Postpartum hemorrhage

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Postpartum hemorrhage is the loss of more than 500mL of blood after labour in the reproductive female, or a loss of more than 1000mL at cesarian section. Early postpartum hemorrhage is defined as blood loss within 24 hours of delivery. Late postpartum hemmorhage is anything between 24 hours and 6 weeks postpartum.

The etiology of postpartum hemmorhage can be broken down into the Four Ts: tone, tissue, trauma, and thrombin.

Tone speaks to abnormal contractions, overdistension, muscle dysfunction or infection. Tissue has to do with retained products, blood clots, and an abnormal placenta. Trauma can be any major traumatic event, and thrombin involves any preexisting coagulopathy.

Treatment

Post-partum hemmorhage should be treated by first identifying the source of the abnormal bleeding and its cause. As with any traumatic case, patients should be assessed for the ABCs. Intravenous access should be secured using a large bore. Also, oxygen and coagulation agents should be given, and the patient crossmatched should blood units be administered.

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