what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is PPH and what is the management?
what is the ectopic pregnancy?
3. 2. Postpartum Hemorrhage (PPH)
• Postpartum Hemorrhage (PPH) is a
blood loss after delivery greater than:
- 500 mL for vaginal delivery, and
- 1,000 mL for cesarean delivery,
- with 10% drop in hematocrit
• PPH is responsible for around 25% of
maternal mortality.
4. PPH Classification
• PPH is classified into:
− Primary (early) occurs
within the first 24 hours
after delivery.
− Secondary (late) occurs
after 24 hours post-birth to 6
weeks after delivery.
5. PPH Risk factors
• Antepartum hemorrhage in this pregnancy.
• Enlargement Uterus Due to Macrosomia or Multiple fetuses.
• Pre-eclampsia.
• Previous PPH.
• Maternal obesity.
• Uterine abnormalities and Surgery.
• Maternal age (35 years or older).
• Maternal anemia.
• Operative vaginal delivery (Use of forceps or vacuum).
• Induction of labor.
• Prolonged first and second stage of labor (over 12 hours
labor).
• Infections.
• Anemia
7. PPH Common Causes
The causes of PPH have been described as the
"four T"
1. Tone: uterine atony (“70%” failure of the uterus
to contract properly after delivery).
2. Trauma: lacerations of the uterus, cervix, or
vagina, and uterus inversion.
3. Tissue: retained placenta.
4. Thrombin: Coagulation abnormalities.
8. 1. Tone:
• Once a baby is delivered, the uterus normally continues to
contract (tightening of uterine muscles) and expels the
placenta.
• After the placenta is delivered, these contractions help
compress the bleeding vessels in the area where the
placenta was attached.
• If the uterus does not contract strongly enough, called
uterine atony, these blood vessels bleed freely and
haemorrhage occurs.
• This is the most common cause of postpartum
haemorrhage.
9. 2. Trauma: Lacerations, hematomas, injury, rupture of
the uterus, cervix, or vagina. And uterus inversion.
3. Tissue: If small pieces of the placenta remain
attached, bleeding is also likely. Or placenta tissues
attack and enter the uterine tissues.
4. Thrombin: Coagulation abnormalities due to many
causes as; HELLP Syndrome, Amniotic fluid
embolism, Vitamin K deficiency.
10. PPH Prevention
• Detect any abnormality (anemia, diabetes…) before the
delivery and try to control it.
• Ensure that the bladder of the mother is empty since a full
bladder makes it more difficult for the uterus to contract.
• We should know the mother’s blood type.
• IV access should be maintained.
• Slow IV infusion.
• Oxytocin medication (A drug used to stimulate uterine
contractions and control bleeding).
• Oxytocin should be routinely used in the third stage of labor.
• Massage the mother’s uterus to help it contract.
11. PPH Management
Tone
• Massage
• Drugs (Oxytocin)
Thrombin
• Drugs (according to
the cause)
• Platelet and blood
transfusion
Tissue
• Drugs (Oxytocin)
• Manual removal of retained
placenta
• Uterine curettage
Trauma
• Manual fixation of
uterus inversion
• Repair the rupture
and laceration
15. PPH Management
• Large-bore intravenous access, and increase
oxytocin.
• Uterus Relaxation Agent
• A blood clotting medication.
• Transfuse blood.
• Bakri Balloon.
• Laparotomy: Surgery to open the abdomen to find
the cause of bleeding.
• If the blood doesn’t stop; Hysterectomy should be
Done (This is always a last resort in all condition).
17. 3. Ectopic Pregnancy
• An ectopic pregnancy is the implanting
of the zygote somewhere other than the
inner endometrial lining of the uterus
(pregnancy that occurs outside the
uterus).
• It occurs in 1%-2% of all pregnancies.
• It is life-threatening to the mother.
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18. 3. Ectopic Pregnancy
• The vast majority of ectopic
pregnancies occur in the fallopian
tube “tubal pregnancy’’ (95%), but the
fertilized ovum can also implant in
the ovary, cervix, or abdominal cavity
(5%).
• Doctors usually discover it between
week 5 and week 14 of pregnancy . 18
22. Ectopic Pregnancy symptoms
• The first warning sign of an ectopic pregnancy is pelvic
pain.
• Abnormal vaginal bleeding.
• Abdominal pain, typically just in one side, which can
range from mild to severe.
• An absent of menstruation (amenorrhea), and other
symptoms of pregnancy.
• Shoulder pain (unknown why).
• If the fallopian tube ruptures, the pain and bleeding
could be severe enough to cause fainting.
• Rectal pressure.
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23. Ectopic Pregnancy Causes
• The most common cause is damaged fallopian tube.
• Zygote abnormality.
• Previous ectopic pregnancy.
• Sexual diseases (typically chlamydia).
• Reproductive organs infections and inflammations.
• Smoking.
• Endometriosis (abnormal uterus lining).
• Using fertility drugs.
• Getting pregnant while having an intrauterine device
(IUD).
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25. Ectopic Pregnancy Complications
• The major health risk of ectopic
pregnancy is rupture leading to
internal bleeding.
• Decreased fertility related to removal
of fallopian tube.
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26. Ectopic Pregnancy Management
• In early stage; a medication used to stop
the egg developing. The pregnancy
tissue is then absorbed into the woman’s
body.
• In more advanced stage; a surgery is
required to remove the egg or Embryo.
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27. Ectopic Pregnancy Management
• If the fallopian tube has ruptured,
emergency surgery is necessary to
stop the bleeding and fix the tube.
• In some cases, the fallopian tube and
ovary may be damaged and will have
to be removed.
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28. Ectopic Pregnancy Management
• The hCG level will need to be rechecked
on a regular basis until it reaches zero if
the entire fallopian tube did not removed.
• An hCG level that remains high could
indicate that the ectopic tissue was not
entirely removed, which would require
another surgery or medical management.
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