Postpartum hemorrhage

Poor uterine contractions, bleeding.  Photo from http://creative.gettyimages.com

Unfortunately, only 14% of births take place without complications. The most common symptom is abnormal postnatal period — bleeding.

Causes

  • The delay in the uterus of the next (share a placenta or membranes);
  • Atonia and hypotonia of the uterus;
  • Soft tissue injury of the birth canal;
  • Violation of blood coagulation (coagulopathy).

Diagnosis and treatment

Massive bleeding from the uterus may occur early (within 2 hours) or late (after 2 hours or more after birth) postnatal period. In hypo-and atony uterus big, relaxed, with outdoor massage may decrease slightly, and then relaxes again, andbleeding resumes.

Hypotonic treatment of bleeding is complex and begins immediately.

Conservative treatment includes:

  • Emptying the bladder catheter;
  • External massage of the uterus through the abdominal wall;
  • Intravenous and intramuscular formulations are administered, reducing the uterus (oxytocin, etc.);
  • Ice on the belly;
  • Restores blood loss.

If, after a massage uterus not reduced or reduced, and then again relaxes and blood loss reached 300 ml, then proceed to further activities. Spendmanual examination of the uterusin which blood clots are removed, conduct an audit of placental site (in case the detainees share a placenta, it is removed), check the integrity of the walls of the uterus.

With timely performance of this operation is used to stop bleeding and prevents further blood loss. In identifying hypotension spend (very carefully) massage uterus on the fist.

To strengthen the effect hemostasis impose cross-stitch on the cervix, is introduced into the posterior vaginal fornix swab soaked with ether, the cervix is administered oxytocin or prostaglandin (funds that reduce the uterus), install an ice pack on the abdomen, reduced blood loss.

In the absence of the effect of all the manipulations and continued bleeding (blood loss of more than 1000 ml) go for surgery — tubal and ovarian vessels, or removal of the uterus (supravaginal amputation, or hysterectomy). Blood substitute solutions are introduced at the same time, a blood transfusion.

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