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MASSIVE OBSTETRIC
HAEMORRHAGE
Major contributor to maternal mortality
Definition
Blood loss requiring replacement of patients total blood
volume
Transfusion requiring > 10 u of blood in 24 hs
50% replacement of blood vol. <3 hs period
Difficult to estimate blood loss
Problem of concealed bleeding
Uterus
Broad lig.
Peritoneal cavity
RECOGNISING SIGNIFICANT
BLOOD LOSS
10 15% 25-35%
500-1000ml 1500-2000ml.
Normal BP BP ~ 70-80mmHg.
No signs. Restlessness,pallor,
oliguria.
15-25%
1000-1500ml 35-45%
BP ~ 100mmHg 2000-3000ml
Dizziness, 50-70mmHg
tachycardia Collapse, air hunger,
anuria
Factors contributing to maternal
death from catastrophic PPH
General Specific
Increased oxygen and Failure to anticipate
cardiac output coagulopathy
requirements of PET, abruption, sepsis,
pregnancy may hamper IUFD, AFE.
adequate blood / volume Abnormal placentation
replacement Placenta praevia / accreta
Placental bed perfusion 600
mls/min Jehovahs witness**
Blood loss
underestimated
Delayed or inadequate
management
Inadequate resources /
personnel
Mechanism of DIC
1) intravascular infusion of thromboplastic
substances that initiate the extrinsic
coagulation system
placental abruption, IUFD
2) conditions associated with endothelial
cell damage, which activates both the
extrinsic and intrinsic coagulation systems
eclampsia/ PET
3) indirect effects of other disease, such
as G- sepsis, AFE etc
Preventative Management PPH
Detect and treat antenatal anaemia
Active Management of Third Stage
Administration of a prophylactic oxytocin
Early cord clamping
Controlled cord traction of the umbilical cord.
Advantage of active management = reduction in the
incidence of PPH by 40%
1/500 deliveries
Most occur during ARM
Presentation
Cord visible outside the introitus
CTG abnormalities appear
variable decelerations
fetal bradycardia