扬州大学：《妇产科学》课程教学课件（PPT讲稿）25 产后出血 Postpartum Hemorrhage（PPH）

PostpartumHemorrhage(PPH)

Postpartum Hemorrhage(PPH)

Major causes of death forpregnancy women(maternalmortality): Postpartum hemorrhage (28%).heart diseasespregnancy-induced hypertension(or Amniotic fluid embolism)infection

Major causes of death for pregnancy women （maternal mortality) • Postpartum hemorrhage（28%) • heart diseases • pregnancy-induced hypertension • (or Amniotic fluid embolism ) • infection

Definition of PPH: be defined as a blood loss exceeding 500mlafter delivery of the infantPPH:occurs in24 hourof delivery: the late PPH: occurs after 24 hour of deliveryto 6weeks

Definition of PPH • be defined as a blood loss exceeding 500ml after delivery of the infant • PPH: occurs in 24 hour of delivery • the late PPH: occurs after 24 hour of delivery to 6 weeks

Majorcauses: Uterine atony (90%): lacerations of the genital tract(6%)retainedplacenta(3%-4%)coagulation defects (blood dyscrasia). (4T: tone, tissue,trauma,thrombin)

Major causes • Uterine atony (90%) • lacerations of the genital tract(6%) • retained placenta(3%-4%) • coagulation defects (blood dyscrasia) • (4T: tone, tissue,trauma,thrombin)

1. Uterine atonyLocalfactorsoverdistention of the uterine(hydramnios, multiple pregnancy,macrosomiacondition that interfere withcontraction(leiomyomas) complications(PIH,anaemia, placentapraevia

1. Uterine atony Local factors • overdistention of the uterine (hydramnios, multiple pregnancy, macrosomia ) • condition that interfere with contraction(leiomyomas) • complications(PIH,anaemia, placenta praevia

Systemic factors:nervous: drugs(magnesium sulfate,sedative): abnormal labor(prolonged,precipitous· History of previous PPH: Preeclampsia, abnormal placentation

Systemic factors: • nervous • drugs(magnesium sulfate,sedative) • abnormal labor(prolonged,precipitous) • History of previous PPH • Preeclampsia, abnormal placentation

pathology: Contraction constricting the spiralarteriespreventing the excessive bleeding fromthe placenta implantation site: the uterine atony give rise to PPHwhen no contraction occur

pathology • Contraction constricting the spiral arteries • preventing the excessive bleeding from the placenta implantation site • the uterine atony give rise to PPH when no contraction occur

Prevention and therapeutic ofuterine atonyAdministrationofmedicinepromotes contraction of the uterine corpusdecreases the likelihood of uterineatonyOxytocinagents: Methegineprostaglandin

Prevention and therapeutic of uterine atony • Administration of medicine: • promotes contraction of the uterine corpus • decreases the likelihood of uterine atony • Oxytocin agents • Methegine • prostaglandin

Mechanical stimulation of uterine contractionMassage of uterus through the abdomen andbimanual compressionintrauterine packing

• Mechanical stimulation of uterine contraction: • Massage of uterus through the abdomen and bimanual compression • intrauterine packing

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