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Postpartum Hemorrhage (PPH) and Ectopic Pregnancy

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Postpartum Hemorrhage (PPH) and Ectopic Pregnancy

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what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is PPH and what is the management?
what is the ectopic pregnancy?

what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is PPH and what is the management?
what is the ectopic pregnancy?

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Postpartum Hemorrhage (PPH) and Ectopic Pregnancy

  1. 1. Placental Abnormalities and Hemorrhagic Complications 1. Antepartum Hemorrhage (APH) 2. Postpartum Hemorrhage (PPH) 3. Ectopic Pregnancy 4. Abortion
  2. 2. 2. Postpartum Hemorrhage (PPH) • Postpartum Hemorrhage (PPH) is a blood loss after delivery greater than: - 500 mL for vaginal delivery, and - 1,000 mL for cesarean delivery, - with 10% drop in hematocrit • PPH is responsible for around 25% of maternal mortality.
  3. 3. PPH Classification • PPH is classified into: − Primary (early) occurs within the first 24 hours after delivery. − Secondary (late) occurs after 24 hours post-birth to 6 weeks after delivery.
  4. 4. PPH Risk factors • Antepartum hemorrhage in this pregnancy. • Enlargement Uterus Due to Macrosomia or Multiple fetuses. • Pre-eclampsia. • Previous PPH. • Maternal obesity. • Uterine abnormalities and Surgery. • Maternal age (35 years or older). • Maternal anemia. • Operative vaginal delivery (Use of forceps or vacuum). • Induction of labor. • Prolonged first and second stage of labor (over 12 hours labor). • Infections. • Anemia
  5. 5. Forceps Birth Vacuum Birth
  6. 6. PPH Common Causes The causes of PPH have been described as the "four T" 1. Tone: uterine atony (“70%” failure of the uterus to contract properly after delivery). 2. Trauma: lacerations of the uterus, cervix, or vagina, and uterus inversion. 3. Tissue: retained placenta. 4. Thrombin: Coagulation abnormalities.
  7. 7. 1. Tone: • Once a baby is delivered, the uterus normally continues to contract (tightening of uterine muscles) and expels the placenta. • After the placenta is delivered, these contractions help compress the bleeding vessels in the area where the placenta was attached. • If the uterus does not contract strongly enough, called uterine atony, these blood vessels bleed freely and haemorrhage occurs. • This is the most common cause of postpartum haemorrhage.
  8. 8. 2. Trauma: Lacerations, hematomas, injury, rupture of the uterus, cervix, or vagina. And uterus inversion. 3. Tissue: If small pieces of the placenta remain attached, bleeding is also likely. Or placenta tissues attack and enter the uterine tissues. 4. Thrombin: Coagulation abnormalities due to many causes as; HELLP Syndrome, Amniotic fluid embolism, Vitamin K deficiency.
  9. 9. PPH Prevention • Detect any abnormality (anemia, diabetes…) before the delivery and try to control it. • Ensure that the bladder of the mother is empty since a full bladder makes it more difficult for the uterus to contract. • We should know the mother’s blood type. • IV access should be maintained. • Slow IV infusion. • Oxytocin medication (A drug used to stimulate uterine contractions and control bleeding). • Oxytocin should be routinely used in the third stage of labor. • Massage the mother’s uterus to help it contract.
  10. 10. PPH Management Tone • Massage • Drugs (Oxytocin) Thrombin • Drugs (according to the cause) • Platelet and blood transfusion Tissue • Drugs (Oxytocin) • Manual removal of retained placenta • Uterine curettage Trauma • Manual fixation of uterus inversion • Repair the rupture and laceration
  11. 11. Uterine curettage
  12. 12. Uterus inversion and how to fix it back
  13. 13. Uterine massage Manual Removal of the Placenta
  14. 14. PPH Management • Large-bore intravenous access, and increase oxytocin. • Uterus Relaxation Agent • A blood clotting medication. • Transfuse blood. • Bakri Balloon. • Laparotomy: Surgery to open the abdomen to find the cause of bleeding. • If the blood doesn’t stop; Hysterectomy should be Done (This is always a last resort in all condition).
  15. 15. Bakri Balloon
  16. 16. 3. Ectopic Pregnancy • An ectopic pregnancy is the implanting of the zygote somewhere other than the inner endometrial lining of the uterus (pregnancy that occurs outside the uterus). • It occurs in 1%-2% of all pregnancies. • It is life-threatening to the mother. 17
  17. 17. 3. Ectopic Pregnancy • The vast majority of ectopic pregnancies occur in the fallopian tube “tubal pregnancy’’ (95%), but the fertilized ovum can also implant in the ovary, cervix, or abdominal cavity (5%). • Doctors usually discover it between week 5 and week 14 of pregnancy . 18
  18. 18. 19
  19. 19. Sites of ectopic pregnancy 20
  20. 20. 21 Bleeding due to ectopic pregnancy
  21. 21. Ectopic Pregnancy symptoms • The first warning sign of an ectopic pregnancy is pelvic pain. • Abnormal vaginal bleeding. • Abdominal pain, typically just in one side, which can range from mild to severe. • An absent of menstruation (amenorrhea), and other symptoms of pregnancy. • Shoulder pain (unknown why). • If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting. • Rectal pressure. 22
  22. 22. Ectopic Pregnancy Causes • The most common cause is damaged fallopian tube. • Zygote abnormality. • Previous ectopic pregnancy. • Sexual diseases (typically chlamydia). • Reproductive organs infections and inflammations. • Smoking. • Endometriosis (abnormal uterus lining). • Using fertility drugs. • Getting pregnant while having an intrauterine device (IUD). 23
  23. 23. Intrauterine device (IUD) 24
  24. 24. Ectopic Pregnancy Complications • The major health risk of ectopic pregnancy is rupture leading to internal bleeding. • Decreased fertility related to removal of fallopian tube. 25
  25. 25. Ectopic Pregnancy Management • In early stage; a medication used to stop the egg developing. The pregnancy tissue is then absorbed into the woman’s body. • In more advanced stage; a surgery is required to remove the egg or Embryo. 26
  26. 26. Ectopic Pregnancy Management • If the fallopian tube has ruptured, emergency surgery is necessary to stop the bleeding and fix the tube. • In some cases, the fallopian tube and ovary may be damaged and will have to be removed. 27
  27. 27. Ectopic Pregnancy Management • The hCG level will need to be rechecked on a regular basis until it reaches zero if the entire fallopian tube did not removed. • An hCG level that remains high could indicate that the ectopic tissue was not entirely removed, which would require another surgery or medical management. 28

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