Postpartum hemorrhage or postpartum bleeding is defined as the loss of more than 500.0 ml within first 24 hrs following childbirth or 1000.0 ml after cesarean section.
Bleeding in the first 24 hours after birth is called early, more than 24 hours – late.
Causes of postpartum hemorrhage:
- violation of the contraction of the uterus (tonus): overstretching of the uterus with polyhydramnios, multiple fetuses, large fetus; fast or prolonged labor, chorioamnionitis, uterine fibroids, placenta previa
- delay parts of the afterbirth in the uterus;
- trauma to the birth canal (rupture of the cervix, vagina, eversion of the uterus)
- coagulation disorders (DIC, coagulopathy)
Treatment of postpartum hemorrhage is based on a team approach. Well coordinated and simultaneous actions of medical staff are the key to the success of therapy.
Лечение послеродовых кровотечений основано на командном подходе. Слаженные и одновременные действия медперсонала являются залогом успеха терапии.
- Assessment of the woman’s condition and hemodynamic parameters. .
- Estimated blood loss.
- Catheterization of the bladder.
- Catheterization of two main vessels for the introduction of crystalloids in the ratio of 3: 1, the introduction of uterotonics.
- Warm the woman
- Provide humidified oxygen
- Laboratory tests (blood type, Rh)
- Examination and determination of the cause of bleeding.
- Etiotropic therapy:
With uterine atony, uterine massage, bimanual compression, uterotonics
manual examination of the uterus to eliminate the delay parts of the afterbirth; rarely curettage;
with trauma, closure of soft glands, correction of uterine reversal, laparotomy with uterine ruptures.
With coagulopathy – a transfusion of fresh frozen plasma, blood and its other components.