产后出血紧急措施 课件.ppt

POSTPARTUM HAEMORRHAGE STEPS TO AVOID HYSTERECTOMY
Professor & Head, Department of Obstetrics & Gynaecology, ’s Hospital Medical School, University of London
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 - Emergency that kills(5’th commonest cause – CIMD)
Anticipate - high risk cases (. twins, polyhydramnios, long labour, fibroids, APH, infection, past H/O PPH, retained tissue etc.)
Prevent - Prophylactic oxytocics (. Syntometrine, syntocinon, ergometrine, misoprostol)
Manage - promptly - 90% uterine atony - 8% trauma and 2% coagulation disorders (. Atony - Oxytocin infusion 40 units in 500ml - 80 mu/min -20 drops in a 20 drops/ml giving set)
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
Large bore IV cannulas (gauge 14 x 2)
Crystalloids
Emergency Trolley
Endotracheal tube
Laryngoscope
Essential drugs
Crystalloids, giving sets, haemacel
Emergency protocols
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
TAMPONADE TEST
Therapeutic & Prognostic
For severe PPH
Stomach balloon
Oesophageal
balloon
Condous G, Arulkumaran S .
Obstetrics & Gynecology. 2003