SlideShare una empresa de Scribd logo
1 de 28
Descargar para leer sin conexión
Postpartum Hemorrhage (PPH) and Ectopic Pregnancy
Placental Abnormalities and
Hemorrhagic Complications
1. Antepartum Hemorrhage (APH)
2. Postpartum Hemorrhage (PPH)
3. Ectopic Pregnancy
4. Abortion
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.
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.
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
Forceps Birth Vacuum Birth
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.
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.
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.
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.
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
Uterine
curettage
Uterus inversion and how to fix it back
Uterine massage
Manual Removal of
the Placenta
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).
Bakri
Balloon
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
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
19
Sites of ectopic pregnancy
20
21
Bleeding due to ectopic pregnancy
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
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
Intrauterine
device (IUD)
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
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
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
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

Más contenido relacionado

La actualidad más candente (20)

Induction of labour
Induction of labourInduction of labour
Induction of labour
 
Mechanism of labour
Mechanism of labourMechanism of labour
Mechanism of labour
 
Medical induction of labour
Medical induction of labourMedical induction of labour
Medical induction of labour
 
Uterine rupture
Uterine ruptureUterine rupture
Uterine rupture
 
Pph mou
Pph mouPph mou
Pph mou
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
Operative obstetrics by Dr muhammad bilal
Operative obstetrics by Dr muhammad bilalOperative obstetrics by Dr muhammad bilal
Operative obstetrics by Dr muhammad bilal
 
Subinvolution
SubinvolutionSubinvolution
Subinvolution
 
PREVENTION OF POST PARTUM HAEMORRHAGE BY DR SHASHWAT JANI
PREVENTION OF POST PARTUM HAEMORRHAGE BY DR SHASHWAT JANIPREVENTION OF POST PARTUM HAEMORRHAGE BY DR SHASHWAT JANI
PREVENTION OF POST PARTUM HAEMORRHAGE BY DR SHASHWAT JANI
 
precipitate labour.pptx
precipitate labour.pptxprecipitate labour.pptx
precipitate labour.pptx
 
Forcep delivery
Forcep deliveryForcep delivery
Forcep delivery
 
Face presentation
Face presentationFace presentation
Face presentation
 
Bleeding in early pregnancy
Bleeding in early pregnancyBleeding in early pregnancy
Bleeding in early pregnancy
 
Post term pregnancy.pptx
Post term pregnancy.pptxPost term pregnancy.pptx
Post term pregnancy.pptx
 
Diagnosis of pregnancy
Diagnosis of pregnancyDiagnosis of pregnancy
Diagnosis of pregnancy
 
Shoulder dystocia rabi
Shoulder dystocia rabiShoulder dystocia rabi
Shoulder dystocia rabi
 
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancy
 
Mechanism of normal labor
Mechanism of normal laborMechanism of normal labor
Mechanism of normal labor
 
breech presentation
breech presentationbreech presentation
breech presentation
 
Induction of labour
Induction of labour Induction of labour
Induction of labour
 

Similar a Postpartum Hemorrhage (PPH) and Ectopic Pregnancy

Placental Abnormalities and Hemorrhagic Complications
Placental Abnormalities and  Hemorrhagic ComplicationsPlacental Abnormalities and  Hemorrhagic Complications
Placental Abnormalities and Hemorrhagic Complicationssosojammoly
 
Highriskpregnancydelfin202 101102174717-phpapp02
Highriskpregnancydelfin202 101102174717-phpapp02Highriskpregnancydelfin202 101102174717-phpapp02
Highriskpregnancydelfin202 101102174717-phpapp02Josh Achaso Labrague
 
High risk pregnancy delfin 202
High risk pregnancy delfin 202High risk pregnancy delfin 202
High risk pregnancy delfin 202shenell delfin
 
Postpartum hemorrhage - with pictures.pptx
Postpartum hemorrhage - with pictures.pptxPostpartum hemorrhage - with pictures.pptx
Postpartum hemorrhage - with pictures.pptxAnzuBista1
 
Abortion and Stillbirth
Abortion and StillbirthAbortion and Stillbirth
Abortion and Stillbirthsosojammoly
 
4 antepartal hemorrhagic disorders
4 antepartal hemorrhagic disorders4 antepartal hemorrhagic disorders
4 antepartal hemorrhagic disordersFarhan ullah
 
Abortion Ectopic Pregnancy Hyperemesis Gravidarum
AbortionEctopic PregnancyHyperemesis GravidarumAbortionEctopic PregnancyHyperemesis Gravidarum
Abortion Ectopic Pregnancy Hyperemesis Gravidarumahmed afify
 
Missed abortion
Missed abortionMissed abortion
Missed abortionJwanSalh
 
Intrauterine Fetal Death (IUFD),(Kurdistan)
Intrauterine Fetal Death (IUFD),(Kurdistan)Intrauterine Fetal Death (IUFD),(Kurdistan)
Intrauterine Fetal Death (IUFD),(Kurdistan)Znar Mzuri
 
Abortion power point.pptx
Abortion power point.pptxAbortion power point.pptx
Abortion power point.pptxestelaabera
 
PPH - Nirmala.pptx
PPH - Nirmala.pptxPPH - Nirmala.pptx
PPH - Nirmala.pptxNimmykutti
 
Antepartum Hemorrhage (APH)
Antepartum Hemorrhage (APH)Antepartum Hemorrhage (APH)
Antepartum Hemorrhage (APH)sosojammoly
 
Early pregnancy hemorrhage
Early pregnancy hemorrhageEarly pregnancy hemorrhage
Early pregnancy hemorrhagehemnathsubedii
 
Bleeding in late pregnancy
Bleeding in late pregnancy Bleeding in late pregnancy
Bleeding in late pregnancy Mostafa Shakshak
 
1623901744851_FIRST TRIMESTER BLEEDING.pptx
1623901744851_FIRST TRIMESTER BLEEDING.pptx1623901744851_FIRST TRIMESTER BLEEDING.pptx
1623901744851_FIRST TRIMESTER BLEEDING.pptxKwizeravirgile1
 
Abortion, ectopic pregnancy and gestational trophoblastic diseases
Abortion, ectopic pregnancy and gestational trophoblastic diseasesAbortion, ectopic pregnancy and gestational trophoblastic diseases
Abortion, ectopic pregnancy and gestational trophoblastic diseasesSADDA_HAQ
 

Similar a Postpartum Hemorrhage (PPH) and Ectopic Pregnancy (20)

Placental Abnormalities and Hemorrhagic Complications
Placental Abnormalities and  Hemorrhagic ComplicationsPlacental Abnormalities and  Hemorrhagic Complications
Placental Abnormalities and Hemorrhagic Complications
 
Highriskpregnancydelfin202 101102174717-phpapp02
Highriskpregnancydelfin202 101102174717-phpapp02Highriskpregnancydelfin202 101102174717-phpapp02
Highriskpregnancydelfin202 101102174717-phpapp02
 
High risk pregnancy delfin 202
High risk pregnancy delfin 202High risk pregnancy delfin 202
High risk pregnancy delfin 202
 
Lecture 21 Postpartum Hemorrhage .pptx
Lecture 21 Postpartum Hemorrhage .pptxLecture 21 Postpartum Hemorrhage .pptx
Lecture 21 Postpartum Hemorrhage .pptx
 
Postpartum hemorrhage - with pictures.pptx
Postpartum hemorrhage - with pictures.pptxPostpartum hemorrhage - with pictures.pptx
Postpartum hemorrhage - with pictures.pptx
 
Abortion and Stillbirth
Abortion and StillbirthAbortion and Stillbirth
Abortion and Stillbirth
 
Abortion
AbortionAbortion
Abortion
 
4 antepartal hemorrhagic disorders
4 antepartal hemorrhagic disorders4 antepartal hemorrhagic disorders
4 antepartal hemorrhagic disorders
 
Abortion Ectopic Pregnancy Hyperemesis Gravidarum
AbortionEctopic PregnancyHyperemesis GravidarumAbortionEctopic PregnancyHyperemesis Gravidarum
Abortion Ectopic Pregnancy Hyperemesis Gravidarum
 
Missed abortion
Missed abortionMissed abortion
Missed abortion
 
Intrauterine Fetal Death (IUFD),(Kurdistan)
Intrauterine Fetal Death (IUFD),(Kurdistan)Intrauterine Fetal Death (IUFD),(Kurdistan)
Intrauterine Fetal Death (IUFD),(Kurdistan)
 
Abortion power point.pptx
Abortion power point.pptxAbortion power point.pptx
Abortion power point.pptx
 
PPH - Nirmala.pptx
PPH - Nirmala.pptxPPH - Nirmala.pptx
PPH - Nirmala.pptx
 
Antepartum Hemorrhage (APH)
Antepartum Hemorrhage (APH)Antepartum Hemorrhage (APH)
Antepartum Hemorrhage (APH)
 
TJ MASHAMBA.ppt
TJ MASHAMBA.pptTJ MASHAMBA.ppt
TJ MASHAMBA.ppt
 
Early pregnancy hemorrhage
Early pregnancy hemorrhageEarly pregnancy hemorrhage
Early pregnancy hemorrhage
 
Bleeding in late pregnancy
Bleeding in late pregnancy Bleeding in late pregnancy
Bleeding in late pregnancy
 
Gynecology for the general surgeon
Gynecology for the general surgeonGynecology for the general surgeon
Gynecology for the general surgeon
 
1623901744851_FIRST TRIMESTER BLEEDING.pptx
1623901744851_FIRST TRIMESTER BLEEDING.pptx1623901744851_FIRST TRIMESTER BLEEDING.pptx
1623901744851_FIRST TRIMESTER BLEEDING.pptx
 
Abortion, ectopic pregnancy and gestational trophoblastic diseases
Abortion, ectopic pregnancy and gestational trophoblastic diseasesAbortion, ectopic pregnancy and gestational trophoblastic diseases
Abortion, ectopic pregnancy and gestational trophoblastic diseases
 

Más de sosojammoly

Absorptive lenses
Absorptive lensesAbsorptive lenses
Absorptive lensessosojammoly
 
Entoptic phenomena
Entoptic phenomenaEntoptic phenomena
Entoptic phenomenasosojammoly
 
The stages of mitosis
The stages of mitosis The stages of mitosis
The stages of mitosis sosojammoly
 
Casarean section
Casarean sectionCasarean section
Casarean sectionsosojammoly
 
Breastfeeding and Nursing
Breastfeeding and NursingBreastfeeding and Nursing
Breastfeeding and Nursingsosojammoly
 
The normal labor and delivery
The normal labor and deliveryThe normal labor and delivery
The normal labor and deliverysosojammoly
 
Puerperium and Postpartum Period
Puerperium and Postpartum PeriodPuerperium and Postpartum Period
Puerperium and Postpartum Periodsosojammoly
 
neonatal resuscitation and care
neonatal resuscitation and careneonatal resuscitation and care
neonatal resuscitation and caresosojammoly
 
Fetal assessment
Fetal assessmentFetal assessment
Fetal assessmentsosojammoly
 
Anemia in Pregnancy (more information)
Anemia in Pregnancy (more information)Anemia in Pregnancy (more information)
Anemia in Pregnancy (more information)sosojammoly
 
7 minute total body workout
 7 minute total body workout 7 minute total body workout
7 minute total body workoutsosojammoly
 
Fetal Assessment During Labor
Fetal Assessment  During LaborFetal Assessment  During Labor
Fetal Assessment During Laborsosojammoly
 
The Normal Labor
The  Normal  LaborThe  Normal  Labor
The Normal Laborsosojammoly
 
Diabetes in Pregnancy
Diabetes in Pregnancy Diabetes in Pregnancy
Diabetes in Pregnancy sosojammoly
 
Hypertension in Pregnancy
Hypertension  in  PregnancyHypertension  in  Pregnancy
Hypertension in Pregnancysosojammoly
 
Anemia in Pregnancy
Anemia in PregnancyAnemia in Pregnancy
Anemia in Pregnancysosojammoly
 

Más de sosojammoly (20)

Absorptive lenses
Absorptive lensesAbsorptive lenses
Absorptive lenses
 
Entoptic phenomena
Entoptic phenomenaEntoptic phenomena
Entoptic phenomena
 
Aberration
AberrationAberration
Aberration
 
The stages of mitosis
The stages of mitosis The stages of mitosis
The stages of mitosis
 
Casarean section
Casarean sectionCasarean section
Casarean section
 
Breastfeeding and Nursing
Breastfeeding and NursingBreastfeeding and Nursing
Breastfeeding and Nursing
 
The normal labor and delivery
The normal labor and deliveryThe normal labor and delivery
The normal labor and delivery
 
Puerperium and Postpartum Period
Puerperium and Postpartum PeriodPuerperium and Postpartum Period
Puerperium and Postpartum Period
 
neonatal resuscitation and care
neonatal resuscitation and careneonatal resuscitation and care
neonatal resuscitation and care
 
Fetal assessment
Fetal assessmentFetal assessment
Fetal assessment
 
Anemia in Pregnancy (more information)
Anemia in Pregnancy (more information)Anemia in Pregnancy (more information)
Anemia in Pregnancy (more information)
 
7 minute total body workout
 7 minute total body workout 7 minute total body workout
7 minute total body workout
 
Fetal Assessment During Labor
Fetal Assessment  During LaborFetal Assessment  During Labor
Fetal Assessment During Labor
 
The Normal Labor
The  Normal  LaborThe  Normal  Labor
The Normal Labor
 
Diabetes in Pregnancy
Diabetes in Pregnancy Diabetes in Pregnancy
Diabetes in Pregnancy
 
Hypertension in Pregnancy
Hypertension  in  PregnancyHypertension  in  Pregnancy
Hypertension in Pregnancy
 
Anemia in Pregnancy
Anemia in PregnancyAnemia in Pregnancy
Anemia in Pregnancy
 
Antenatal Care
Antenatal CareAntenatal Care
Antenatal Care
 
The eye atlas
The eye atlas The eye atlas
The eye atlas
 
Pregnancy
PregnancyPregnancy
Pregnancy
 

Último

Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 

Último (20)

Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 

Postpartum Hemorrhage (PPH) and Ectopic Pregnancy

  • 2. Placental Abnormalities and Hemorrhagic Complications 1. Antepartum Hemorrhage (APH) 2. Postpartum Hemorrhage (PPH) 3. Ectopic Pregnancy 4. Abortion
  • 3. 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.
  • 4. 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.
  • 5. 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
  • 7. 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.
  • 8. 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.
  • 9. 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.
  • 10. 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.
  • 11. 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
  • 13. Uterus inversion and how to fix it back
  • 15. 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).
  • 17. 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
  • 18. 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
  • 19. 19
  • 20. Sites of ectopic pregnancy 20
  • 21. 21 Bleeding due to ectopic pregnancy
  • 22. 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
  • 23. 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
  • 25. 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
  • 26. 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
  • 27. 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
  • 28. 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