Postpartum hemorrhage;

medical treatment

M.D .OBST&GYNAEM.D .OBST&GYNAE..Waled ayadWaled ayad

Post partum hg text Post partum hg text bookbook

whowho recommendation recommendation for pphfor pph

WhyWhy??

25% of maternal death25% of maternal death

Most causes preventableMost causes preventable

Prgnosis&outcome depend Prgnosis&outcome depend on on trained team&sch.drilltrained team&sch.drill

RISK FACTORSRISK FACTORS

Prophylactic tttProphylactic ttt

Ante natalAnte natal ; (history-exam-inv) ; (history-exam-inv)Intra natalIntra natal ; (6p) ; (6p)Post natalPost natal ; ( 3 ; ( 3rdrd+4+4thth stage) stage)

Active managementActive managementMedicalMedicalsurgicalsurgical

Ante natal Ante natal assysmentassysment

historyhistory

examinationexamination

investigationinvestigation

Intra natalIntra natalAAssysment of ssysment of 3P3PPPartogramartogramPProper use of oxytocinroper use of oxytocinAAnticipation –early nticipation –early recognition & intervention recognition & intervention for poor progress of labourfor poor progress of labour

Post natalPost natal

Active management of 3Active management of 3rdrd stage of labour should be stage of labour should be

offered routinelyoffered routinely ((grade Agrade A) )

VVaginal 5unit synto.imaginal 5unit synto.im

CCs 5unit synto iv drips 5unit synto iv drip

MMisoprostol 600 isoprostol 600 orally or rectallyorally or rectally

CARBETOCINCARBETOCINLONG ACTING OXYTOCINLONG ACTING OXYTOCIN..NOTNOT. PPH. BUT AMOUNT OF BLOOD . PPH. BUT AMOUNT OF BLOOD LOSS&NEED UTROTONIC AGENTLOSS&NEED UTROTONIC AGENT..

RECOMRECOM, ONLY IN , ONLY IN ELECTIVE CSELECTIVE CS NOT NOT IN EMERGENCY OR VAGIN BIRTHIN EMERGENCY OR VAGIN BIRTHDOSE:100MICR IM-IV (1 MINUTEDOSE:100MICR IM-IV (1 MINUTE))

DON’T FORGT 4DON’T FORGT 4THTH STAGE OF STAGE OF LABOURLABOUR

Active managementActive management

Guidelines Guidelines RCOGRCOG

RCOG 2016RCOG 2016 OX OX 5u5u

M M .5.5 OXOX 40u40u

C C .25.25 MM 400400

oxytocinoxytocin

Iv ½ x 2 x1/2Iv ½ x 2 x1/2

Im 5 min & prsist 1 Im 5 min & prsist 1 hour hour

MethergineMethergine4x40x44x40x4

Recomb.factor 7Recomb.factor 7LIFE SAVING..LIFE THRETEN(DVT)LIFE SAVING..LIFE THRETEN(DVT)

WHEN; MASSIVE HG AFTER #MED,SURWHEN; MASSIVE HG AFTER #MED,SUR..

DOSE; 90mi/kgDOSE; 90mi/kg

FIBRINOGEN & PLATLETFIBRINOGEN & PLATLET

RememberRememberAntepartum weaken but pph can Antepartum weaken but pph can killkill

4T4T

Rule of 30Rule of 30

CRMACRMA