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Postpartum Hemorrhage, Uterine: Atonic uterus, partial/retained placenta…

- - - - Use of oxytocics at delivery
    - - Avoid uterine massage before placental separation
- - - - Causes: prolonged labor, polyhydramnios, large baby, retained placenta.
- - - - Causes:
      - Uterine atony , Trauma
      - Retained placenta
      - Clotting disorders
      - C. Secondary PPH : Occurs after 24 hours up to 6 weeks postpartum.
        
        Causes:
        
        Retained products
        
        Infection
        
        Delayed uterine involution
        
        Neoplasms
        
        Uterine inversion
- - - - Pallor, sunken eyes , Subnormal temperature, Falling blood pressure , Temporary blindness (amaurosis) , Coma (in fatal cases)
    - - (Differentiating Atonic vs. Traumatic PPH):
        
        Atonic PPH
        
        Large, flabby, poor contraction
        
        Dark, clotted, intermittent gush
        
        Expulsion of clots
        
        Traumatic PPH
        
        Small, firm, good contraction
        
        Bright red, continuous
        
        No effect
        
        Feature
        
        Uterus
        
        Blood Flow
        
        Response to Squeeze
- - - - Uterine devascularization
      - Internal iliac artery ligation
      - Hysterectomy (if life-saving)
      - Coagulopathies:
        
        Fresh frozen plasma
        
        Blood transfusions
        
        Treat underlying cause