Postpartum hemorrhage

This is a brief video on postpartum hemorrhage, or excess bleeding following childbirth.

I created this presentation with Google Slides.
Images were created or taken from Wikimedia Commons
I created this video with the YouTube Video Editor.

ADDITIONAL TAGS
Postpartum hemorrhage
Overview
Causes
Medications
Other management
By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 1170, Public Domain, https://commons.wikimedia.org/w/index...
Excess bleeding following childbirth

Defined as, in 24 hours after delivery:
Over 500 ml blood loss after vaginal delivery
Over 1000 ml blood loss after c-section
Signs and symptoms include faintness/lightheadedness with standing/straining, increased heart rates and respiratory rates
Severe blood loss: low BP, feeling cold, loss of consciousness (hypovolemia and shock)
Risk factors: infection (chorioamnionitis), prolonged labor, multiple gestations
Overview
Overview
Causes
Medications
Other management

Tone:
Uterine atony (inability to contract), sign: boggy uterus
Retained placental tissue, infection can contribute to atony
Prolonged labor contributes to atony (uterus is tired)
Inverted uterus, sign: absent uterus
Trauma: injury to uterus, cervix, vagina, or perineum, both before and during delivery (often precipitous deliveries)
Sign: lacerations
Perineal injury: 1st degree is mucosa only, 2nd involves perineal body, 3rd involves rectal sphincter, 4th involves rectal mucosa
Tissue: retained tissue from placenta or fetus
Placenta burrows deeply into uterus (accreta increta percreta); might have accessory lobes, placental tear
Dx with ultrasound or placental inspection (blood vessels at placental edge)
Sign: firm uterus
Thrombin: failure to clot blood, such as from coagulation disorders, DIC

Causes - four Ts
Overview
Causes
Medications
Other management

Dehydration: two large bore IVs, fluids

Oxytocin - contracts uterus, prolongs contractions (for uterine atony)
Consider other management (next slide)
Misoprostol, carboprost - prostaglandin analogs
Side effects: fever and shivering
Methylergonovine - ergot drug, which vasoconstricts decreasing blood supply to bleeding organ
Oxytocin + ergometrine in combination drug Syntometrine

Medications
Overview
Causes
Medications
Other management

Uterine massage
Surgery and/or sutures to repair lacerations
Hysterectomy in severe cases
Uterine artery embolization with help of interventional radiology or ligation with obstetrics
D&C to remove retained products of conception
Other management
Overview
Causes
Medications
Other management
By Valerie Henry - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index... and ***48357595