PPH-lession(英文).ppt

Postpartum Hemorrhage Dr.Yan Long Department of Obst.Gynaec Beijing Friendship Hospital Definition Postpartum Hemorrhage (PPH ) is defined as blood loss of more than 500 ml during the first 24 hours after delivery. Epidemiology Diagnosis Symptom Excessive bleeding Weak ，palmus shock Sign: Vital sign: pulse rate↑ , blood pressure↓ pale Laboratory findings hematocrit (red blood cell count). clotting factors in the blood Management plan Postpartum hemorrhage-Guideline for immediate action Step 1 Immediate action：prevent shock establish intravenous access, Replacing lost blood and fluids Step 2 Check for Uterine tone ，Trauma，Placenta Bimanual compression Step 3 Drug therapy: Oxytocin Ergometrine Misoprostol Prostaglandin F2α rFVIIa Postpartum hemorrhage-Guideline for immediate action Step 4 Balloon tamponade Step 5 B-Lynch Step 6 Other procedures Uterine artery embolization Stepwise devascularization Internal iliac artery ligation Hysterectomy Bimanual massage of the uterus Stepwise devascularization Prevention of PPH Recognize the risk factors of PPH Active management of the third stage Offer oxytocin，ergometrine，misoprostol carboprost Following delivery, administering a uterotonic drug that lasts at least 2-3 hours is reasonable Summary Remember 4 Ts: Tone Tissue Trauma Thrombin Summary “TONE” Rule out Uterine Atony Palpate fundus. Massage uterus. Oxytocin 40U/L +250cc / h. Methergine one amp IM (not in hypertensives) Hemabate IM q 15min Summary “Tissue” R/O retained placenta Inspect placenta for missing cotyledons. Explore uterus. Treat abnormal implantation. Summary: remember 4 Ts “TRAUMA” R/o cervical or vaginal lacerations. Obtain good exposure. Inspect cervix and vagina. Worry about slow bleeders. Treat hematomas. Summary “THROMBIN” Check labs if suspicious. *