Postpartum Hemorrhage

Pregnancy, Childbirth, & the Puerperium


Clinicals - History

Fact Explanation
{"ops":[{"insert":"Definition"},{"insert":"\n"}]}
{"ops":[{"insert":"Primary postpartum haemorrhage (PPH) is the excessive bleeding from the genital tract within 24 hours of childbirth, but most cases manifest immediately after birth. It is defined as total blood loss \u003E500\u2009mL after vaginal delivery and \u003E1000\u2009mL after delivery by a Caesarean section. Massive PPH refers to the loss of 30%\u201340% of the patient\u2019s blood volume. Secondary PPH occurs between 24\u2009hours and 12\u2009weeks post-delivery."}]}
{"ops":[{"insert":"Causes"},{"insert":"\n"}]}
{"ops":[{"insert":"The Four T\u0027s mnemonic is used to quickly identify and address the four most common causes of postpartum haemorrhage:\nT \u2013 Tone for uterine atony;\nT- Trauma for laceration, hematoma, inversion, rupture;\nT \u2013 Tissue for retained tissue or invasive placenta; and\nT\u2013 Thrombin for congenital or acquired coagulopathy."}]}
{"ops":[{"insert":"Risk factors"},{"insert":"\n"}]}
{"ops":[{"insert":"Risk factors for PPH include: advanced maternal age, antepartum hemorrhage, augmented or prolonged labor, chorioamnionitis, fetal macrosomia, maternal anemia, multifetal gestation, preeclampsia, placenta praevia, placental abruption, invasive placentation, instrumental delivery, previous PPH or Caesarean section. 20% of PPH occurs in women with no risk factors."}]}
{"ops":[{"insert":"Symptoms of hypovolemia"},{"insert":"\n"}]}
{"ops":[{"insert":"PPH can occur without obvious signs of external bleeding. It may present only with symptoms of hypovolemia including dizziness, nausea, restlessness, palpitations and excessive thirst. Loss of consciousness or maternal collapse, in the setting of vaginal bleeding after childbirth, indicate severe PPH complicated by hypovolemic shock."}]}
{"ops":[{"insert":"Dyspnea"},{"insert":"\n"}]}
{"ops":[{"insert":"Shortness of breath and air hunger are decompensating features, suggesting significant PPH with more than 40% total blood volume loss."}]}
{"ops":[{"insert":"Pain"},{"insert":"\n"}]}
{"ops":[{"insert":"Excessive or persistent pelvic pain after delivery may indicate hematoma formation. Abdominal pain is a feature of secondary PPH indicating endometritis."}]}
{"ops":[{"insert":"History of clotting dysfunction"},{"insert":"\n"}]}
{"ops":[{"insert":"Coagulopathy can cause PPH or be the result of one. PPH can be anticipated in women with known congenital or acquired clotting disorders. Clotting defects should be suspected in women who have history of abnormal bleeding and bruising, or present with petechial, subconjunctival and mucosal haemorrhage."}]}
{"ops":[{"insert":"Definition"},{"insert":"\n"}]}
{"ops":[{"insert":"Primary postpartum haemorrhage (PPH) is the excessive bleeding from the genital tract within 24 hours of childbirth, but most cases manifest immediately after birth. It is defined as total blood loss \u003E500\u2009mL after vaginal delivery and \u003E1000\u2009mL after delivery by a Caesarean section. Massive PPH refers to the loss of 30%\u201340% of the patient\u2019s blood volume. Secondary PPH occurs between 24\u2009hours and 12\u2009weeks post-delivery."}]}
{"ops":[{"insert":"Causes"},{"insert":"\n"}]}
{"ops":[{"insert":"The Four T\u0027s mnemonic is used to quickly identify and address the four most common causes of postpartum haemorrhage:\nT \u2013 Tone for uterine atony;\nT- Trauma for laceration, hematoma, inversion, rupture;\nT \u2013 Tissue for retained tissue or invasive placenta; and\nT\u2013 Thrombin for congenital or acquired coagulopathy."}]}
{"ops":[{"insert":"Risk factors"},{"insert":"\n"}]}
{"ops":[{"insert":"Risk factors for PPH include: advanced maternal age, antepartum hemorrhage, augmented or prolonged labor, chorioamnionitis, fetal macrosomia, maternal anemia, multifetal gestation, preeclampsia, placenta praevia, placental abruption, invasive placentation, instrumental delivery, previous PPH or Caesarean section. 20% of PPH occurs in women with no risk factors."}]}
{"ops":[{"insert":"Symptoms of hypovolemia"},{"insert":"\n"}]}
{"ops":[{"insert":"PPH can occur without obvious signs of external bleeding. It may present only with symptoms of hypovolemia including dizziness, nausea, restlessness, palpitations and excessive thirst. Loss of consciousness or maternal collapse, in the setting of vaginal bleeding after childbirth, indicate severe PPH complicated by hypovolemic shock."}]}
{"ops":[{"insert":"Dyspnea"},{"insert":"\n"}]}
{"ops":[{"insert":"Shortness of breath and air hunger are decompensating features, suggesting significant PPH with more than 40% total blood volume loss."}]}
{"ops":[{"insert":"Pain"},{"insert":"\n"}]}
{"ops":[{"insert":"Excessive or persistent pelvic pain after delivery may indicate hematoma formation. Abdominal pain is a feature of secondary PPH indicating endometritis."}]}
{"ops":[{"insert":"History of clotting dysfunction"},{"insert":"\n"}]}
{"ops":[{"insert":"Coagulopathy can cause PPH or be the result of one. PPH can be anticipated in women with known congenital or acquired clotting disorders. Clotting defects should be suspected in women who have history of abnormal bleeding and bruising, or present with petechial, subconjunctival and mucosal haemorrhage."}]}

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