Management of Primary Postpartum Hemorrhage (PPH)

Definition of Primary Postpartum Hemorrhage (PPH):

Excessive bleeding from or into the genital tract after birth within 24 hours is primary PPH. In the majority, hemorrhage occurs within 2 hours following delivery.

  • 3rd stage Hemorrhage: Excessive bleeding before expulsion of placenta,
  • True PPH: Bleeding after expulsion of placenta (majority cases).

What Do You Mean By Postpartum Hemorrhage (PPH)?

Postpartum Hemorrhage also known as PPH is any amount of bleeding from or into genital tract following birth of the baby up to the end of the puerperium which adversely affects the general condition of the patient evidence by rise in pulse rate and falling blood pressure.

Management of primary postpartum hemorrhage (PPH)
Fig: Management of primary postpartum hemorrhage (PPH)

Management of Primary Postpartum Hemorrhage (PPH):

1. Shout for help to mobilize all the staffs.

2. Measures to stop the bleeding and to resuscitate simultaneously.

3. A quick evaluation of the patient-

  • Whether patient is haemodymamically stable or not,
  • Whether uterus is contracted or not,
  • Whether a cord is found hanging or not.

4.To stop bleeding- Inj. Ergometrin 2 ampules IM or IV-ifIV fluid remains (for sustained contraction).

5. Resuscitation of the patient:

  • IV cannula should be inseted,
  • Blood is sent for grouping and cross matching,
  • IV fluid infusion rich in oxytocin. (4 ampules in 1000 ml. Hartmans solutionis best, if it is not found DNS),
  • Blood transfusion,
  • Antibiotics,
  • Catheterization.

6. Gentle uterine massage by left hand if uterus is flabby.

7. Placenta is removed by controlled cord traction.

8. If placenta is not separated then manual removal of placenta under G/A.

9. If bleeding is not stopped-

  • Bimanual compression of uterus or,
  • Aortic compression.

10. If bleeding continues – Coagulopathy must be excluded.

11. If bleeding continues – Patient is taken to the OT followed by-

  • Condom catheter: If normal vaginal delivery,
  • B-lynch stitch, if C/S.

12. If bleeding continues:

  • If family incomplete: Hysterectomy,
  • If incomplete: Uterine arterial ligation,
  • Ligation of anterior division internal life artery (rare).

13. If morbid adhesion of placenta is detected:

  • Hysterectomy is the Rx of choice,
  • If fertility is very important,
  • Keep the placenta with cord in situ,
  • Broad spectrum antibiotics,
  • Autolysis of placenta with sloughing of the placenta.

14. After gentle massage of the uterus, if the uterus contracted, PPH is due to laceration of genital tract and then laceration should be repaired.

More questions related to this article:

  • What is postpartum hemorrhage (PPH)?
  • What do you mean by primary postpartum hemorrhage (PPH)?
  • How will you manage a case of primary postpartum hemorrhage (PPH)?
  • How will you manage atonic primary postpartum hemorrhage (PPH)?
  • Mention important steps of management for primary postpartum hemorrhage (PPH) due to uterine atony.

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