Postpartum hemorrhage

This is a brief video on postpartum hemorrhage, or excess bleeding following childbirth.
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ADDITIONAL TAGS
Postpartum hemorrhage
Overview
Causes
Medications
Other management
By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 1170, Public Domain, commons.wikimedia.org/w/index...
Excess bleeding following childbirth
Defined as, in 24 hours after delivery:
Over 500 ml blood loss after vaginal delivery
Over 1000 ml blood loss after c-section
Signs and symptoms include faintness/lightheadedness with standing/straining, increased heart rates and respiratory rates
Severe blood loss: low BP, feeling cold, loss of consciousness (hypovolemia and shock)
Risk factors: infection (chorioamnionitis), prolonged labor, multiple gestations
Overview
Overview
Causes
Medications
Other management
Tone:
Uterine atony (inability to contract), sign: boggy uterus
Retained placental tissue, infection can contribute to atony
Prolonged labor contributes to atony (uterus is tired)
Inverted uterus, sign: absent uterus
Trauma: injury to uterus, cervix, vagina, or perineum, both before and during delivery (often precipitous deliveries)
Sign: lacerations
Perineal injury: 1st degree is mucosa only, 2nd involves perineal body, 3rd involves rectal sphincter, 4th involves rectal mucosa
Tissue: retained tissue from placenta or fetus
Placenta burrows deeply into uterus (accreta increta percreta); might have accessory lobes, placental tear
Dx with ultrasound or placental inspection (blood vessels at placental edge)
Sign: firm uterus
Thrombin: failure to clot blood, such as from coagulation disorders, DIC
Causes - four Ts
Overview
Causes
Medications
Other management
Dehydration: two large bore IVs, fluids
Oxytocin - contracts uterus, prolongs contractions (for uterine atony)
Consider other management (next slide)
Misoprostol, carboprost - prostaglandin analogs
Side effects: fever and shivering
Methylergonovine - ergot drug, which vasoconstricts decreasing blood supply to bleeding organ
Oxytocin + ergometrine in combination drug Syntometrine
Medications
Overview
Causes
Medications
Other management
Uterine massage
Surgery and/or sutures to repair lacerations
Hysterectomy in severe cases
Uterine artery embolization with help of interventional radiology or ligation with obstetrics
D&C to remove retained products of conception
Other management
Overview
Causes
Medications
Other management
By Valerie Henry - Own work, CC BY-SA 4.0, commons.wikimedia.org/w/index... and ***48357595

[@MrsOrrDiaries]

Looking for detailed information, delivered my baby 3 days ago and hemorrhage happened.
I remember oxytocin IV , I remember laughing gas, injections after injections including antibiotics, I remember my body shaking for about an hour, and hemoglobin dropped to 80... so many things happened in about 3 hours

[@sarahmina1442]

Thank you.

[@melissahall7009]

Thank you!

[@AnshikaSingh-og2gv]

Thank you so much ☺️

[@thekingdomofheaven1693]

Thanks

[@reemalaraibi8188]

thank you

[@Naomi-tb1xn]

I was induced for no reason 2 days past my due date and had to get a C section, since I wasn't progressing enough. I was pushing for hours at 10cm. I had the baby and ended up hemorrhaging that night and my hemoglobin level was a 6. I got 2 infusion bags and things seemed to get better after that. I asked the nurse practitioner what happened and she said it was uterine atony and all the Pitocin was a factor. 6 weeks later I was still bleeding like a heavy period every day. I went in for my checkup and there was something still in my uterus. The OB said it must be a blood clot I couldn't pass. 2 weeks later, at week 8 after delivery, I had to go in for a D&C to clean out my uterus. 2 weeks after, when I saw the doctor, she said there was a piece of the placenta in there, along with the clot. I'm still confused and terrified to have another baby. I did IVF for male factor infertility and none of this was remotely natural. I had a perfectly healthy and normal pregnancy and thank God the baby is fine, but i'm terrified of hemorrhaging again when I do my next transfer.

[@douglasayub2990]

Wobderful

[@shaikhamman9482]

It was awesome N u clearly defined it....
I've my test tomorrow N as usual my mam will become happy frOm me in sha Allah just bcz of u sir...👍

[@medstudywithhf4182]

👍👍👍

[@user-uw7ms4tt2m]

❤

[@patriciacpitts529]

Thank you!