Causes of pph

Causes of Traumatic Postpartum Hemorrhage (PPH)

  • Traumatic PPH can occur due to various factors; key causes include:
    • Malpresentation: Abnormal positioning of the fetus can lead to complications during delivery.
    • Malposition: The fetus's position may cause trauma to the mother’s pelvic structures during birth.
    • Physical trauma: This includes injuries that impact the delivery process, potentially causing severe blood loss.

Signs and Symptoms of Traumatic PPH

  • Immediate bleeding after delivery:
    • If bleeding begins immediately post-delivery, trauma should be suspected.
    • The blood will appear bright red and flow steadily.
  • Condition of the uterus:
    • The uterus is typically firmly contracted in traumatic PPH situations.
  • Inspection findings:
    • Lacerations may be visible at the perineum or vaginal wall, or they might not be visible, necessitating a suspicion of potential cervical damage.

Management of Traumatic PPH

  • Initial Reassurance:
    • It's essential to reassure the patient that they are in safe hands and that the healthcare professional is competent.
  • Direct Pressure Application:
    • Apply direct pressure at bleeding points, which may involve using fingers or instruments like artery forceps to hold compresses in place.
  • Preparation for Suturing:
    • If necessary, prepare the required materials for suturing any identified lacerations.
  • Advanced interventions:
    • If extensive laceration occurs, particularly in the lower uterine segment, consult a doctor for potential laparotomy (surgical opening of the abdominal cavity) to repair damage.

Hypofibrinogenemia and Its Effects

  • Hypofibrinogenemia refers to a deficiency of fibrinogen in the blood, impacting the clotting process:
    • If fibrinogen levels fall between 80-120 mg/100 mL of blood, bleeding may continue unabated as the open blood sinuses at the placental site cannot clot.
  • Treatment Protocol:
    • Administer calcium salts and thromboplastin, the enzyme that activates Vitamin K, which in turn is necessary for producing prothrombin in the blood.
    • Prothrombin and fibrinogen together help form a clot via the action of thrombin which converts fibrinogen into fibrin.

Understanding Hyperfibrinogenemia

  • The phenomenon where fibrinogen levels in the bloodstream can lead to coagulation disorders if fluid, known as languid fluid, enters the circulation.
  • Questions are raised regarding signs and symptoms associated with hypofibrinogenemia, particularly as it relates to PPH:
    • It is noted that signs include:
    • Blood that appears watery.
    • The uterus remains well contracted, indicating effective uterine tone despite ongoing bleeding.

Clinical Testing and Management

  • Confirmatory Testing for Clotting Disorders:
    • Collect blood samples in glass containers for laboratory analysis; assess clotting time. If no clot forms within ten minutes, hypofibrinogenemia is confirmed.
  • IV Fluid Management:
    • Cautiously manage IV drips; given the state of the blood being watery, the procurement of access to veins requires caution and potentially calls for assistance from more experienced colleagues.

Summary with Additional Information

  • Addressing potential complications of PPH includes:
    • Diagnosis of adhered placenta and its treatment protocols.
    • Complications related to abnormal fetal positions, which include various delivery challenges and potential for hemorrhagic events.

Conclusion

  • The session concludes with an invitation for questions from participants, reinforcing learning collaboration and a summary of key concepts covered related to traumatic PPH.

Final Notes

  • Engaging with educational materials and assignments is encouraged to deepen understanding.