Management and Treatment of Secondary Postpartum Hemorrhage (PPH)

Secondary Postpartum Hemorrhage (PPH): Management and Treatment

What is Postpartum Hemorrhage (PPH)?

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 is called PPH (Postpartum Hemorrhage).

Definition of Secondary Postpartum Hemorrhage (PPH):

Excessive bleeding from or into the genital tract after 24 hours of delivery up to 6 weeks (the end of puerperium) is secondary PPH.

Management and treatment of secondary postpartum hemorrhage
Fig: Management and treatment of secondary postpartum hemorrhage

Management of Secondary Postpartum Hemorrhage (PPH):

By the below way, anyone can manage a case of secondary PPH:

Clinical Features of Secondary Postpartum Hemorrhage (PPH):

It includes-

  • P/V bleeding – bright red and of varying amount,
  • Anemia,
  • Evidence of sepsis,
  • PV exam: May reveals – sub involution of uterus with patulous cervical OS.

Investigation of Secondary Postpartum Hemorrhage (PPH):

It includes-

  • Blood: TC, DC, ESR, Hb%,
  • Blood grouping, Rh typing and Cross matching,
  • Blood culture,
  • USG of pelvic organs.

Treatment of Secondary Postpartum Hemorrhage (PPH):

It includes-

1. General Rx:

  • Bed rest,
  • Fluid,
  • Blood transfusion, if necessary,
  • Cauterization,
  • Ergometrine 0.5 mg IM,
  • Broad spectrum antibiotic + Metronidazole.

2. Active Rx:

  • Exploration of the uterine cavity under G/A if retained products are seen. The suction curette may also be used.
  • Bleeding sometimes persists after evacuation. Occasionally packing uterus and even hysterectomy are required.

Prevention of Postpartum Hemorrhage (PPH):

1. Antenatal:

  • Improvement of the health status of the mother and to keep the Hb level normal (>10mg/dl).
  • High risk patient are to be screened and delivered in a well-equipped hospital.
  • Blood grouping should be done for all women.

2. Intra-natal: Prevention of PPH:

  • Slow delivery of the baby.
  • Expert obstetric anesthetist in needed when delivery is conducted under G/A.
  • During C/S spontaneous separation of placenta reduces blood loss.
  • Active management of 3rd stage should be a routine examination of placenta and membrane should be a routine.
  • In all cases of induced or accelerated labour by oxytocin, the infusion should be continued for at least one hour after delivery.
  • Exploration of utero vaginal canal for evidence of trauma following difficult labour or instrumental delivery.
  • To observe the patient for about two hours after delivery and if the uterus remains hard and contracted only then she should be send to the ward.

More questions related to this article:

  1. What do you mean by postpartum hemorrhage (PPH)?
  2. What is secondary postpartum hemorrhage?
  3. What are the clinical features of secondary postpartum hemorrhage?
  4. What are the sign and symptoms of secondary postpartum hemorrhage?
  5. What are the investigations of secondary postpartum hemorrhage?
  6. What is the treatment of secondary postpartum hemorrhage?
  7. Mention the management process of secondary postpartum hemorrhage.
  8. How will you manage a case of secondary postpartum hemorrhage?
  9. How can you prevent postpartum hemorrhage (PPH)?
  10. Mention all the preventive measures of postpartum hemorrhage.

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