Company LOGO OBSTETRICAL HEMORRHAGE 763 Placental abruption 14119
Company LOGO ������� OBSTETRICAL HEMORRHAGE ����������
������������������� 763 ����� ( ��������� ( Placental abruption 141(19) Laceration/uterine rupture 125(16) Uterine atony 115(15) Coagulopathies 108(14) Company Logo
����� ( ��������� ( Placenta previa 50(7) Uterine bleeding 47(6) Placental adherens 44(6) Retained placenta 32(4) (Chichakli & Colleagues, 1999 as cited Cunningham et al, 2005. ) Company Logo
������ Antepartum Hemorrhage Company Logo
Definition �������������� 20 ������� (Cunningham, Leveno, Bloom, Hauth, Gilstrap & Wenstrom, 2005( Company Logo
������ 1 ���������� �� ������ 1. 1 ����� ( Placenta previa( 1. 2 �������� (Abruptio placentae( 1. 3 ���� ( Rupture of the uterus( 1. 4 ����� vasa previa 1. 5 ����� marginal sinus Company Logo
������ (Abruptio placentae) ���� Company Logo
�����������. 1 Revealed hemorrhage ���� External hemorrhage ������ 80% 2 Concealed hemorrhage ���� Internal hemorrhage ������ 20% 3. Combined hemorrhage ���� Mixed ����������� 1 ��� 2 ������ )Cunningham et al. , 2005) Company Logo
������� 1. Hypovolumic shock 2. Hypofibrinogenemia 3. DIC 4. Postpartum Hemorrhage 5. Renal failure 6. Sheehan’s syndrome Company Logo
����� 1. Preterm birth 2. Fetal distress ��� Asphyxia ��������� Uteroplacenta insufficiency 3. ������������������ Asphyxia Company Logo
���� Placenta previa Company Logo
Definition ��������������������� (Lower uterine segment) ��������������������� (Genovese, 2000: 849; Pillitteri, 1999 : 382( Company Logo
�������� 1. Low lying placenta ������� internal os ����� 2 ��. 2. Marginal placenta previa ���������� os ������ 2 ��. 3. Partial placenta previa ���������� internal os ������ 4. Complete placenta previa Company Logo
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������ 1. �������������� 2. Ultrasound sensitivity ������ 95 3. Double setup Company Logo
���� ( uterine rupture ) Perinatal and mothernal motarity Company Logo
v. Definition v uterine wall tear after fetal viability Company Logo
v v v Type - Complete rupture - Incomplete rupture v rupture - dehiscence Company Logo
v Incident 1 : 100 – 1: 11, 000 Company Logo
v v v v Causes - previous scar - difficult obstetrics procedure - severe abdominal trauma - grand multiparity - oxytocic drugs - obstructed labor - placenta percreta or increta Company Logo
v v v Diagnosis 1. sign and symptom 1. 1 threatened uterine rupture - tetanic contraction - suprapubic tenderness - Bandl’s ring Company Logo
v 1. 2 uterine rupture v - decrease pain v - tear sensation v - with shock? v - FHB loss v - fetal part v - PV – float , become higher station v - hematuria Company Logo
v v v DDx - Abruptio placenta -Placenta previa -Ectopic pregnancy -tetanic uterine contraction -colpotthexis Company Logo
Rx - keep in mild - get rid of threatened uterine rupture - Rx shock - Exploratory laparotomy - hypogastric arteries ligation - blood tranfusion - antibiotic Company Logo
v Complication v - APH & PPH v - Infection v - increase perinatal- mothernal mortality v - fetal asphyxia v Company Logo
Vasa Previa rupture v Definition v umbilical or placental vv. insert at fetal membrane pass internal cervical os ( velamentous insertion ) Company Logo
v Incident 1: 2000 -3000 Company Logo
v Diagnosis v- Pre- rom: PV – synchronous pulse v : amnioscopy v : u /s v - Post- rom : fetal hemoglobin (alkali denaturation test ) v : placental and membrane exam Company Logo
v. DDx v : prolapse of the umbilical cord v : placenta previa Company Logo
v v Rx : keep in mind v : c/s in pre-rom period Dx v : rom case – rapid termination of labor Company Logo
v v Prognosis – fetal dead 60 -70% Company Logo
������ Postpartum hemorrhage Company Logo
�������������� , ������ ������� (Sheir, Sarid, Levy, Seidman & Hallak, 2005 ) ����������� 1. Retained placenta �������� 2. Failed to progress during 2 nd stage of labor 3. Placenta accreta 4. Laceration Company Logo
�������� 5. Instrumental delivery 6. Large size newborn 7. Hypertensive disorder 8. Induction of labor 9. Augmentation of labor with oxytocin Company Logo
������� , �������� (Stone, Paterson & Saunder, 1993) �����������. 1 Prolonged labor. 2 Augmentation labor. 3 History of postpartum hemorrhage. 4 Episiotomy, Especially mediolateral. 5 Preeclamsia Company Logo
����������� (. 6 Over distension uterus. 7 Operative delivery. 8 Asia or Hispanic ethnicity. 9 Chorioamniotis Company Logo
��������� Primary • Uterine atony • Retained placentaespecially placenta accreta • Defects in coagulation • Uterine inversion Secondary • Subinvolution of placental site • Retained products of conception • Infection • Inherited coagulation defects Company Logo
A Stepwise Approach to the Management of Postpartum Hemorrhage 1 2 3 ������� � �������� ������� �� Company Logo
A Stepwise Approach to the Management of Postpartum Hemorrhage 1 �������� Initial Assessment and Treatment Resuscitation • large bore IV (s) • oxygen by mask • monitor BP, PR, RR, I/O • retained Foley catheter • +/- oxygen saturation Assess Etiology • Tone • Tissue • Trauma • Thrombin Laboratory Tests • CBC • coagulation screen • M/G Company Logo
A Stepwise Approach to the Management of Postpartum Hemorrhage “Tone” • massage • compress • drugs “Tissue” • manual removal • curettage “Trauma” 2 • correct inversion • repair laceration • identify rupture ������������� “Thrombin” • reverse • anticoagulation • replace factors Company Logo
A Stepwise Approach to the Management of Postpartum Hemorrhage 3 3. 1 ������������� 3. ���������� ) ����������� 3. 2 ������� ( ������ 1. Get Help • anesthesiologist • lab and ICU 2. �������� • ��������� • ������ BP��� ��������� 4 ������� • ���� , ���� 4. 1 Abdominal packing / umbrella packing 4. 2 Arterial embolization / Recombinant Factor VIIa Company Logo
DRUG THERAPY FOR PPH v Oxytocin IV 10 -40 unit ����� Lactated Ringer 1 L ������ IM 10 unit v. Methylergonovine IM ���� IV ��� � 0. 2 ��. ����� 2 -4 ������� v - 15 methyl PGF 2 a 0. 25 ��. IM ���� 1590 ������� 8 ����� Company Logo
Bimanual compression Company Logo
Uterine packing Company Logo
B lynch sutures Company Logo
Uterine artery ligation Company Logo
Right hypogastric artery ligation Company Logo
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