Complications related to pregnancy and childbirth can occur after childbirth. For one of these complications include post-partum bleeding. Postpartum hemorrhage is the most severe complication of childbirth. The share of all diseases of pregnancy and childbirth account for 25% of obstetric hemorrhage (detachment of the placenta, its presentation, sequence and post-partum bleeding). Of these, 10% are post-partum haemorrhage. But timely and properly surveyed pregnant woman's risk of postpartum hemorrhage is minimal. That is why it is important to register early in pregnancy (before 12 weeks) and undergo the necessary tests prescribed by the doctor.

Predisposing factors of postpartum hemorrhage

Contributing factors are chronic diseases

• kidney
• Cardiovascular
• liver
• CNS

as well as scarring and uterine tumors. Furthermore, predispose to postpartum hemorrhage and the course of pregnancy

• preeclampsia
• incorrect position and fetal presentation
• large fruit
• polyhydramnios and oligohydramnios
• multiple pregnancy and others.

Causes of postpartum hemorrhage

• delay parts of the placenta and fetal membranes in the uterus (including additional slice of the placenta);
• hypotension, and atony of the uterus;
• violation of blood coagulation;
• improper management of labor, especially the sequence of the period;
• obstructed labor (uterine inertia forces, prolonged labor, rapid and quick delivery);
• soft tissue injuries of the birth canal.

Clinic postpartum hemorrhage

Bleeding may occur as early (within two hours of delivery) postpartum, and late (after two hours and no later than six to eight weeks after the birth of a baby).

In the early postpartum bleeding is profuse, painless, but the woman's condition deteriorates rapidly, there is a weakness, pale skin, and then develop hemorrhagic shock. Normally, postpartum hemorrhage must be not more than 0, 5% of body weight or puerperal not more than 400 ml. The uterus becomes flabby, does not respond to the external massage, very increased in size. In some cases, it may cause internal bleeding when no external release, and blood accumulates in the uterus. Early postpartum hemorrhage can occur in two ways:

• Once it becomes profuse bleeding, abundant and does not stop.
• Bleeding periodically, 150-300 ml, resumed after a short break.

In the late postpartum hemorrhage is also abundant, it can be intermittent and often delayed due to parts of the placenta in the uterus. Signs, alarming the woman, massive bleeding (impregnated pad for an hour), a bright red color What color goes red: beware   and the smell of rot is not terminated within four days after birth. Equally important is a symptom after some time suddenly stop allocation (lohiometra).

Treatment of postpartum hemorrhage

Treatment for postpartum hemorrhage can be conservative and surgical.

Conservative therapy begins with the elimination of urine catheter (which must be done immediately after birth) and external massage of the uterus (to stimulate uterine contractions). After that you should put a chill on the area of ​​the uterus and enter uterotonic agents intravenously and intramuscularly (oxytocin metilergometrin). At the same time spend infusion therapy (saline, starches and dextrans) and blood transfusion. If all of these methods have no effect, proceed to surgery.

Operative therapy begins with a manual examination of the uterus during which audits the placental site, determine whether there is uterine rupture, and remove the remnants of the placenta and the blood clots. Then gently massage the uterus to carry out his fist. This procedure is performed under general anesthesia. In case of failure of the procedure proceeds to laparotomy during which a bandage ovarian and uterine vessels or performed a hysterectomy (removal of the uterus).

Anna Sozinova

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