From a postpartum occurs when the blood loss during or immediately after the third stage of labor is> 500 ml at vaginal delivery or> 1000 ml for cesarean delivery. The diagnosis is made clinically. The treatment depends on the etiology of the bleeding.

From a postpartum occurs when the blood loss during or immediately after the third stage of labor is> 500 ml at vaginal delivery or> 1000 ml for cesarean delivery. The diagnosis is made clinically. The treatment depends on the etiology of the bleeding. Causes In most cases of postpartum hemorrhage is uterine risk factors for uterine include Uterine hyperinflation (caused by multiple pregnancy, polyhydramnios or an unusually large fetus) prolongation or the labor Grand multiparity (birth of ? 5 viable fetuses) relaxante anesthetics Fast contractions chorioamnionitis Other causes of postpartum hemorrhage include injuries to the genital tract tearing an episiotomy uterine bleeding disorders retention of placental tissue hematoma uterine inversion chorioamnionitis subinvolution (incomplete regression) of Plazent ahaftfl├Ąche (which occurs usually early, but may also invest up to one month after birth occur). Fibroids can contribute to the development of postpartum hemorrhage. Earlier postpartum hemorrhage may indicate an increased risk. Diagnosis Clinical Investigation The diagnosis of postpartum hemorrhage is made clinically. Treatment distance retained placenta tissue and supply genital injuries uterotonic drugs (eg. B. oxytocin, prostaglandins, methylergonovine) hydration and sometimes transfusion Occasionally surgical procedures The intravascular volume is injected i.v. with up to 2 l of 0.9% NaCl solution replenished. If this volume of NaCl solution is insufficient, then a blood transfusion. As a postpartum process is treated by Kate Barrett, MD and Will Stein, MD, National Naval Medical Center Residency in Obstetrics and Gynecology; Barton State, MD, Uniformed Services University; and Shad Deering, COL, MD, director of the Department of Obstetrics and Gynecology, National Naval Medical Center Residency in Obstetrics and Gynecology; with the help of Elizabeth N white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw at the Val G. Hemming Simulation Center at the Uniformed Services University. var model = {videoId: ‘5504401033001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5504409217001_5504401033001-vs.jpg?pubId=3850378299001&videoId=5504401033001’, title: ‘As a postpartum is treated’ description: ” credits’ method of Kate Barrett, MD and will Stein, MD, National Naval Medical Center Residency in Obstetrics and Gynecology; Barton State, MD, Uniformed Services University; and Shad Deering, COL, MD, director of the Department of Obstetrics and Gynecology, National Naval Medical Center Residency in Obstetrics and Gynecology; with the help of Elizabeth N white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw at the Val G. Hemming Simulation Center at the Uniformed Services University ‘hideCredits. true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true} ; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); How to repair a cervical laceration is method by Will Stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of Obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University. var model = {videoId: ‘5504384188001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5504400206001_5504384188001-vs.jpg?pubId=3850378299001&videoId=5504384188001’, title: ‘As a cervical laceration to repair’, description: ” credits’ method by Will stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University ‘hideCredits. True hideTitle: false, hideDescription: true loadImageUrlWithAjax: true} ; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); How to Make a vaginal tear second degree fixes method of Kate Barrett, MD and Will Stein, MD, National Naval Medical Center Residency in Obstetrics and Gynecology; Barton State, MD, Uniformed Services University; and Shad Deering, COL, MD, director of the Department of Obstetrics and Gynecology, Uniformed Services University and Walter Reed National Military Medical Center. With the help of Elizabeth N white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University. var model = {videoId: ‘5759932641001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5759932618001_5759932641001-vs.jpg?pubId=3850378299001&videoId=5759932641001’, title: ‘How can a vaginal tear second degree fixes’, description:’ ‘credits’ method of Kate Barrett, MD and Will Stein, MD, National Naval Medical Center Residency in Obstetrics and Gynecology; Barton State, MD, Uniformed Services University; and Shad Deering, COL, MD, director of the Department of Obstetrics and Gynecology, Uniformed Services University and Walter Reed National Military Medical Center. With the help of Elizabeth N white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University ‘hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Hemostasis is iv over a bimanual massage the uterus and oxytocin trying to achieve. An oxytocin infusion added (10 or 20 [up to 80] I.E./1000 ml of the infusion solution) in 125-200 ml / h. The drug is given until the uterus is fixed, then reduced or discontinued. Oxytocin should not as an i.v. Bolus be administered because it can lead to severe hypertension. In addition, the uterus injuries and retained placental tissue must be investigated. Cervix and vagina are also examined; Injuries are to be supplied. Bladder drainage via catheter may occasionally reduce uterine. 15 Methylprostaglandin F2a (250 ug in every 15-90 minutes to 8 times), or every 2-4 hours methylergonovine (0.2 mg in, possibly followed by 0.2 mg po, 3-4 times / day a total of 1 week), if persists excessive bleeding during oxytocin infusion. During a Caesarean section, these drugs can be injected directly into the myometrium. 10 units of oxytocin can also be injected directly into the myometrium. Women with asthma should not receive prostaglandins, women with high blood pressure not methylergonovine. In some cases with misoprostol (800-1000 micrograms rectal) of uterine tone can be increased. By filling or placement of a Bakri balloon uterine tamponade can sometimes be achieved. This silicone balloon can hold up to 500 ml and resist internal and external pressure of up to 300 mmHg. If no hemostasis be achieved, surgical placement of a B-Lynch-seam (seam for compression of the lower uterine segment across multiple insertions), ligation of A. hypogastrica or hysterectomy may be necessary. A uterine rupture should be treated surgically. Blood products are, if necessary, depending on the degree of blood loss and clinical signs of shock, transfused. Infusion of factor VIIa (50-100 micrograms / kg, as a slow iv bolus over 2-5 minutes) can cause bleeding in women with severe life-threatening bleeding. The dose is given every 2-3 hours until hemostasis. Prevention predisposing factors (eg. As leiomyomas of the uterus, polyhydramnios, multiple pregnancy, maternal bleeding disorder purerperale bleeding or postpartum in history) must be detected before birth and, where possible, treated. When women have an unusual blood type, blood type is available in advance. Target a careful, quiet birth with minimum intervention should always be. With oxytocin 10 IU in the. or dissolved in an infusion (10-20 I.U. in 1000 ml of a solution I.V., 125-200 ml / hr over 1-2 h) are usually to achieve a good uterine contraction and a reduced blood loss to the solution of the placenta. After their expulsion, the placenta should be carefully examined for completeness. If it is incomplete, the uterus is blanked manually and retained parts of the placenta are removed. Rarely curettage must be performed. The uterine and vaginal the amount of blood loss have to 1 h after completion of the third stage of labor can be observed. Summary Before Enbindung should be assessed the risk of postpartum hemorrhage, including the identification of prenatal risk factors (eg., Bleeding disorders, multiple pregnancy, polyhydramnios, unusually large fetus, high multiparity). An intravascular volume should be filled, supplied genital injuries and retained placental tissue are removed. The uterus was massaged and uterotonic drugs (eg. B. oxytocin, prostaglandins, methylergonovine) are added if necessary. If the bleeding continues, tampons, surgical procedures, and transfusion of blood products should be considered. Women at risk should not relieve slowly and without unnecessary intervention.

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