1、Postpartum HemorrhageUnion HospitalDefinitionPostpartum hemorrhage denotes excessive bleeding(500mL in vaginal delivery)following delivery.Incidence 58%Postpartum hemorrhage is the most common cause of excessive blood loss in pregnancy.Etiology Uterine atony Obstetric lacerations Retained placental
2、tissue Coagulation deffectsUterine atony Uterine atony exists when the myometrium cannot contract Atony is the most common cause of postpartum hemorrhage(50%of cases)Retained placental tissue Placenta accreta in manual removal of the placenta in mismanagement of the third stage of labor in unrecogni
3、zed succenturiate placentaCoagulation deffects Abruptio placentae excess thromboplastin from a retained dead fetus amniotic fluid embolism severe preeclampsia eclampsia sepsisPrevention Predelivery preparation delivery third stage of normal labor(placenta separation)Evaluation of persistent bleeding
4、 Manually compress the uterus obtain assistance if not already done,obtain blood for typing and cross-matching observe blood for clotting to rule out coagulopathy carefully explore the uterine cavityMeasures to control bleeding Manual exploration of the uterus Bimanual compression curettage Oxytocin
5、 Radiographic embolization of pelvic vessels Operative management Operative management Pressure occlusion of the aorta Uterine artery ligation Internal iliac artery ligation B-lynch brace suture HysterectomyPostpartum puerperium infectionsDefinition Puerperal morbidity due to infection has occurred
6、if the patients temperature is higher than 380C on 2 separate occasions at least 24 hours apart following the first 24 hours after delivery.Incidence 2-8%undergone operative delivery premature rupture of the membranes long labors multiple pelvic examinationsMorbidity and motality Contribute to the d
7、eath of about 8%of all pregnant women who die each year.Pathogenesis Aerobic bacteria Anaerobic bacteria Mycoplasma UreaplasmaMechanisms to prevent overt infection Acidity of the normal vagina thick,tenacious cervical mucus maternal antibodies to most vaginal floraEtiology Cesarean section undergone
8、 operative delivery premature rupture of the membranes long labors multiple pelvic examinationsClinical findings Endometritis Urinary tract infection Generalized sepsis septic pelvic thrombophlebitis pelvic abscessSymptoms and signs Fever Uterine tendernessLaboratory findings Leukocytosis urinalysis bacterilogic findings(Aerobic bacteria,Anaerobic bacteria,Mycoplasma,Ureaplasma)Differential diagnosis Involuntary chills extragenital infectionsTreatment The use of antibiotics Physical treatment Chinese medicine
