1. Mohd Fadhli Karim

2. Definition
 Bleeding more than 500ml following delivery
 Primary:
 within 24 hours
 Secondary:
 after 24hours to 6 weeks postpartum

3. Epidemiology
 2% of pregnancy
 Most common cause of maternal mortality worldwide

4. Aetiology
 Primary:
 TONE (MAJOR 90%)
myometrium has not contracted to cut off spiral arteries

 TISSUE
Retained placental fragments

 TRAUMA
Lacerations, episiotomy, uterine rupture or inversion

 THROMBIN
DIC, Haemophilia, vWD


5. Aetiology
 Secondary:
 Endometritis
 Retained placental tissue

6. Risk Factor
 Overdistention  Atony
 (Multiple pregnancies, polyhydramnios, LGA).
 Labor & Delivery:
 Antepartum haemorrhage, placenta praevia.
 C-section (Emergency>Elective).
 Prolonged labor >12hour
 Pre-eclampsia
 Previous PPH
 HELLP

7. Clinical Presentation
 Bleeding
 continuous bleeding after delivery of placenta
 blood soaked pads and bedding
 Shock
 pallor
 collapse
 hypotension
 tachycardia

10. Bimanual Compression

12. B-Lynch Brace Suture

13. Reduction of Uterine Inversion
 Johnson’s Method
Recognition Replacement Restitution

14. Management Secondary PPH
 Exclude retention of placental tissue as a cause
 Ultrasound (identify retained placental tissue)
 Ultrasound guided removal of placental tissue under
general anaesthesia
 Endometritis
 Antibiotic therapy

15. Summary
 Bleeding more than 500 ml from genital tract after
delivery
 Primary and secondary
 4t – tone, tissue, trauma, thrombin
 Multidiscipline management

16. Thank you!