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Chapter 13a - Management of obstetric hemorrhage: obstetric management

from Section 5 - Hemorrhagic disorders

Published online by Cambridge University Press:  06 December 2010

Sue Pavord
Affiliation:
Leicester Royal Infirmary
Beverley Hunt
Affiliation:
Guy's and St Thomas' NHS Foundation Trust
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Summary

Primary postpartum hemorrhage (PPH) is the most common obstetric hemorrhage (OH) and is defined by the WHO as the loss of blood estimated to be >500ml from the genital tract within 24 hours of delivery. Prevention of PPH is through the recognition of any risk factors present either ante-natally or during the intrapartum period, and the subsequent implementation of preventative management/strategies. Active management involves the administration of oxytocin with, or shortly following, delivery of the anterior shoulder of the baby. There are numerous reasons for the uterus failing to contract effectively including exhaustion, sepsis, and retained products. Other causes of PPH include perineal trauma, uterine inversion, clotting disorders, pelvic hematomas, and cervical tears. Diagnosis of OH is typically by the visualization of blood loss from the genital tract. In the case of antepartum hemorrhage (APH), management depends on the amount of bleeding, maternal compromise and/or degree of fetal distress.
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Publisher: Cambridge University Press
Print publication year: 2010

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