Management of post-partum haemorrhage (PPH) involves
the treatment of uterine atony
How should you manage postpartum hemorrhage?
Replacing lost blood and fluids
is important in treating postpartum hemorrhage. You may quickly be given IV (intravenous) fluids, blood, and blood products to prevent shock. Oxygen may also help. Postpartum hemorrhage can be quite serious.
What are the management of PPH?
The medications most commonly used in PPH management are
uterotonic agents
. These medications include oxytocin (Pitocin
®
), misoprostol (Cytotec
®
), methylergonovine maleate (Methergine
®
,), carboprost tromethamine (Hemabate
®
), and dinoprostone (Prostin E2
®
). All of these medications are available in the United States.
What is the first line management of postpartum hemorrhage?
| Clinical recommendation Evidence rating References | Oxytocin (Pitocin) is the first choice for prevention of postpartum hemorrhage because it is as effective or more effective than ergot alkaloids or prostaglandins and has fewer side effects. A 2,25,26 |
|---|
What are the 3 main principles of the treatment of a PPH?
The treatment of patients with PPH has 2 major components:
(1) resuscitation and management of obstetric hemorrhage and, possibly, hypovolemic shock and (2) identification and management of the underlying cause(s) of the hemorrhage
.
What causes PPH?
Uterine atony
.
This is the most common cause of PPH. It happens when the muscles in your uterus don’t contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.
What are the types of PPH?
Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage, which occurs within 24 hours of delivery, and
late postpartum hemorrhage
, which occurs 24 hours to 6 weeks after delivery.
How does Anaemia cause postpartum haemorrhage?
Background: Anemia in pregnancy is common and linked to postpartum hemorrhage in
terms of uterine atony
. The more severe the anemia, the more likely the greater blood loss and adverse outcome.
What medications are used to treat a patient experiencing a postpartum hemorrhage?
| DRUG DOSE | Oxytocin (Pitocin) 10-40 units per 500-1000ml solution continuous infusion OR 10 units IM | Methyl-ergonovine (Methergine) 0.2 mg IM every 2 to 4 hours | Prostaglandin F2 Alpha (Hemabate) 250 micrograms IM (may repeat in q15 – 90 minutes, maximum 8 doses) OR Intramyometrial: 250 micrograms |
|---|
How do I know if my uterus has gone back to normal?
For the first couple of days after giving birth, you’ll be able to feel the top of your uterus near your belly button. In a week, your uterus will be half the size it was just after you gave birth.
After two weeks
, it will be back inside your pelvis. By about four weeks, it should be close to its pre-pregnancy size.
WHO recommendations Uterotonics for prevention of postpartum haemorrhage?
The World Health Organization (WHO) recommends provision of prophylactic uterotonics for
every woman during the third stage of labour
[5]. Five drugs are available for PPH prevention: oxytocin, carbetocin, ergometrine, misoprostol, and prostaglandin.
What is primary PPH?
Primary postpartum haemorrhage (PPH) is
loss of blood estimated to be >500 ml, from the genital tract, within 24 hours of delivery
(the most common obstetric haemorrhage): Minor PPH is estimated blood loss of up to 1000 mls. Major PPH is any estimated blood loss over 1000 mls.
Who is at risk for uterine Atony?
Risk factors for uterine atony include
uterine overdistention secondary to hydramnios
, multiple gestation, use of oxytocin, fetal macrosomia, high parity, rapid or prolonged labor, intra-amniotic infection and use of uterine-relaxing agents.
What is a severe PPH?
Severe PPH was defined as
blood loss ≥1500 mL
or the need for blood transfusion for excessive bleeding at the time of delivery.
Why is oxytocin given in post partum haemorrhage?
In low-income countries, drugs to prevent or treat postpartum haemorrhage (uterotonics) are not always available. Oxytocin is one such drug.
Oxytocin prevents excessive postpartum bleeding by helping the uterus to contract
.
What are 3 types of hemorrhage?
There are three main types of bleeding:
arterial, venous, and capillary bleeding
. These get their names from the blood vessel that the blood comes from. Additionally, bleeding can be either external, such as what comes from a minor skin scrape, or internal, such as what comes from an injury to an organ or bone.
