Defined as >500 ml blood loss vaginal or >1000 ml blood loss after c-section
PPH - Cause
Think of the 4 T’s:
Tone – decreased uterine tone – most common cause
Trauma – Laceration / Uterine inversion
Tissue – retained placental tissue
Thrombin – depleted coagulation factors
PPH – Retained placenta
Failure to deliver placenta in 30 minutes
Gentle cord traction
Consider injection of 20 units of pitocin in the umbilical vein (2 ml of pitocin in 20 ml saline)
27 yr G1P0 is in active labor. Her pregnancy was uncomplicated. She was complete at 1300. At 1415 she delivers an OA Head over an intact perineum. A “turtle sign” is noted. You suction the fetal mouth and nose and then assist restitution of the head. Despite maternal pushing, you are unable to deliver the head over the next minute.
Definition: Delivery in which the anterior shoulder of the baby is impacted against the maternal symphysis pubis and is not deliverable in 60 seconds.
Prior shoulder dystocia
Maintenance of good glycemic control in pregnant diabetic women decreases fetal macrosomia
Elective C-section for fetal macrosomia
Third trimester bleeding
Painful third trimester bleeding.
1:120 pregnancies, approx. 1%.
Recurrence rate of 10%.
Port wine stained amniotic fluid.
Painless third trimester vaginal bleeding
1:200 pregnancies in 3rd trimester
1:50 grand multiparas,1:1500 nulliparas