Post Partum Complications

Posted by e-Medical PPT
Bleeding of 500 mL or more following delivery
Traditional definition vs. “new” definition:
Traditional:
 NVD => 500cc
 C-section => 1000cc
“New” criteria:
 Decreased Hct of 10 points OR
 The need for fluid replacement after birth

Early Post-Partum Hemorrhage
Hemorrhage occurs during first 24 hours after delivery
>500cc of blood loss
Caused by:
 retained fragments of placenta
 UTERINE ATONY 
  80-90% of the cases
 Blood may be expelled or retained in the vagina
 perineal injuries/lacerations
 inversion of uterus
 Episiotomy
 Hematomas: vulvar, vaginal, subperitoneal
 Coagulation disorders (i.e. hemophilia, thalassemia)

Most Common Causes of Hemorrhage
Residual placenta
Bleeding from placenta accreata – parts of the placenta adhers to the endometrium, in this case the chorionic villi attaches directly to the myometrium of the uterus (accounts for 80% of adherent placenta to the endometrium)
Placenta accreata may cause:
Maternal hemorrhage
Failure of the placenta to separate
Less common to bleed from placenta increta or placenta percreta (other placenta adherences)
Abdominal hysterectomy may be necessary, depending on involvement
Retained placenta: Surgical removal (D&C)

Late Post-Partum Hemorrhage
Hemorrhage occurs after the first 24 hours following delivery
Usually within 1-2 weeks after childbirth

Etiology: Late PP Hemorrhage
Subinvolution of the placenta site (due to):
Retained placental fragments
Signs of subinvolution:
Fundal height is greater than expected
Makes sure the woman ambulates and empties bladder
Lochia rubra fails to progress from        
 RUBRA----SEROSA----ALBA
Lochia rubra that persists > 2 weeks PP is highly suggestive of subinvolution

Post-Partum infection
Any infection of the reproductive organs that occurs within 28 days of delivery or abortion
Categories of Infections:
Puerperal infection: overall category
An infection of the reproductive tract associated with childbirth that occurs up to 6 weeks PP
1)  Endometritis or metritis
2)  Pelvic cellulites / Parametritis
3)  Peritonitis
4)  Salpinitis

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