What are the 4 T’s of PPH?

There are four main causes of postpartum hemorrhage that account for the majority of cases. Also known as the “Four T’s”, these are Tone (uterine atony), Tissue (retained placenta), Trauma (laceration), and Thrombin (coagulopathy).

What are the 5 most common causes of PPH?

In many International and local studies it was revealed that the main cause of PPH is uterine atony followed by vaginal hematoma, cervical or vaginal tear, adherent placenta, uterine angle extension and retained placenta [3,5].

What are the 3 main causes of postpartum hemorrhage?

Conditions that may increase the risk for postpartum hemorrhage include the following: Placental abruption. The early detachment of the placenta from the uterus. Placenta previa.

What is the difference between primary PPH and secondary PPH?

Primary postpartum hemorrhage is bleeding that occurs in the first 24 hours after delivery, while secondary postpartum hemorrhage is characterized as bleeding that occurs 24 hours to 12 weeks postpartum.

What are the complications of PPH?

Immediate and late complications of primary postpartum hemorrhage include hypovolemic shock, cerebral anoxia, renal failure, anemia, puerperal sepsis, and Sheehan’s syndrome. The antepartum hemoglobin status and the rate of blood loss influence hemorrhage outcome.

Who PPH treatment?

In December 2018, WHO issued new recommendations on uterotonics for PPH prevention (table 1). 15 Oxytocin (10 IU, intravenously or intramuscularly) remains the recommended uterotonic of choice for all births.

What are the causes of secondary PPH?

Common causes of secondary PPH include retained placental or fetal tissue, infection, and subinvolution of the placental site (delayed or inadequate physiologic closure and sloughing of the superficial modified spiral arteries at the placental attachment site).

What is the duration of secondary PPH?

Secondary PPH is generally defined as any significant uterine bleeding occurring between 24 hours and 12 weeks postpartum [1,2]. However, definitions vary (eg, between 48 hours and 6 weeks postpartum).

What is the most common cause of PPH?

Uterine atony.

This is the most common cause of PPH. It happens when the muscles in your uterus don’t contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.

What is the most common cause of PPH?

Uterine atony.

This is the most common cause of PPH. It happens when the muscles in your uterus don’t contract (tighten) well after birth. Uterine contractions after birth help stop bleeding from the place in the uterus where the placenta breaks away.

What is the most common cause of secondary PPH?

Common causes of secondary PPH include retained placental or fetal tissue, infection, and subinvolution of the placental site (delayed or inadequate physiologic closure and sloughing of the superficial modified spiral arteries at the placental attachment site).

What causes bleeding after delivery?

After the placenta is delivered, these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, these blood vessels bleed freely. This is the most common cause of postpartum hemorrhage.

What is the duration of secondary PPH?

Secondary PPH is generally defined as any significant uterine bleeding occurring between 24 hours and 12 weeks postpartum [1,2]. However, definitions vary (eg, between 48 hours and 6 weeks postpartum).

What is the management of secondary PPH?

The majority of cases of secondary PPH are due to subinvolution of the uterus caused by uterine infection and/or retained placental tissue. Initial management should include resuscitation as discussed above, the use of uterotonic agents, administration of antibiotics and consideration of surgical evacuation (Table 4).

What is PPH management?

Procedures used in PPH management include manual removal of the placenta, manual removal of clots, uterine balloon tamponade, and uterine artery embolization. 14, 19, 21, 22. Laceration repair is indicated when PPH is a result of genital tract trauma.

What are risk factors for PPH?

Conclusion: Labour induction, augmentation of labour, and prior Caesarean section are significantly associated with the risk of PPH, and their increase over the study period largely explains the observed rise in PPH.

What is atony?

Uterine atony (atony of the uterus) occurs when your uterus doesn’t contract (or tighten) properly during or after childbirth. It’s a serious complication that can cause life-threatening blood loss.

What is lochia period?

Lochia is the vaginal discharge you have after giving birth. It contains a mix of blood, mucus and uterine tissue. It has a stale, musty odor like menstrual period discharge and can last several weeks. Lochia is heavy at first but gradually subsides to a lighter flow until it goes away. This can last for a few weeks.

How can you prevent PPH?

The most effective strategy to prevent postpartum hemorrhage is active management of the third stage of labor (AMTSL). AMTSL also reduces the risk of a postpartum maternal hemoglobin level lower than 9 g per dL (90 g per L) and the need for manual removal of the placenta.

How is blood loss measured in PPH?

Add the fluid volume collected in the drapes to the blood volume measured by weighing soaked items to determine the cumulative volume of blood loss or quantification of blood loss. Weigh all blood-soaked materials and clots to determine cumulative volume. 1 gram weight=1 milliliter blood loss volume.