The issue is characterized by the separation and expulsion of the placenta, cord and membranes following the resumption of uterine contractions that occur a few minutes after delivery of the newborn. This is a sensitive period because it is accompanied by bleeding, which can sometimes be very important. So when they exceed 500 mL, one speaks of “postpartum hemorrhage”. The estimated frequency of this last 5% of deliveries.
Given its potential seriousness, it requires an obstetrical and anesthetic quick and organized.
The causes of postpartum hemorrhage are numerous.
The most common cause is the placenta, the latter is total or partial. It was a bad result for retraction of the uterus and thus bleeding persists even their accent.
Another common cause is uterine atony, that is to say that the uterus does not shrink and including if there is not retained placenta. Circumstances favoring uterine atony uterine overdistension are (twin pregnancy, fetal weight or macrosomia significant, excess amniotic fluid or polyhydramnios, work long …).
Sometimes the bleeding may be due to vaginal and cervical complex fostered by a difficult delivery.
Finally, clotting disorders can accentuate a postpartum hemorrhage. These conditions may be the result of a general medical condition, congenital or acquired, or a pathology of pregnancy (such as preeclampsia complicated).
The first sign of postpartum hemorrhage is the occurrence of bleeding “vaginal” externalized in the aftermath of childbirth (by definition, up to 24 hours). This can be very important at the outset, or otherwise moderate but persistent.
This bleeding is usually quantified by the establishment of a transparent bag collection in the immediate aftermath of childbirth.
Signs are associated with the consequences of bleeding, ie a rapid pulse, decreased blood pressure, dizziness.
The postpartum hemorrhage is an emergency. Its management must not suffer any delay or diagnostic or therapeutic, and the entire team must be present and responsive.
If the bleeding does not stop, despite this support, the obstetrician will opt for a more effective drug treatment (sulprostone) always having to help the uterus to shrink and thus promote the “coagulation” physiological.
In case of persistent bleeding and according to their importance, the obstetrician may either surgically ligated vessels responsible for some bleeding (cesarean incision) or to perform interventional radiology treatment (embolization), whose goal is to obstruct some vessels of interest, using a catheter inserted in a vessel of the thigh.
Along with these treatments, a transfusion of red blood cells and / or platelets may be necessary.
The anesthetic management is also continued throughout these steps.
All preventive measures are being implemented to decrease the likelihood of postpartum hemorrhage.
First of all, during the release of the baby’s shoulder, an injection of oxytocin is often done, the “directed delivery,” designed to reduce the incidence of postpartum haemorrhage.
And in the immediate aftermath of childbirth, the patient be closely monitored for two hours in the delivery room, and to trace the faster a potential bleeding beginner.
By definition, the occurrence of postpartum hemorrhage is a stressful event. In a few seconds, childbirth which was conducted under favorable conditions becomes the theater where many actors find themselves.
The patient should as far as possible remain calm, even if the actions of caregivers can sometimes betray some precipitation.
Finally, keep in mind that the PPH must not suffer any delay or diagnostic or therapeutic.