 mL estimated blood loss at the time of cesarean delivery. Cumulative blood loss greater than 1000 mL with signs and symptoms hypovolemia within 24 hours of the birth process, regardless of the route of delivery.
Management & Education
Shock managements
- Resusitation
- Transfusion
- Provide oxygen by mask
- Crossmatch
Trauma
- Suture lacerations
- Drain expanding hematoma
- Replace inverted uterus
Tissue
- Inspect placenta
- Explore uterus
- Manual removal of placenta
- Curettage
Uterine atony
- Oxytocint 20-40 IU in 1L normal saline
- Carboprost (Hemabate) 250 mcg IM (2 mg total)
- Methylergonovine (Methergine) 0,2 mg IM every two hours- four hours
- Misoprostol 800-1000 mcg rectally or 600-800 mcg sublingually/orally
Thrombin
- Observe clotting
- Check coagulation studies
- Replace clotting factors, platelets
- Supply fresh frozen plasma
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Complication & prognosis
Prognosis
Depends on its duration, the amount of blood loss, comorbid conditions, and eh effectiveness of treatment
Complications
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Anterior pituitary ischemia with delay or failure of lactation (i.e., Sheehan syndrome or postpartum pituitary necrosis)
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Normal Labor
Seven discrete cardinal movements of the fetus occur over the course of labor and delivery: engagement, descent, flexion, internal rotation, extension, external rotation or restitution, and expulsion.
Pathophysiology
Uterine atony is a failure of the uterine myometrial fibers to contract and retract. Trauma to the genital tract in pregnancy results in significantly more bleeding . The trauma specifically related to the delivery of the baby, either vaginally in a spontaneous or assisted manner or by cesarean delivery, can also be substantial and can lead to significant disruption of soft tissue and tearing of blood vessels.
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