PPH is the most common obstetric hemorrhage being the most common reason for maternal death. Massive hemorrhage is considered when the blood loss is considered more than 1500 ml and loss of Hb is 4gm.
PPH can be primary or secondary depending on the time of the blood loss, primary states that the blood loss is within 24 hours and secondary suggests that the blood loss is between 24 hours to 12 weeks.
Causes:- 4 Ts
- Tone - atonic uterus
- Tissue - remaining bits of placenta causing infections
- Trauma - injury
- Thrombin - coagulopathies
Treatment :-
- Doc- oxytocin, carbetocin
- Misprostol
- Fibrinogen
- Uterine artery embolism
- Surgical suture
- Devascularisation
APH bleeding after 28 weeks of gestation and is caused by placenta previa, abruption, vasa previa, trauma, CA cervix etc. Placenta previa being the most common cause, leads to painless bleeding.
Treatment:-
- Resuscitation
- Steroids
- Ligation
- C section
.