1/25/2024 0 Comments Retained placental fragmentsSevere bleeding before placental delivery.Prior history of retained placenta (most common).General measures (e.g., monitor vital signs, fluid therapy) and immediate manual uterine reposition.Ultrasound (confirms diagnosis in uncertain cases).Absent fundus (top of the uterus) at the periumbilical position during transabdominal palpation.Round mass (inverted uterus) protruding from the cervix or vagina.Uncontrolled cord traction and/or excessive fundal pressure during the third stage of labor.Surgical procedures (uterine balloon tamponade or packing).Active management of the third stage of labor ( see “Prevention” below).Other (e.g., p reterm delivery, maternal BMI > 40 kg/m 2).Medications lowering contractions (e.g., anesthetics, MgSO 4).Anatomical abnormalities (e.g., uterine leiomyomas).Exhausted myometrium (e.g., prolonged oxytocin use).Overdistention of the uterus (e.g., multiple pregnancies).Overview of common causes of postpartum hemorrhage A hysterectomy is often considered as a last resort in uncontrolled postpartum hemorrhage. Treatment depends on the underlying condition and may include general measures to control blood loss and maintain adequate perfusion to vital organs, suturing of bleeding lacerations, active management of the third stage of labor like manual maneuvers to aid in placental separation, and use of uterotonic agents for uterine atony. Diagnosis is done through early recognition of clinical findings, systematic evaluation of the most common causes, and, in some cases, confirmed with ultrasound. Clinical findings are related to the amount of blood loss and can include anemia (e.g., lightheadedness, pallor) or hypovolemic shock (e.g., hypotension, tachycardia). The most significant causes of postpartum hemorrhage are uterine atony, maternal birth trauma, abnormal placental separation, velamentous cord insertion, and coagulation disorders. The onset may be within 24 hours (primary PPH) to 12 weeks postpartum (secondary PPH). PPH is generally associated with symptoms of hypovolemia. It is the number one cause of maternal morbidity and mortality worldwide. Postpartum hemorrhage (PPH) is an obstetric emergency and is defined as a blood loss ≥ 1000 mL or blood loss presenting with signs or symptoms of hypovolemia within 24 hours of delivery.
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