产后出血紧急措施幻灯片.ppt

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POSTPARTUM HAEMORRHAGE STEPS TO AVOID HYSTERECTOMY S.ARULKUMARAN Professor & Head, Department of Obstetrics & Gynaecology, St.George’s Hospital Medical School, University of London PPH - Old problem - new thoughts PG potentiates the action of oxytocin Tamponade test - Therapeutic & Diagnostic Uterine Compression Sutures Severe Shock & Golden Hour - Definitive Surgery Body weight – Blood volume & Hb% ‘Wash Out’ phenomenon - fibrinogen/ PPH - Emergency that kills (5’th commonest cause – CIMD) Anticipate - high risk cases (e.g. twins, polyhydramnios, long labour, fibroids, APH, infection, past H/O PPH, retained tissue etc.) Prevent - Prophylactic oxytocics (e.g. Syntometrine, syntocinon, ergometrine, misoprostol) Manage - promptly - 90% uterine atony - 8% trauma and 2% coagulation disorders (e.g. Atony - Oxytocin infusion 40 units in 500ml - 80 mu/min -20 drops in a 20 drops/ml giving set) Prostaglandin potentiates the action of oxytocin Stepwise quick progression - syntometrine/ergometrine/oxytocin infusion/prostaglandins IV;IM;IntraMyometrial Use misoprostol 400 ug rectally /orally whilst using oxytocin infusion The “Tamponade Test” Therapeutic - No further intervention (14/16); Continue oxytocin infusion for 12 hrs, small vaginal pack, IV antibiotics, check fundal height, bleeding pv. Prognostic - No need to do a laparotomy - answer known in few minutes COMPRESSION SUTURES Quick, safe and effective B-Lynch Horizontal full thickness sutures Vertical full thickness sutures Square sutures Combination of sutures Placental bed haemorrhage Through and through figure of eight or transverse sutures involving full thickness of the uterine wall Infiltration of placental bed with vasoconstrictors Hot packs and pressure Combination of Compression Suture and the Tamponade PPH Coagulation disorders ‘Wash Out Phenomenon’ DIVC- FDP inhibits clotting “Washout phenomenon” - the coagulation factors are consumed and washed out at the site of bleeding The “wa

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