1. Obststric Haemorrhage Obstetric Emergencies
Hemorrhage
Obstetric Emergencies

2. Obststric Haemorrhage
Hemorrhage
Causes of ANTEPARTUM haemorrhage
Abruptio Placenta
Placenta previa
Local causes
Unknown origin

3. ABRUPTIO PLACENTA Underlying pathology Hypertensive Disease
Multiple pregnancy
Trauma
Anemia
Polyhydramnios

4. PLACENTA PREVIA Predisposing factors Previous Caesarean Section
Most have no known cause – presumed late implantation

5. Local & Unknown Causes of APH
Rupture of uterus
Carcinoma of cervix
Trauma
Cervical polyp
Bilharzia of cervix
? Edge bleed
? Hemorrhoids

6. Hemorrhage
Induction of labor with oxytocin is associated with an increased rate of uterine rupture in gravid women with 1 prior uterine scar, in comparison with the rate in spontaneously laboring women.

7. Abruptio Placenta Features Pain and tenderness Often I.U.F.D
“Hypotension on hypertension”
Clotting defects
Renal impairment

8. Antepartum Hemorrhage
Exclude abruption, uterine rupture, placenta previa with labor
Is she stable? - ?BP, pulse
Check Abdomen - previous C/S scar, fundal height and uterine tenderness
Check FH
Vaginal examination and ARM

9. Abruptio placenta
APH = ARM

10. Abruptio Placenta Resuscitate - FDP, whole blood
Monitor BP and urine output
Give oxytocin infusion or prostaglandin if necessary to induce contractions
Avoid Cesarean Section unless salvageable baby, or no progress
Watch out for PPH

11. Placenta Previa Suspicion from low uterine souffle
Diagnose by Ultrasound
Resuscitate, monitor BP and amount of bleeding
Persistent bleeding requires delivery whatever the gestation

12. Complete Placenta Previa
Transfer anterior placenta previa
Elective cesarean if  37 weeks
Birth through the placenta

13. Post Partum Hemorrhage
Predisposing factors
Antepartum hemorrhage
Multiple pregnancy
Prolonged labour
Cesarean Section

14. Post Partum Hemorrhage
Causes
Uterine atony
Obstetric trauma
*Use Large Bore IV Lines*

15. Post Partum Hemorrhage
Atonic uterus (soft uterus)
Compression - bimanual is best
Oxytocin - 10 units IV or (insert dosage) IM
Syntometrine 1 amp IM
Misoprostol (Cytotec) 1mg (5 tabs) rectally
Trauma (hard uterus)
Vaginal tears are most common
Cervical tears rare unless instrumental
Remember the ruptured uterus
Uterine inversion

16. Post Partum Haemorrhage
Other causes
Instrumental Delivery
Infection - 2° PPH
Retained placental fragments

17. Post Partum Haemorrhage
Rub up a contraction
Get help
Insert two large bore IV lines - Haes-Steril
Give an oxytocic
Explore digitally for fragments and tears
Explore with speculum for tears - especially cervix
Evacuate under GA

18. Rupture of Uterus
Two types
True rupture
Dehiscence of scar

19. Rupture of Uterus True Rupture Contractions stop Continuous pain
Tender abdomen
Fundus ill-defined
PV Bleeding
Fetal heart dips or absent fetal heart
Scar Dehiscence
Dehiscence may be silent – no bleeding
Fetal distress
Hematuria
Vague uterine outline
Failed induction

20. Rupture of Uterus
High Index of suspicion in grande multips and in scarred uteri
All cases of Ante and Intra partum haemorrhage must exclude rupture
Laparotomy if suspected
Repair or Hysterectomy?