上海交通大学医学院：《妇产科学》（双语） 25 Postpartum Hemorrhage(Pph)

Postpartum Hemorrhage(PPH) 产后出血 林建华

Postpartum Hemorrhage(PPH) 产后出血 林建华

Maior causes of death for pregnancy women (maternal mortality) Postpartum hemorrhage (28%) heart diseases pregnancy-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 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

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

Major causes Uterine atony(90%) lacerations of the genital tract(6%) retained placenta(3%0-4%) 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 atony Local factors overdistention of the uterine (hydramnios, multiple pregnancy, macrosomia) condition that interfere with contraction(leiomyomas) complications(PIH, anaemia, placenta praevia

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 spiral arteries preventing the excessive bleeding from the placenta implantation site the uterine atony give rise to PPH when 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 of uterine atony Administration of medicine promotes contraction of the uterine corpus decreases the likelihood of uterine atony Oxytocin agents Methegine prostaglandin

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 contraction Massage of uterus through the abdomen and bimanual compression intrauterine packing

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