Postpartum Hemorrhage: Definitions, Causes, and Management in Obstetrics

What is the definition of postpartum hemorrhage (PPH)?

Blood loss ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean section within 12 weeks of delivery.

What is the ACOG definition of PPH?

Blood loss ≥ 1000 mL irrespective of type of delivery or bleeding associated with signs and symptoms of hypovolemia.

How is PPH clinically defined?

A fall in hematocrit ≥ 10% between admission and postpartum period or excessive bleeding needing blood transfusion.

What is the primary cause of maternal mortality in India?

Postpartum hemorrhage (PPH).

What is the most common cause of shock after delivery?

Postpartum hemorrhage (PPH).

What is primary PPH?

PPH that occurs within 24 hours of delivery, with atonic PPH being the most common cause.

What is secondary PPH?

PPH that occurs ≥ 24 hours but within 12 weeks of delivery, commonly caused by retained placental tissue.

What are the 4 T's that cause PPH?

Tone (decreased uterine tone), Trauma, Tissue (retained tissue), Thromboplastin (bleeding disorders).

What is the first step in the initial management of PPH?

Maternal resuscitation, including uterine massage.

What is the recommended dose of oxytocin for PPH management?

20-40 units, administered IM or via IV infusion.

What is the contraindication for giving IV bolus in PPH management?

It can cause cardiac arrest.

What is the dose of methylergometrine for PPH?

0.2 mg IM.

What is the WHO recommended dose of misoprostol for PPH?

800 mcg sublingual/oral or per rectal.

What is the maximum dose of Carboprost (PGF) for PPH?

250 mcg IM, repeated every 15-90 minutes, maximum 8 doses (2 mg).

What is the role of Tranexamic acid in PPH management?

It should be given within 3 hours of hemorrhage.

What is the algorithm for managing atonic PPH?

Resuscitate the patient, confirm atonic PPH, administer uterotonic drugs, and perform uterine massage.

What is the purpose of the Bakri balloon catheter in PPH management?

To provide mechanical compression for bleeding control.

What should be done if bleeding continues despite initial management?

Shift to operating theater for surgical intervention.

What is a common suture used for compression in PPH?

B lynch suture.

What is the maximum capacity of the Bakri balloon catheter?

500 mL.

What is the significance of uterine artery ligation in PPH management?

It is performed when bleeding is not controlled and the patient's vitals are unstable.

What is the difference between subtotal hysterectomy and total abdominal hysterectomy?

Subtotal hysterectomy spares the cervix, while total abdominal hysterectomy removes both the uterus and cervix.