Type:
Educational Exhibit
Keywords:
Obstetrics, Embolism / Thrombosis, Embolisation, Arterial access, CT-Angiography, Catheter arteriography, Interventional vascular, Interventional non-vascular
Authors:
S. S. Rahila1, M. K. Yadav2, M. Unni3, D. Bindal4; 1Thiruvananthapuram/IN, 2Trivandrum/IN, 3THIRUVANANTHAPURAM, KERALA/IN, 4Trivandrum, ke/IN
DOI:
10.1594/ecr2018/C-2262
Background
Postpartum haemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth or any amount of blood loss that makes a patient hemodynamically unstable.
Types of PPH
- Primary PPH: Occurs in first 24hrs following the delivery.
- Secondary PPH: Occurs between 24hrs and 12 weeks postnatal.
Typically,
patients were initially treated with uterotonic drugs,
for blood loss will start blood infusion,
FFB etc.
If bleeding was not controlled,
a decision of hysterectomy or Uterine artery embolization.
The causes of PPH have been described as the "four T's"
-
Tone: Uterine atony,
distended bladder
-
Trauma: Laceration of uterus,
cervix or vagina
-
Tissue: Retained placenta or clots
-
Thrombin: Pre-existing or acquired coagulopathy
The most common cause of Primary postpartum haemorrhage is Uterine atony,
followed by retained placenta.
Risk factors for PPH include maternal obesity and a large baby,
in addition to well-known factors such as antepartum haemorrhage and multiple pregnancy.
Increased maternal age and prolonged labour were also risk factors.
Risk factors are relevant to discussions about the place of delivery and to the need for increased vigilance but PPH occurs unpredictably in low risk women.
Research on prevention has focussed on routine measures to be taken in all labours..
Major haemorrhage is easy to recognise but in some cases unspectacular bleeding can be persistent,
and its seriousness may not be appreciated until compensatory mechanisms fail and blood pressure falls.
Careful observation after delivery is important.