Postpartum Hemorrhage
To view the entire topic, please log in or purchase a subscription.
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
- Postpartum hemorrhage (PPH) after 20 wk gestation
- Primary: Hemorrhage occurring ≤24 hr after delivery:
- Also known as early PPH
- Secondary: Hemorrhage occurring 24 hr–12 wk after delivery:
- Also known as delayed PPH
- Definitions:
- >500 mL after vaginal delivery
- >1,000 mL after C-section
- Occurs in 4% of vaginal deliveries
- Occurs in 6% of C-sections
- Accounts for 25% of pregnancy-related deaths
- ∼50% of postpartum deaths are due to PPH
- 95% of PPH caused by:
- Uterine atony (50–60%)
- Retained placenta (20–30%)
- Cervical/vaginal lacerations (10%)
- Complications:
- Hypovolemic shock
- Blood transfusion
- Acute respiratory distress syndrome
- Renal and/or hepatic failure
- Sheehan syndrome (postpartum pituitary necrosis)
- Loss of fertility
- Disseminated intravascular coagulopathy (DIC)
ALERT
Leading cause of death in pregnancy worldwide
Etiology
- 4 Ts of primary PPH:
- Tone:
- Uterine atony
- Tissue
- Lower genital lacerations
- Retained placental tissue
- Trauma
- Placenta accreta
- Uterine rupture
- Uterine inversion
- Ovarian or splenic artery rupture
- Puerperal hematoma
- Genital tract trauma
- Thrombin
- Coagulopathy (ITP, TTP, von Willebrand, DIC)
- Tone:
- Causes of secondary PPH:
- Retained products of conception
- Postpartum endometritis
- Withdrawal of exogenous estrogen
- Puerperal hematoma
- Associated conditions:
- If bleeding is present at other sites, consider coagulopathy
- Risk factors:
- Prior PPH
- Advanced maternal age
- Multiple gestations
- Prolonged labor
- Polyhydramnios
- Instrument-assisted delivery
- Fetal demise
- Anticoagulation therapy
- Placental abruption
- Fibroids
- Prolonged use of oxytocin
- C-section (especially emergent)
- Placenta previa and accreta
- Chorioamnionitis
- General anesthesia
- Large fetus/infant
- Obesity
- Pyrexia
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Postpartum hemorrhage (PPH) after 20 wk gestation
- Primary: Hemorrhage occurring ≤24 hr after delivery:
- Also known as early PPH
- Secondary: Hemorrhage occurring 24 hr–12 wk after delivery:
- Also known as delayed PPH
- Definitions:
- >500 mL after vaginal delivery
- >1,000 mL after C-section
- Occurs in 4% of vaginal deliveries
- Occurs in 6% of C-sections
- Accounts for 25% of pregnancy-related deaths
- ∼50% of postpartum deaths are due to PPH
- 95% of PPH caused by:
- Uterine atony (50–60%)
- Retained placenta (20–30%)
- Cervical/vaginal lacerations (10%)
- Complications:
- Hypovolemic shock
- Blood transfusion
- Acute respiratory distress syndrome
- Renal and/or hepatic failure
- Sheehan syndrome (postpartum pituitary necrosis)
- Loss of fertility
- Disseminated intravascular coagulopathy (DIC)
ALERT
Leading cause of death in pregnancy worldwide
Etiology
- 4 Ts of primary PPH:
- Tone:
- Uterine atony
- Tissue
- Lower genital lacerations
- Retained placental tissue
- Trauma
- Placenta accreta
- Uterine rupture
- Uterine inversion
- Ovarian or splenic artery rupture
- Puerperal hematoma
- Genital tract trauma
- Thrombin
- Coagulopathy (ITP, TTP, von Willebrand, DIC)
- Tone:
- Causes of secondary PPH:
- Retained products of conception
- Postpartum endometritis
- Withdrawal of exogenous estrogen
- Puerperal hematoma
- Associated conditions:
- If bleeding is present at other sites, consider coagulopathy
- Risk factors:
- Prior PPH
- Advanced maternal age
- Multiple gestations
- Prolonged labor
- Polyhydramnios
- Instrument-assisted delivery
- Fetal demise
- Anticoagulation therapy
- Placental abruption
- Fibroids
- Prolonged use of oxytocin
- C-section (especially emergent)
- Placenta previa and accreta
- Chorioamnionitis
- General anesthesia
- Large fetus/infant
- Obesity
- Pyrexia
There's more to see -- the rest of this topic is available only to subscribers.