PPH-lession(英文)

Postpartum Hemorrhage,Dr.Yan LongDepartment of Obst.GynaecBeijing Friendship Hospital,Definition,Postpartum Hemorrhage (PPH ) is defined as blood loss of more than 500 ml during the first 24 hours after delivery.,Epidemiology,The incidence is about 2%-6%Most cases occure during the third stage or within 2 hours after deliveryPPH remains a leading cause of maternal mortality elsewhere. In the developed countries, ranks in the top 3 In the developing countries , ranks in the top 1,Etiology ( 4T ),1%,70 % -80%,20%,10%,Anderson JM. Am Fam Physician 2007;75:876.,Risk factors for Tone,Risk factors for Tissue,Risk factors for Trauma,Risk factors for Thrombin,Diagnosis,SymptomExcessive bleedingWeak ，palmusshockSign:Vital sign: pulse rate , blood pressurepale Laboratory findings hematocrit (red blood cell count). clotting factors in the blood,Management plan,Postpartum hemorrhage-Guideline for immediate action,Step 1 Immediate action：prevent shock establish intravenous access, Replacing lost blood and fluids Step 2 Check for Uterine tone ，Trauma，Placenta Bimanual compressionStep 3 Drug therapy: Oxytocin Ergometrine Misoprostol Prostaglandin F2 rFVIIa,Step 4 Balloon tamponadeStep 5 B-LynchStep 6 Other procedures Uterine artery embolization Stepwise devascularization Internal iliac artery ligation Hysterectomy,Postpartum hemorrhage-Guideline for immediate action,Bimanual massage of the uterus,Packing and Tamponade procedures,B-Lynch suture,Stepwise devascularization,Uterine artery embolization,子宫动脉栓塞前,子宫动脉栓塞后,Prevention of PPH,Recognize the risk factors of PPHActive management of the third stage Offer oxytocin，ergometrine，misoprostol carboprost Following delivery, administering a uterotonic drug that lasts at least 2-3 hours is reasonable,Summary,Remember 4 Ts:ToneTissueTraumaThrombin,Summary,“TONE”Rule out Uterine Atony,Palpate fundus.Massage uterus.Oxytocin 40U/L +250cc / h.Methergine one amp IM (not in hypertensives)Hemabate IM q 15min,Summary,“Tissue”R/O retained placenta,Inspect placenta for missing cotyledons.Explore uterus.Treat abnormal implantation.,Summary: remember 4 Ts,“TRAUMA”R/o cervical or vaginal lacerations.,Obtain good exposure.