(精选)Postpartum Haemorrhage (PPH)教学课件.pptVIP

Postpartum Haemorrhage (PPH) By Bernadette Gregory, Senior Lecturer in Midwifery Updated by Jacqui Williams, Senior Lecturer in Midwifery Definitions An excessive bleeding from the genital tract occurring at any time from the birth of the child to 12 weeks postnatal. PRIMARY most common refers to the 1st 24 hours commonest and most dangerous(Mousa Alfiric, 2007) Incidence approx. 6% of all deliveries SECONDARY occurs after 24 hours up to 12 weeks postnatal (Alexander et al, 2002). Incidence 1-3% of all pregnancies Definitions cont’d. PPH traditionally over 500 mls. (WHO, 1990; 1989) but may vary between hospitals/countries. Smaller losses than this would be treated as serious later in the puerperium. Definitions are of limited value –it is much more important to assess the effect of blood loss on the mother. “Excessive” in some contexts may be a much smaller amount which may affect the mother. Blood loss Minor 500-1000ml Major more than 1000ml Moderate 1000-2000ml Severe over 2000ml (RCOG, 2009) Estimating blood loss- how scientific? Difficult to measure Unreliable Underestimation Unpredictable Unexpected Relevant research Levy Moore (1985) Prasertcharoensuk et al (2000) Buckland Homer (2007) Causes The placental site – the failure of the uterus to contract and retract adequately- the myometrium is flaccid or atonic. Are there any retained products ? Genital tract trauma/ damage – is it cervical, vaginal or uterine ? Risk factors History of previous PPH or retained placenta and membranes multiple pregnancy polyhydramnios anaemia Antepartum haemorrhage (APH) prolonged labour Pre eclampsia/ Pregnancy induced hypertension (P.I.H.) general anaesthesia Fibroids Mismanagement of the 3rd stage of labour Risk factors contd.. Retained placenta or retained products Use of tocolytic drugs Induced or augmented labours Inversion of the uterus Infection eg chorioamnionitis More common in grande multiparity DIC other clotting disorders unknown