POSTPARTUM HEMORHAGIC

POSTPARTUM HEMORRHAGIC Bleeding is still the biggest cause of maternal death in addition to preeclampsia / eclampsia and infectionsDefinition : Bleeding in excess of 500 mL after the newbornClassifications :Primary : occurs 24 hours after the baby is bornCause : uterine atony , laceration of the birth canal , the remaining portion of the placenta , uterine inversionSecondary : the case, 24 hours after childbirth , usually because the rest of the placental membranes and some residual

Causes of Postpartum Hemorrhagic Bleeding from the placental implantationHypotony to AtonyAs a Result of AnesthesiaExcessive Distension ( Gemelli , Big Boy , Hydramnios )Prolonged Labor , Obstructed Labor Displaced Precipitate Parturition ( Too Fast )Due To The Induction Of OxytocinMultiparityChorioamnionitisHistory of Previous AtonyHistory of Anemia Before Pregnancy

The rest of the placentaThe rest of the membrane or cotyledons ,placenta accreta , increta , percretaSince the birth canal laceration :Episiotomy wideA torn perineum , vagina , cervix , uterine ruptureCoagulation disorders :Very rare example thrombophilia cases , HELLP syndrome , preeclampsia / eclampsia , placental abruption , intrauterine fetal death ( IUFD ) , amniotic fluid embolism

UTERINE ATONY Weak / no uterine contractions uterine not able to close the open bleeding from the placental implantation sitePreventionActive management of the third stageProvision of 2-3 tablets of misoprostol orally (400-600 mg) immediately after birthDiagnosisMassive bleeding , found after the baby and placenta birthHigh fundus ( TFU ) is still as high as the centralContraction soft / noActions Depends on a lot of blood is lost : AnemiaDecreased consciousnessHypovolemic shock

RIPS ROAD BIRTHDue to a very manipulative help labor and traumaticCauses by:Wide episiotomy , spontaneous perineal laceration , traumatic forceps , vacuum extraction versionClassification :Lightweight : abrasions , lacerationsMedium : how wide episiotomy , perineal tear up a total rupture , laceration of the vaginal wall , uterine fornix , cervix , the area around the clitorisWeight : uterine rupture

RETAINED PLACENTADefinition entrainment of the placenta and a half hours after the child is bornClassification : Captiva Placenta : placenta had separated but confined within the uterine cavityAccrete Placenta : implantation penetrate the decidua basalis . The placenta penetrates the myometriumPercrete Placenta : penetrate perimetriumAdhesive Placenta : placenta cling tightly to the endometrium

UTERINE INVERSIODefinition : the lining of the uterus ( endometrium ) dropped out of the OUE, can be complete or incompleteThe causes are :Atony uterine , cervix is still wide openthe presence of an attractive factor deficiencies fundus down ( placenta accrete , increte , percrete )The pressure on the fundus of the above ( Crede maneuver ) or intra-abdominal prisoners harsh and abrupt .

POST PARTUM HEMORRHAGE DUE TO BLOOD CLOTTING DISORDERAfter other causes ruled out suspected blood clotting disorderSuspected also if there is a history of previous delivery of blood clotting disordersGeneral description :Time of bleeding and clotting time extendsThrombocytopeniaHipofibrinogenemiaThe presence of FDP ( fibrin degradation product)Test elongate prothrombin

PREVENTION POSTPARTUM HEMORRHAGICBefore Pregnant improved chronic disease , anemiaKnow the predisposing PPP : multiparity , anakbesar , twins , hydramnios , the former section , a history of previous PPP and other high- risk pregnancies .Delivery must be completed within 24 hoursHigh risk pregnancies give birth in hospital referralAvoiding the shaman must labor with health workers