POSTPARTUM HEMORRHAGIC

Bleeding is still the biggest cause of maternal death in addition to

preeclampsia / eclampsia and infections
Definition : Bleeding in excess of 500 mL after the newborn
Classifications :
Primary : occurs 24 hours after the baby is born
Cause : uterine atony , laceration of the birth canal , the remaining portion
of the placenta , uterine inversion
Secondary : the case, 24 hours after childbirth , usually because the rest of
the placental membranes and some residual

Causes of Postpartum Hemorrhagic
Bleeding from the placental implantation
Hypotony to Atony
As a Result of Anesthesia
Excessive Distension ( Gemelli , Big Boy , Hydramnios )
Prolonged Labor , Obstructed Labor Displaced
Precipitate Parturition ( Too Fast )
Due To The Induction Of Oxytocin
Multiparity
Chorioamnionitis
History of Previous Atony
History of Anemia Before Pregnancy

The rest of the placenta
The rest of the membrane or cotyledons ,placenta accreta ,
increta , percreta
Since the birth canal laceration :
Episiotomy wide
A torn perineum , vagina , cervix , uterine rupture
Coagulation disorders :
Very rare example thrombophilia cases , HELLP syndrome ,
preeclampsia / eclampsia , placental abruption , intrauterine
fetal death ( IUFD ) , amniotic fluid embolism

UTERINE ATONY
Weak / no uterine contractions uterine not able to close the open
bleeding from the placental implantation site
Prevention
Active management of the third stage
Provision of 2-3 tablets of misoprostol orally (400-600 mg) immediately after birth
Diagnosis
Massive bleeding , found after the baby and placenta birth
High fundus ( TFU ) is still as high as the central
Contraction soft / no
Actions
Depends on a lot of blood is lost :
Anemia
Decreased consciousness
Hypovolemic shock


RIPS ROAD BIRTH
Due to a very manipulative help labor and traumatic
Causes by:
Wide episiotomy , spontaneous perineal laceration , traumatic forceps ,
vacuum extraction version
Classification :
Lightweight : abrasions , lacerations
Medium : how wide episiotomy , perineal tear up a total rupture , laceration
of the vaginal wall , uterine fornix , cervix , the area around the clitoris
Weight : uterine rupture

RETAINED PLACENTA
Definition entrainment of the placenta and a half hours after the
child is born
Classification :
Captiva Placenta : placenta had separated but confined within the
uterine cavity
Accrete Placenta : implantation penetrate the decidua basalis . The
placenta penetrates the myometrium
Percrete Placenta : penetrate perimetrium
Adhesive Placenta : placenta cling tightly to the endometrium

UTERINE INVERSIO
Definition : the lining of the uterus ( endometrium ) dropped out of
the OUE, can be complete or incomplete
The causes are :
Atony uterine , cervix is still wide open
the presence of an attractive factor deficiencies fundus down ( placenta
accrete , increte , percrete )
The pressure on the fundus of the above ( Crede maneuver ) or intra-
abdominal prisoners harsh and abrupt .

POST PARTUM HEMORRHAGE DUE TO
BLOOD CLOTTING DISORDER
After other causes ruled out suspected blood clotting disorder
Suspected also if there is a history of previous delivery of blood
clotting disorders
General description :
Time of bleeding and clotting time extends
Thrombocytopenia
Hipofibrinogenemia
The presence of FDP ( fibrin degradation product)
Test elongate prothrombin

PREVENTION POSTPARTUM
HEMORRHAGIC
Before Pregnant improved chronic disease , anemia
Know the predisposing PPP : multiparity , anakbesar , twins ,
hydramnios , the former section , a history of previous PPP and other
high- risk pregnancies .
Delivery must be completed within 24 hours
High risk pregnancies give birth in hospital referral
Avoiding the shaman must labor with health workers