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A Comprehensive Approach to PPH
Seethamma Rapoor
1:
Introduction to PPH
2:
Haemostasis Physiology and Its Maintenance at Delivery
PHYSIOLOGY OF HAEMOSTASIS
RESPONSE TO INJURY
Separation of Placenta in Obstetrics
Mechanism of Clotting
Anticlotting Mechanism
HAEMOSTASIS AT DELIVERY
Compensatory Mechanisms Against PPH
Induced Hypervolaemia during Pregnancy
Myometrium and Its Functions
Intact Coagulation System
3:
Classification of PPH
DEFINITION OF PPH
CLASSIFICATION
4:
Atonic PPH
AETIOLOGY
MECHANISM OF PPH
Overdistended Uterus
Rapid Uterine Evacuation
Metabolic Factors
Uterine Atony
Calcium
Drugs
CLINICAL CHARACTERS
COMPLICATIONS OF PPH
Late Complications
Prognosis in PPH
PREVENTION OF PPH
RECOMMENDATIONS OF WHO
DIAGNOSIS AND TREATMENT
Bleeding Before Delivery of the Placenta
Causes
Retained placenta
Retained placenta caused by contracted cervix
Retained placenta by abnormal attachment to uterus
Bleeding After Delivery of Placenta
Treatment
TREATMENT OF UTERINE ATONY
Uterine Brace Sutures
B Lynch Suturing
Technique
Modified B Lynch Suture
Chow Suture
Uterine Artery Ligation
Bilateral Internal Iliac Artery Ligation
Anatomy
Procedure (Figs 4.5A and B)
Post-ligature Observations
Limitations and Complications of Internal Iliac Artery Ligation
Arterial Embolisation
Indication
Uterine Artery Embolisation
Procedure
Limitations of Angiographic Embolisation
Hysterectomy
5:
Traumatic PPH
CAUSATIVE FACTORS IN TRAUMATIC PPH
Intrapartum Rupture of Uterus
Diagnosis of Intrapartum Rupture
Rupture of Vaginal Vault (Colporrhexis)
Treatment of Colporrhexis
Lacerations of Cervix
Bleeding from Episiotomy Wounds
Perineal Tears
Types of Perineal Tears
6:
PPH Due to Coagulation Defects
COAGULATION FAILURE IN OBSTETRICS
Protective Mechanism Against Coagulation Failure During Pregnancy and Labour
Critical Levels of Clotting Factors and FDP in Coagulation Failure
Clinical Features
Investigations
Inference of Investigations
MANAGEMENT
Correction of Coagulation Failure
Correction of Fibrinolysis
7:
Management of PPH—Flow Chart
8:
Nischay—2007 Social Aspects of Postpartum Haemorrhage
ACTION
Perception
Awareness
Trust and Visibility
Creating Events
Creating Events—Walk for Your City/town
SPECIAL FEATURES OF NISCHAY—2007
Name
From Simple to Complex (Known to Unknown)
Community Participation
Minimum Costs
Strengthening the Third Interface
Progress so far
Well Begun is Half Done
Bibliography
Safe Motherhood Committee
MEMBER COMMITMENT
Chairperson – FOGSI Safe Motherhood Committee 2003-07
Zonal Coordinators
North Zone
South Zone
East Zone
Vice-President Incharge
Advisors
Members
INDEX
TOC
Index
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