产后出血紧急措施-ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,POSTPARTUM HAEMORRHAGE STEPS TO AVOID HYSTERECTOMY,Professor & Head, Department of Obstetrics & Gynaecology, St.Georges Hospital Medical School, University of London,POSTPARTUM HAEMORRHAGE STEPS,PPH -,Old problem - new thoughts,PG potentiates the action of oxytocin,Tamponade test - Therapeutic & Diagnostic,Uterine Compression Sutures,Severe Shock & Golden Hour - Definitive Surgery,Body weight Blood volume & Hb%,Wash Out phenomenon - fibrinogen/,PPH - Old problem - new though,PPH - Emergency that kills,(5th commonest cause CIMD),Anticipate - high risk cases,(e.g. twins, polyhydramnios, long labour, fibroids, APH, infection, past H/O PPH, retained tissue etc.),Prevent - Prophylactic oxytocics,(e.g. Syntometrine, syntocinon, ergometrine, misoprostol),Manage - promptly - 90% uterine atony - 8% trauma and 2% coagulation disorders,(e.g. Atony - Oxytocin infusion 40 units in 500ml - 80 mu/min -20 drops in a 20 drops/ml giving set),PPH - Emergency that kills(5,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,Prostaglandin potentiates the action of oxytocin,Stepwise quick progression - syntometrine/ergometrine/oxytocin infusion/prostaglandins IV;IM;IntraMyometrial,Use misoprostol 400 ug rectally /orally whilst using oxytocin infusion,Prostaglandin potentiates the,Large bore IV cannulas (gauge 14 x 2),Crystalloids,Large bore IV cannulas (gauge,Emergency Trolley,Endotracheal tube,Laryngoscope,Essential drugs,Crystalloids, giving sets, haemacel,Emergency protocols,Emergency TrolleyEndotracheal,Placenta,Uterus,External hand steadies the uterine fundus,Internal hand along plane of cleavage,MANUAL REMOVAL OF PLACENTA,Anaesthesia,Antibiotics,IV line,Oxytocics,Check placenta is complete,Check the uterus is empty,Check for trauma of GT,PlacentaUterusExternal hand st,TAMPONADE TEST,Therapeutic & Prognostic,For severe PPH,Stomach balloon,Oesophageal,balloon,Condous G, Arulkumaran S .,Obstetrics & Gynecology. 2003,TAMPONADE TESTStomach balloonO,The “Tamponade Test”,Therapeutic,- No further intervention (14/16); Continue oxytocin infusion for 12 hrs, small vaginal pack, IV antibiotics, check fundal height, bleeding pv.,Prognostic,- No need to do a laparotomy - answer known in few minutes,The “Tamponade Test”Therapeuti,COMPRESSION SUTURESQuick, safe and effective,B-Lynch,Horizontal full thickness sutures,Vertical full thickness sutures,Square sutures,Combination of sutures,COMPRESSION SUTURESQuick, saf,B-Lynch Suture,B-Lynch Suture,COMPRESSION SUTURES,Cornu,Fallopian tube,Ovary,Hayman R, Arulkumaran S, Steer P,Obstetrics & Gynecology. 2002,COMPRESSION SUTURESCornuFallop,Placental bed haemorrhage,Through and through figure of eight or transverse sutures involving full thickness of the uterine wall,Infiltration of placental bed with vasoconstrictors,Hot packs and pressure,Placental bed haemorrhageThro,COMPRESSION SUTURES,Vertical,Compression,Sutures,Horizontal,Compression,sutures,Hayman R, Arulkumaran S, Steer P,Obstetrics 2002.,COMPRESSION SUTURESVerticalHor,Combination of Compression Suture and the Tamponade,Combination of Compression Su,LIGATION OF UTERO-OVARIAN VESSELS,LIGATION OF UTERO-OVARIAN VES,LIGATION OF UTERINE VESSELS,LIGATION OF UTERINE VESSELS,LIGATION OF ANT.BRANCH OF,INTERNAL ILIAC ARTERY,LIGATION OF ANT.BRANCH OF,Point of ILA,ligature,RADIOLOGICAL INTERVENTION EMBOLISATION,Point of ILARADIOLOGICAL INTER,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,PPH Coagulation disordersWash Out Phenomenon,DIVC- FDP inhibits clotting,“Washout phenomenon” - the coagulation factors are consumed and washed out at the site of bleeding,The “washout” is the major phenomenon that prevents arrest of haemorrhage,PPH Coagulation disordersWas,Reason for excessive uncontrolled bleeding,Consumption coagulopathy,Excessive fibrinolysis -,Dilutional coagulopathy - haemodilution,Hypothermia slow enzymatic process of + function,Multitransfusion syndrome Depleted and clotting factors,Metabolic changes acidosis + citrate,Reason for excessive uncontrol,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,Clinical classification of hypovolaemic shock,Mild Shock,- upto 20% blood volume loss,Decreased perfusion of nonvital organs and tissues (skin, fat, skeletal muscle and bone),Pale cool skin, patient complains of feeling cold.,Clinical classification of hyp,Moderate Shock - 20-40% blood volume loss,Decreased perfusion of vital organs (liver, gut, kidneys),Oliguria to anuria and slight to significant drop in blood pressure, mottling in extremities especially legs,Moderate Shock - 20-40% blood,Severe Shock40% or more blood volume loss,Decreased perfusion to heart and brain,Restlessness, agitation, coma, cardiac irregularities, ECG abnormalities and cardiac arrest,Severe Shock40% or more blood,Haemorrhagic Shock,Severe acute loss of blood produces failure of cardiovascular support for the bodys metabolic needs.,Body weight - Blood loss - Shock,Bodyweight in Kg /12 = Blood volume in litres. E.g. 48 kg = 4 L; 84 kg = 7 L,40% blood loss causes severe shock. 1.5 L blood loss may produce severe shock in a 48 Kg and mild shock in a 84 Kg lady,Haemorrhagic Shock Severe acu,THE GOLDEN HOUR,As more time elapses between the point of severe shock and the start of resuscitation, the percentage of surviving patient decreases,The “Golden Hour” is the time in which resuscitation must begin to achieve maximum survival,THE GOLDEN HOURAs more time el,产后出血紧急措施-ppt课件,PPH - Aggressive Surgery,Systolic BP 20 to 30 min,Continued blood loss (esp3 L) despite other surgical measures (, uterine, infundibulo pelvic vessel ligatures),Inadequate response to blood replacement,ECG changes,Placenta praevia/acreta with bleeding,DIVC/ washout phenomenon with difficulty in getting clotting factors +/- clinical picture,Subtotal or Total Hysterectomy,PPH - New thoughts ,ALGORITHM FOR ACTION,Oxytocin infusion + Misoprostol,Parenteral PG,Tamponade test,Compression sutures +-Tamponade ligation of vessels Hysterectomy,Clotting factors - fibrinogen, Factor VII a,Aggressive surgery,(Degree of shock - Golden hour),Blood (+blood products) replacement - start early and in adequate quantities,( Shock lung syndrome ARDS blood without leucocytes),PPH - New thoughts ALGORITHM,Maternal mortality due to PPH,CONFIDENTIAL ENQUIRY INTO MATERNAL DEATHS,TOO LITTLE TOO LATE,Too Little (IV fluids, oxytocics, BLOOD, Clotting factors),Too Late (PG, resuscitation - blood replacement, decision for surgery + to get senior surgeon & anaesthetist involved),Maternal mortality due to PPHC,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,产后出血紧急措施-ppt课件,