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Postpartum Hemorrhage & Abnormal PlacentationManuel FonsecaMSIIIHospital San Lucas GuayamaOB/GYNDr.Miranda
PostPartum HemorrhageBleeding more than 500 ml after vaginal delivery or more than 1000 mL following cesarean deliveryEarly postpartum bleeding ocurrs within 24 hours of deliveryLate postpartum bleeding ocurrs 24 hours to 6 weeks later
The diagnosis is reserved for pregnancies that have more than 20 weeks gestation.
Less than 20 weeks gestational age are spontaneous abortions.
Post Partum HemorrhageUterine Atony Risk Factors - Anesthesia -Uterine over distention (twins, Polyhydramnios) -Prolonged laborBimanual examinationR/O uterine rupture , Retained placentaIf unresponsive to bimanual massage administer oxytocin
PostPartum HemorrhageRetained placenta (Accreta)Genital lacerations
Failure to progress during the second stage of labor
Large-for-gestational-age (LGA) newborn
Hypertensive disorders
Augmentation of labor with oxytocin
Sheehan SyndromeMassive bleeding and hypotension ->Infarction of pituitary ->Hypopituitarism-No lactation -Amenorrhea-Cold intolerance - Loss of pubic hair
4 TsToneTissueTrauma-Cervical laceration-Uterine ruptura-Very prolongad or vigorous labor-Vaginal sidewall laceracin-Lower vaginal trauma, either spontaneously or because of episiotomyThrombosis-Thrombocytopenia idiopathic thrombocytopenic purpura-acquired secondary to HELLP syndrome -Abruptio placentae-(DIC)-Coagulopathies -Sepsis
Layers of endometriumStratum compactum*Stratum spongiosum*Stratum basale = Base layerMyometrium
Placenta PreviaImplantation of the placenta in the lower uterine segment;
placenta overlies cervical os (opening).
Presents as third-trimester painless bleeding
Placenta Previa
Dx.UltrasoundRisk Factors: -Multiparity-Prior C-sectionTx: C-section
Vasa PreviaFetal blood vessels cover cervizRisk of fetal hemorrhage
Placenta AccretaImproper implantation of placenta into the myometrium with little or no intervening decidua(directly to myometrium)
Presents with difficult delivery of the placenta and postpartum bleeding ( Cannot detach after delivery)
Tx. Hysterectomy
Placenta incretaPlacenta grows into wall of uterusPlacenta percretaPlacenta perforates through uterusRisk factor : previous c-section
Placenta AbruptionSeparation of placenta from the decidua prior to delivery of the fetus
Painful Vaginal Bleeding 3rd trimester
Common cause of stillbirth (fetus dies in utero)
Can Lead to DIC or fetal death
Risk Factors- Trauma, Abuse-Smoking , HTN , Cocaine
DX: Kleihauer-Betke test
Indicactions for vaginal delivery and c-sectionC-section-uncontrollable maternal hemorrhage-rapidly expanding concealed hemorrhage-fetal distress -rapid placenta separationVaginal Delivery-placental separation is limited -separation is extensive and fetus is dead