The PPH Full form stands for “Postpartum Hemorrhage”.
- 1 What is PPH
- 2 What are the causes of PPH
- 3 WHO is at risk of PPH
- 4 Symptoms of PPH
- 5 How we can prevent PPH
- 6 Prognosis of PPH
- 7 How can we treat postpartum hemorrhage
- 8 Conclusion
What is PPH
The full form of PPH is POSTPARTUM HEMORRHAGE is an obstetric medical condition, postpartum hemorrhage means the hemorrhage “after the act of giving birth, childbirth”, it is a common cause of maternal death in developing countries and in low socioeconomic countries. In worldwide 60 percent of women, death is due to postpartum hemorrhage.
The postpartum hemorrhage is defined as excessive blood loss from or into the genital tract after birth/ delivery of the baby up to end of puerperium ( It is the time period after the birth of a baby till 6 weeks after delivery). PPH occurs immediately after baby birth as we consider blood loss greater than 500ml- 1000ml in 24 hours after delivery.
Excessive blood loss may cause hypovolemic shock to the mother if PPH not treated immediately there will be excessive blood loss from the body and insufficiency of blood to vital organs ( brain, heart, kidney, lungs, liver, spleen) ultimately leads to maternal death.
To prevent the mother from hypovolemic shock and minimize bleeding, stabilize mother condition quick intervention of fluid replacement therapy should be done. Immediate diagnose of the cause of bleeding, risk For mother and treatment as with medication or by surgical procedure.The PPH Full form stands for “Postpartum Hemorrhage”.
What are the causes of PPH
there are four main causes as mentioned below :-
Tone ( Atonic uterus)
It means the normal tone of uterus contraction and retraction get disturbed or imperfect contraction or retraction of uterus. Atonic uterus is the commonest cause of PPH. 80 % PPH occur due to atonic uterus.
Tissue ( Retained tissue )
The retention of tissue, bits of placenta, blood clots inside uterus after delivery of baby with in 24 hours cause PPH due to imperfect uterine retraction.
Trauma (uterine rupture, laceration)
The blood loss due to any trauma inside the uterus (during operative delivery or in normal vaginal delivery ), blood loss from the episiotomy wound, the trauma involves usually the cervix, vagina, perineum, paraurethral region. 20 % PPH occurs due to trauma
Thrombin (blood coauglopathy)
Blood coagulation disorder diminished procoagulants or increased fibrinolytic activity.
- Overdistension of uterus
- Antepartum hemorrhage
- Prolonged labor
- Anesthesia (anesthetic drugs ex- ether, halothane)
- Placenta detachment ( central or marginal)
- Precipitated labor
- previous PPH
The PPH Full form stands for “Postpartum Hemorrhage”.
WHO is at risk of PPH
- Malnourished mother
- Anemic mother
- Malformation of uterus
- Uterine fibroids
- Age ( less than 18 years and more than 40 years)
- Other placental condition ( Abrutio placenta , placenta previa)
Symptoms of PPH
- Excessive uncontrolled bleeding
- Tachycardia (rapid heartbeat due to defficency of blood, heart work rapidly to compensate blood needs)
- Hypotension (decreased blood pressure due to hypovolemia)
- Dizziness ( altered sense of balance)
- Altered sense of conscious
- Tachypnea (rapid abnormal shallow breathing)
How we can prevent PPH
PPH cannot always be prevented, but we can prevent severity of PPH.The incidence and magnitude can be reduced by early assessing the risk factors ,by diagnosis of risk and advance plan of safe delivery.
- Antenatal prevention can be done by Improving women’s health status.
- Intranasal prevention can be done by effective management of labour process.
DIAGNOSIS OF PPH CAN BE DONE – In the majority of cases vaginal bleeding is visible outside in rare cases it is concealed ( hemorrhage is there but blood is not coming out of the vagina, blood remain concealed and form hematoma)
- predelivery hemoglobin level.
- Measuring the amount of blood loss per vagina after birth of a baby in 24 hours if in normal delivery blood loss is greater then 500ml within 24 hours it is a symptom of PPH. Degree of pregnancy-induced hypovolemia, speed of blood loss.
- Measure vital signs of patient-
- Body Temperature- Increase in temperature If due to septic condition during delivery or any infection.
- Blood pressure- increasing blood pressure or Decreasing blood pressure mainly there is a decrease in blood pressure of the patient , a drop in blood pressure is a warning sign.
- Pulse – decreased pulse rate √Respiratory rate- increase in breathing rate and shallow breathing.
Prognosis of PPH
Postpartum Hemorrhage is one of the life-threatening emergencies. It is one of the major causes of maternal deaths both in developed and developing countries. Prevalence of malnutrition and anemia, inadequate antenatal and intranasal care, and lack of blood transfusion facilities, substandard care are some of the important contributing factors. There is also increased morbidity.
How can we treat postpartum hemorrhage
- If occur after the discharge of the mother then immediately go for a nearby hospital. FIRST AID used NASG (nonpneumatic anti-shock garment) is a type of first aid for women in case of excessive bleeding after delivery is used when hospital setting is so far to reach, NASG prevents the mother from hypovolemic shock until women get treatment. If the PPH occurs within a hospital setting then medical management is done.
- If ongoing bleeding monitors maternal status airway, breathing, and circulation.
- Intravenous fluid administration in bouls, the aim of intravenous fluid administration is to maintain fluid balance in the body and to keep blood pressure greater than 100/50 mm Hg.
- Oxytocin 20-40 IU/L intravenous fluid administration.
- Give Uterine massage, empty the bladder, and do an examination to determine the cause of bleeding.
- Give blood products if available.
- Tight uterine packaging or Ballon tamponade is done.
- If blood does not stop and needs surgical treatment then immediately go for surgery to determine the site of bleeding and to cease bleeding. surgical management are
- ligation of uterine arteries is done.
- B lynch compression suture and multiple square sutures.
- ligation of ovarian and uterine artery anastomosis.
- ligation of the anterior division of the internal iliac artery.
- Angiographic selective arterial embolization.
- Hysterectomy (done in rare cases if all of the above measures fail to stop bleeding).
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