Postpartum Haemorrhage

Question 1

Defintion Postpartum Haemorrhage

Answer 1

Excessive bleeding following childbirth (within 24 hours) :

Blood loss of 500 milliliters or more after a vaginal birth

Blood loss of 1,000 milliliters or more after a cesarean section.

Question 2

Causes Postpartum Haemorrhage

Answer 2

Uterine atony (most common)

Trauma (Iatrogenic): Injury to the birth canal, cervix, or perineum during delivery can lead to bleeding.

Retained placental tissue

Uterine rupture

Coagulation disorders

Placenta accreta/increta/percreta(Abnormal attachment of the placenta to the uterine wall)

Infection

Question 3

Symptoms Postpartum Haemorrhage

Answer 3

Heavy or prolonged vaginal bleeding that saturates pads within a short time.

Passage of large blood clots.

Signs of hypovolemia or shock, such as lightheadedness, dizziness, rapid heart rate, low blood pressure, and pale skin.

Abdominal pain or discomfort.

Feeling of pelvic pressure or fullness.

Signs of anemia, including fatigue, weakness, and shortness of breath.

Question 4

Diagnosis Postpartum Haemorrhage

Answer 4

Clinical assessment: Evaluate the patient’s symptoms, measure blood loss, and assess vital signs.

Blood tests: Hemoglobin and hematocrit levels are measured to determine the extent of blood loss and evaluate anemia.

Ultrasound: To assess for retained placental tissue or other abnormalities.

Pelvic examination: To check for trauma, assess the size of the uterus, and evaluate the cervix.

Question 5

Treatment Postpartum Haemorrhage

Answer 5

-Uterine massage

-Manual removal of placenta or retained tissue

-Uterine tamponade: Placing balloons or packing materials in the uterus to apply pressure and control bleeding.

-Medications:
(Uterotonics): Oxytocin-Misoprostol(Uterotonics)
Tranexamic acid: A medication that helps to prevent blood clot breakdown and reduce bleeding.

-Surgical interventions:
Uterine artery embolization
Surgical ligation or compression
Hysterectomy (In severe cases)

Question 6

Complications Postpartum Haemorrhage

Answer 6

Hypovolemic shock
Anemia
Infection
Organ damage

Question 7

List the Postpartum infections and their treatment.

Answer 7

○ Postpartum endometritis- noted with fever, chills, foul smelling lochia.
○ Typically due to group b strep species or bacteroides fragilis
○ the endometrium in endometritis is edematous and hyperemic, with marked
inflammatory infiltrates of the endometrial glands, primarily by neutrophils. The
inflammatory process may invade the myometrium and perimetrium, and there may
be areas of necrosis and thrombosis.
○ Clindamycin and gentamicin iv for broad spectrum coverage