William V S.

Tubman
College of Health Sciences
Department of Nursing and Midwifery

Course title:
Topic: Postpartum Hemorrhage 
To:
Group( 3) members
Name: ID#
Lovina N. Gehma 02300
Daisy G Boatue 00653
Harrimah L.P Tiah 02430
Martha K. Sieh 02175
Rufina M. Nagba 01780
Definition of Postpartum
Hemorrhage
• Postpartum Hemorrhage is blood loss in excess of 500mls following
Vaginal delivery or 1000mls following caesarean section.
• Some problems have been associated with this definition; Estimates
of blood loss are notoriously low, often half of the actual loss. This is
because blood is mixed with amniotic fluid and sometimes with urine.
It is also dispersed on sponges, towels and linen, buckets and on the
floor.
• The importance of a given volume of blood loss varies with the
woman’s Hemoglobin level. A woman with a normal hemoglobin will
tolerate blood loss but can be fatal for a woman with low hemoglobin.
Classification of Postpartum

• Primary Postpartum Hemoglobin (PPH): Excessive bleeding within 24

hours of child birth.
• Secondary Postpartum Hemoglobin (PPH): Excessive vaginal bleeding
24 hour following childbirth until 6 week after childbirth.
 The causes of PPH are classified in to four groups

1.Uterine Atony
This is when the uterus fails to contract adequately. Any condition that
interferes with uterine contractions will predispose to atonic uterus. The
result is excessive blood loss that can result in maternal death within
2hours.
2. Trauma
• Trauma to the perineum, vagina, cervix or uterus is the second most
frequent cause of PPH. Tars may co-exist with atonic uterus. One should
always suspect a cervical or a vaginal tear whenever there is postpartum
bleeding with a connected uterus. Unrepaired or poorly repaired
episiotomies or tears or can also cause severe bleeding.
 Causes cont.
3.Tissue
Retained Placenta this is defined as failure to deliver the placenta within
30minties of child birth. This interfere with uterine contractility. Retain
Placental fragments, as well as retained membranes also result in PPH by
predisposing to uterine Atony.
4. Thrombin
• Coagulation disorders are rare cause of PPH according for only1% of PPH.
When the blood fails to clot despite the routine interventions, a coagulation
should be suspected.
• Predisposing factors for disseminated intravascular coagulation include:
Severe pre-eclampsia, Placenta abruption, Intrauterine fetal death
 Prevention
• Oxytocin: first line from prophylaxis
10 units/1ml IM or 5units to be given by slow IV push with in the first minute
after the delivery.
• Ergometrine or Methylergometrine: 0.2 mg IM, within the first minute after
the delivery
( WHO/RHR/09.22) It is recommended that the trained health worker should
offer Misoprostol 600 microgram orally immediately after the birth of the baby.
In such cases no active intervention to deliver the placenta should be carried
out.
WHO recommend the used of Misoprostol in setting where it is not possible to
use oxytocin or another injectable uterotonic such as ergometrine or
oxytocin/ergometrine fixe-dose combination in circumstances outlined below:
In the absence of personnel to offer active management of the third stage
of labour.
Difficulties in ensuring safe injection practices and/or refrigeration
preventing the use of oxytocin.
 Management of PPH

management of primary PPH

• Call for help
• Empty the bladder
• Give oxytocin IM
• Massage uterine fundus
• Cross match blood
 Management of Secondary PPH
Assess the condition
Set up IV fluid
Give oxytocin or ergometrine
Start with broad spectrum antibiotics: Amoxicillin 500mg IV,
Gentamicin 160mg IM
Metronidazole 500mg IV
Refer to next level of health facility for further emergency care.
Blood Transfusion if severely anaemic.
 Reference
• Bennet R and Brown L: Textbook for Midwives. Great Britain. English language
book; Publisher;11th edition.
• Breen M.: June 1999. Essential Obstetric and Gynecology guidelines for District
Hospitals. British Council Pretoria South Africa.
• WHO/UNFPA/UNICEF,WB: 2006: Pregnancy, Childbirth, Postpartum and
Newborn care. A Guide for Essential Practice.
• WHO 2012: Guidelines on the use of Misoprostol.