Postpartum hemorrhage

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Definition

• Postpartum hemorrhage has been defined as the loss of 500ml or more blood after the delivery of the fetus (completion of the third stage of labor).

• Hemorrhage after the first 24 hours is designated late postpartum hemorrhage.

Sheehan syndrome

• Severe intrapartum or early postpartum hemorrhage is on rare occasions followed by sheehan syndrome, which in the classical case is characterized by failure in laceration, amenorrhea, atrophy of the breasts, loss of pubic and axillary hair, superinvolution of the uterus, hypothyroidism and adrenal cortical insufficiency.

Sheehan syndrome

• In some but not all instances of sheehan syndrome, varying degrees of anterior pituitary necrosis with impaired secretion of one or more trophic hormones account for endocrine abnormalities. Some cases imply impaired hypothalamic function.

Etiology

• Uterine atony(uterine inertia)

• Genital tract lacerations

• Placenta factors

• Impaired coagulation mechanism

Clinical manifestation and diagnosis

• Bleeding

• shock., infection

• uterine atony

• genital tract lacerations

• placenta factors

Placenta factors• Retained placenta fragments

• placenta adherence

• placenta accreta, increta and percreta

– placenta accreta is used to describe any placental implantation in which there is abnormally firm adherence to the uterine wall.Placenta villi are attached to the myometrium in placenta accreta; actually invade the myometriumin placenta increta, or penetrate through the myometrium in placenta percreta

Puerperal Infection

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definition

• Puerperium: is the postpartum period during which the pelvic organs return to their prepregnant conditions

• puerperium infection is a general term used to describe any bacterial infection of the genital tract after delivery

• puerperium morbidity:

Puerperium morbidity• Temperature 38.0 or higher, the temperature

to occur on any 2 of the first 10days postpartum, exclusive of the first 24 hours, and to be taken by mouth by a standard technique at least four times daily.– Although it is suggests that all puerperal fevers

are the consequence of pelvic infection, temperature elevations may be the results of other causes.

Extragenital causes of puerperal fever

• Respiratory complications

• pyelonephritis

• intense breast engorgement

• bacterial mastitis

• thrombophlebitis

• incisional wound abscess

Bacteria commonly responsible for female genital infections

• Aerobes

– Group A, B and D streptococci

– Enterococcus

– Gram-negative bacteria---E. Coli, Klebsiella

– staphylococcus aureus

• Anaerobes

– peptococcus species

– peptostreptococcus species

– bacteroides bivius, B. Fragilis,B. Disiens

– clostridium species

– fusobacterium species

• others------mycoplasma hominis

– chlamydia trochomatis

Clinical manifestation• Acute episiotis, vulvovaginitis and cervitis• metritis(postpartum uterine infection)

– endometritis, endomyometritis, endoparametritis– subinvoluted, tenderness, rebound tenderness– lochia

• adnexal infections: acute salpingitis• parametrial phlegmen and pelvic abscess• acute pelvic peritonitis or general peroitonitis• septic pelvic thrombophlebitis:femoral,saphena• pyemia and sepsis