Of the deaths 99% are in low and middle income countries. Systemic antifibrinolytic agents are widely used in surgery to prevent clot breakdown fibrinolysis in. Obstetric haemorrhage encompasses both antepartum and postpartum bleeding. Primary postpartum haemorrhage pph is loss of blood estimated to be 500 ml, from the genital tract, within 24 hours of delivery the most common obstetric haemorrhage. Most deaths resulting from pph occur during the first 24 hours after. Definition aph is defined as any bleeding from the genital tract after the 20th week of gestation but before the onset of labour. Secondary pph is defined as abnormal bleeding from the genital tract.
Definition antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term. Postpartum haemorrhage management, risks, and maternal. As adjectives the difference between antepartum and postpartum is that antepartum is describing the period before childbirth. Antepartum haemorrhage aph defined as bleeding from the genital tract in the second half of pregnancy, remains a major cause of perinatal mortality and maternal morbidity in. Uterine atony is the leading cause of pph, and trauma, including iatrogenic trauma, increases the risk for postpartum hemorrhage. The evidencebased management of postpartum haemorrhage pdf. Obstetric haemorrhage is the leading cause of maternal mortality, most occurring in the postpartum period. Antepartum haemorrhage pv bleeding 20 weeks 25% of pregnancies classification.
Antepartum hemorrhage knowledge for medical students and. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Antepartum haemorrhage caused by cervical ectropion can be expected and is. An antepartum hemorrhage is vaginal bleeding that happens during later pregnancy up to birth. Antepartum hemorrhage an overview sciencedirect topics. It is commonly caused by difficulties with the placentas attachment to the uterus that lead to tissue tearing or rupture. Antepartum haemorrhage excluding placenta praevia introduction obstetric haemorrhage both antepartum and postpartum is one of the leading causes of maternalperinatal morbidity and mortality in the developed world.
Death from hemorrhage still remains a leading cause of maternal mortality. Together with suggested overhead slides to be used with each module, these handouts are also included in a separate folder. Postpartum haemorrhage free download as powerpoint presentation. Antepartum and postpartum hemorrhage prediction and. Rare causes include vasa previa and uterine rupture. Differentiate the clinical features of placenta previa, abruptio placenta and other possible causes. Postpartum haemorrhage pph is commonly defined as a blood loss of 500 ml or more within 24 hours after birth. Active man agement of the third stage of labor should be. An antepartum haemorrhage with fetal distress or fetal death is almost always due to abruptio placentae. This greentop guideline is restricted in scope to the management of aph. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise.
Antepartum and postpartum hemorrhage prediction and management. If antepartum, the consultant obstetrician may consider expediting delivery. Should antibiotics be offered after manual extraction of the placenta as part of the. Active man agement of the third stage of labor should be used routinely to reduce its incidence. Who recommendations for the prevention and treatment of. The causes of obstetric haemorrhage differ, depending on whether the haemorrhage occurs antepartum, intra or postpartum. Avoiding delays in diagnosis and treatment will have a significant impact on sequelae and chance of survival.
Global burden of maternal haemorrhage in the year 2000. Antepartum haemorrhage definition bleeding from the vagina any time after 24 weeks gestation until the birth of the baby blood loss greater than 300mls or any amount causing hypovolaemic shock incidence 35% of all pregnancies. Of the 383 deaths from postpartum haemorrhage, there were 4 main groups of primary causes. Antepartum hemorrhage often presents greater threat to the life of. Who guidelines for the management of postpartum haemorrhage. Essential antenatal, perinatal and postpartum care 2 required resources and visual aids the handouts required to accompany sessions have been included with each module. Intrapartum can refer to both the woman and the fetus. Diagnosis and management of postpartum haemorrhage the bmj.
Antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. By contrast, postpartum haemorrhage continues to be a major cause of maternal death both in the developing as well as in the developed world1. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption. Antepartum hemorrhage often presents greater threat to the life of the fetus. Thirty percent of maternal deaths are caused by antepartum haemorrhage of which 50% are associated with avoidable factors. Primary postpartum haemorrhage refer to online version, destroy printed copies after use page 4 of 37 flow chart. Postpartum hemorrhage can result in severe maternal morbidity such as hysterectomy, hypovolemic shock, disseminated intravascular coagulation, and sheehans syndrome. Postpartum haemorrhage pph is a major cause of maternal morbidity and mortality, accounting for about onethird of all pregnancyrelated deaths in africa and asia. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Predisposing risk factors for obstetric haemorrhage. Women with pph in a pregnancy are at increased risk of pph in a subsequent pregnancy.
The woman trial world maternal antifibrinolytic trial. Prevention and management of postpartum haemorrhage ranzcog. Massive haemorrhage protocol mhp queensland clinical guidelines. Describe an appropriate management plan based on the probable cause. It is one of the top five causes of maternal mortality in both high and low per capita income countries, although the absolute risk of death from pph is much lower in highincome countries. Francois and others published antepartum and postpartum hemorrhage find, read. Antepartum hemorrhage aph affects 5% to 20% of pregnancies, defined as genital tract bleeding after 20 or 24 weeks. Even in the absence of antepartum hemorrhage, placenta previa carries a risk for postpartum hemorrhage, primarily caused by uterine atony, as the lower uterine segment does not have the same contractile ability as the fundus after delivery. It is associated with significant maternal and fetal morbidity and mortality. Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage.
Obstetric haemorrhage remains a major cause of maternal mortality in the uk and is now the third leading. Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester. Aph occurs in 25 per cent of pregnancies and half are of unknown cause. Ongoing research is being conducted in hopes of preventing the occurrence of postpartum hemorrhage and providing more efficient ways to treat the issue that so many. Obstetric haemorrhage clinical guideline royal cornwall. Severe antepartum haemorrhage aph occurs in 35% of pregnancies. Pph remains an important cause of maternal morbidity in both developing and technologically advanced countries. Antepartum haemorrhage is defined as bleeding from the vagina after 24weeks.
Some of the causes of aph might also cause intrapartum bleeding for example. This greentop guideline is restricted in scope to the management of postpartum haemorrhage pph. Women who have an antepartum haemorrhage aph are at significant risk of a postpartum haemorrhage pph. Antepartum haemorrhage are sometimes associated with subsequent postpartum haemorrhage. The most important causes of aph are placenta praevia and placental abruption, although these are not the most common. Prevention and management of postpartum haemorrhage. Postpartum hemorrhage pph is an obstetric emergency. The time period spanning childbirth, from the onset of labor through delivery of the placenta. Who guidelines for the management of postpartum haemorrhage and retained placenta 2 establish the cause of the haemorrhage, and possibly obtain the assistance of other care providers, such as an obstetrician, anaesthetist or radiologist. Prevention and management of postpartum haemorrhage green. It occurs in 25% of pregnancies and is an important cause of fetal and maternal death. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that. From sites other than the placental surface, including cervical lesions, e.
Pph is the leading cause of maternal mortality in lowincome countries and the primary cause of nearly one quarter of all maternal deaths globally. A monograph of the management of postpartum haemorrhage. Cumulative blood loss of greater than or equal to ml, or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process includes intrapartum loss regardless of the route of delivery. Obstetric haemorrhage encompasses both antepartum and postpartum. Timely recognition, appropriate resources, and appropriate response are critical for preventing death. This greentop guideline is restricted in scope to the. Antepartum haemorrhage aph complicates 25% of pregnancies and is defined in some literature as any bleeding from the genital tract after the 20 th week of pregnancy and before labour. Essential antenatal, perinatal and postpartum care. Hemorrhage was a direct cause of more than 18 percent of 3201 pregnancyrelated maternal deaths. Aph complicates 35% of pregnancies and is a leading cause of. Definition loss of blood more than 500 ml from the genital tract post delivery of a baby who excessive pvb that cause haematocrit drop more than 10% that require immediate transfusion acog 3. Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding.
Antepartum bleeding, also known as antepartum haemorrhage or prepartum hemorrhage, is genital bleeding during pregnancy after the 28th week of pregnancy up to delivery. Postpartum hemorrhage pph is a leading cause of death and morbidity relating to pregnancy. Depending on the underlying cause, it can be painless, or accompanied by pain and discomfort. A placenta praevia is the most likely cause of a massive antepartum haemorrhage that threatens the patients life. Antepartum haemorrhage is caused in approximately half of the. Postpartum haemorrhage is a major cause of death during pregnancy and early motherhood, accounting for 25% of maternal deaths worldwide,1 and is the second leading direct cause of maternal deaths in the uk. Obstetric haemorrhage management guideline royal berkshire.