Date post: | 14-Apr-2017 |
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Health & Medicine |
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Postpartum hemorrhage;
medical treatment
M.D .OBST&GYNAEM.D .OBST&GYNAE..Waled ayadWaled ayad
Post partum hg text Post partum hg text bookbook
whowho recommendation recommendation for pphfor pph
WhyWhy??
25% of maternal death25% of maternal death
Most causes preventableMost causes preventable
Prgnosis&outcome depend Prgnosis&outcome depend on on trained team&sch.drilltrained team&sch.drill
RISK FACTORSRISK FACTORS
Prophylactic tttProphylactic ttt
Ante natalAnte natal ; (history-exam-inv) ; (history-exam-inv)Intra natalIntra natal ; (6p) ; (6p)Post natalPost natal ; ( 3 ; ( 3rdrd+4+4thth stage) stage)
Active managementActive managementMedicalMedicalsurgicalsurgical
Ante natal Ante natal assysmentassysment
historyhistory
examinationexamination
investigationinvestigation
Intra natalIntra natalAAssysment of ssysment of 3P3PPPartogramartogramPProper use of oxytocinroper use of oxytocinAAnticipation –early nticipation –early recognition & intervention recognition & intervention for poor progress of labourfor poor progress of labour
Post natalPost natal
Active management of 3Active management of 3rdrd stage of labour should be stage of labour should be
offered routinelyoffered routinely ((grade Agrade A) )
VVaginal 5unit synto.imaginal 5unit synto.im
CCs 5unit synto iv drips 5unit synto iv drip
MMisoprostol 600 isoprostol 600 orally or rectallyorally or rectally
CARBETOCINCARBETOCINLONG ACTING OXYTOCINLONG ACTING OXYTOCIN..NOTNOT. PPH. BUT AMOUNT OF BLOOD . PPH. BUT AMOUNT OF BLOOD LOSS&NEED UTROTONIC AGENTLOSS&NEED UTROTONIC AGENT..
RECOMRECOM, ONLY IN , ONLY IN ELECTIVE CSELECTIVE CS NOT NOT IN EMERGENCY OR VAGIN BIRTHIN EMERGENCY OR VAGIN BIRTHDOSE:100MICR IM-IV (1 MINUTEDOSE:100MICR IM-IV (1 MINUTE))
DON’T FORGT 4DON’T FORGT 4THTH STAGE OF STAGE OF LABOURLABOUR
Active managementActive management
Guidelines Guidelines RCOGRCOG
RCOG 2016RCOG 2016 OX OX 5u5u
M M .5.5 OXOX 40u40u
C C .25.25 MM 400400
oxytocinoxytocin
Iv ½ x 2 x1/2Iv ½ x 2 x1/2
Im 5 min & prsist 1 Im 5 min & prsist 1 hour hour
MethergineMethergine4x40x44x40x4
Recomb.factor 7Recomb.factor 7LIFE SAVING..LIFE THRETEN(DVT)LIFE SAVING..LIFE THRETEN(DVT)
WHEN; MASSIVE HG AFTER #MED,SURWHEN; MASSIVE HG AFTER #MED,SUR..
DOSE; 90mi/kgDOSE; 90mi/kg
FIBRINOGEN & PLATLETFIBRINOGEN & PLATLET
RememberRememberAntepartum weaken but pph can Antepartum weaken but pph can killkill
4T4T
Rule of 30Rule of 30
CRMACRMA