OBGYN: Postpartum Hemorrhage

PPH (Postpartum Hemorrhage)

- Excessive blood loss from the female genital tract starting at the time of the 3^rd stage of labor until 42 days after the delivery of the baby.

Note: Normal blood loss after NVD: upto 500 ml

Normal blood loss after a C-Section: upto 1000 ml

Primary PPH: Blood loss within 24 hours of the 3^rd stage of labor.

Secondary PPH: Blood loss starting after 24 hours of the delivery of the baby until 42 days post-partum.

Causes of Primary PPH:

I. Uterine atony (accounts for 90% of the cases of Primary PPH)

- Myometrial and Placental causes of Uterine atony.

II. Genital tract trauma (7%)

III. Coagulopathies (3%)

I. Uterine Atony: The uterus is unable to contract.

Myometrial causes of Uterine atony:

1. In multipara females, the uterus is over-distended as a result of multiple pregnancies.
2. The uterine muscle is replaced by fibrous tissue in some areas.
3. Prolonged 1^st and 2^nd stage of labor
4. Fibroid uterus

Placental causes of uterine atony:

1. Placental retention
2. Placenta Accreta
3. Placenta Previa
4. Placenta Abruptio

II.Genital tract trauma (Accounts for 7% PPH cases)

1. Deep episiotomy
2. Perineal tears
3. Cervical tears
4. Uterine tears
5. Wound dehiscence

III.Coagulopathies (Account for 3% PPH cases)

1. Thrombocytopenic purpura
2. DIC
3. Pre-eclampsia
4. HTN