ТМА lecture for students 4 courses

of therapeutic faculty OBSTETRIC BLEEDING

Prof. Jabbarova Y.K.

Maternal mortality: global tragedyAnnually 585, 000 women die of pregnancy complications

99% in the developing worlds

~ 1% in industrial countries

Каждую минуту...

Hours of maternal mortality

380 women pregnant

190 women with unplanned and unwanted pregnancy

110 women passes through complications, caused by pregnancy

Каждую минуту...

Hours of maternal mortality

40 women

Make

Criminal abortion

1 woman die from complications in pregnancy time and after births of children

Global causes of maternal mortality

24.8

14.9

12.96.912.9

7.9

19.8

Кровотечение 24,%

Инфекция 14,9%

Эклампсия 12,9%

Затяжные роды6,9%Криминальныйаборт 12,9%Другие прямыепричины 7,9%Косвенныепричины 19,8

ЭОВ; 2,0%

ЭГЗ; 16,1%

Сепсис; 15,2%

Гестоз; 15,3%

Кровотечение; 51,4%

Structure of maternal mortality

Obstetrics bleeding

Obstetrics bleeding in structure of maternal mortality steadily occupy leading the place.

The frequency them range from 28% up to 50% variously republic regions 0001 the frequency

Obstetrics bleeding during pregnancy

I half:

• Abortions

• Ectopic pregnancy

• Molar pregnancy

II half: • The premature

detachment is normal disposed placenta

• Placental presentation

• Uterine ruptures

Obstetrics bleeding during labor

I and II period:

1. The premature abruptio is normal disposed placenta

2. Placental presentation

3. Uterine ruptures

III period:

1.Partial dense fastening of placenta

2.Afterbirth restriction

3.Hypo and metratonia

4. Injuries of soft maternal passages

Postpartum hemorrhages:

Early: - <4 tons> 1.Parts delay of afterbirth

(fabric ) 2.Hypo and metratonia

(tonus ) 3. Injuries of soft maternal

passages 4.D I C- syndrom

(thrombus )

Late:

1. Parts delay of afterbirth

2. Endometritis

3. Subinvolution

4. Lochiometra

5. Fibromyoma

Obstetric bleeding (unentangled with pregnancy )

Cervical erosion Cervix cancer Varicosis Injuries of soft maternal

passages Cervical polyps

Causes of bleedingCauses of bleeding

Out-and-out placental detachment - 35%

Complete presentation - 15%

After septic shock - 8%

Inborn and acquired disorders of haemostasis - 7%

Anesthetic, stillbirth - 3%

Amniotic fluid embolism -?

Hypotonia - 88%

Partial placental separation - 3%

Incomplete placental presentation - 3%

massive mild

Premature Detachment

is normal Disposed Placenta

Etiology• Hypertension • Renal disease • Anaemia • Rheumatismus • Diabetes mellitus • Multiple pregnancy • Dropsy of amnion • Short umbilical cord • Entire amniotic bag

PathogenesisBreak of uteroplacental capillaries:

A. Centered on:

Retroplacental hematoma

Uterus of Cuveler

B. With territory:

External hemorrhage

DIAGNOSISTopalgia

Violation of fetal heart sound

USE: retroplacental hematoma

Vaginal bleeding

Symptoms of hemorrhagic shock

Thrombocytopenia, fibrinopenia

COMPLICATIONS

Hemorrhagic shock Overvoltage limiter DIC-syndromAsphyxia and fruit death Maternal mortality

TREATMENTCesarean section Amputation Extirpation Dressing of a. iliaca interna

PLACENTA PREVIA

CLINIC

Bleeding: • Painless • Without presence EGD and hypertension • Abrupt • Repetitive • Plentiful • Than lower are arranged placenta before

gestational age begins the bleeding (even with 13-16 weeks )

TACTIC

Pregnancy conservation:

Rest

Bed rest

Antispasmodic drugs

Tocolytics

Progestagens, gestagens

TACTIC

Caesarean section:

Central and side presentation

Term 36-37 weeks

Hemorrhea

Early recognition and help challenges:

State estimating PS, BP,

Colour of dermal covers,

Awareness

T bodies,

Respiration rate,

Vaginal precipitations, urination

Challenges of ambulance and transporting in permanent establishment 2 and 3 levels

Primary of intensive care:

To setup one or two intravenous catheter tube of large diameter (the size 16 or more )

To start the introduction (1 litre for 15 minutes ) cristalloid

Saline solution:

At the rate of 3мл of solution to 1 bloodloss magnetic tape

Primary of intensive care:

At hand of shock sign, additionally: - lower down the head - to free respiratory tract To provide the oxygen supply through mask (6-8 l/min) To heat up the woman (to draw the blanket over, to interchange wet sheets on dry )

Why die these woman?The belated decision request assistance Lack of understanding of complication Receivability of maternal mortality Low social women status Social and cultural hedges to get help Later help receipt Mountains, islands, rivers - imperfect organisation of transporting Later help receipt Resources, personnel Poorly trained staff when penalty system Financial difficulty

Thank you for your attention!