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Video transcript

postpartum hemorrhage it's as scary as the name sound and it is always an emergency and unfortunately it's not an uncommon one because postpartum hemorrhage is one of the top three causes of maternal mortality and it is the absolute most common reason that postpartum women are admitted to ICU or intensive care units and you guys probably want a definition of postpartum hemorrhage and I wish I could give you a simple clear-cut definition but people have been struggling with coming up with one for a really long time there's what I think is the best definition that that postpartum hemorrhage is any significant amount of blood loss that occurs after delivery that makes the woman symptomatic so an amount of blood loss that makes the woman feel fatigued or or lightheaded or confused and sweaty or perhaps makes her look pale or a significant amount of blood loss that results in signs of low blood volume so signs such as low blood pressure or rapid heart rate or perhaps decreased urine production so that's what I think is the best sort of definition of postpartum hemorrhage any significant amount of blood loss that either results in symptoms or in signs of low blood volume and then there's the most common definition that postpartum hemorrhage is a blood loss of more than 500 milliliters so more than 500 milliliters after a vaginal delivery 500 million use after a vaginal delivery and more than a thousand milliliters with a c-section but this isn't the best way really to define things since practitioners tend to underestimate the amount of blood loss and actual studies have shown that and then finally there's a definition that postpartum hemorrhage is anything that results in more than a ten percent fall in hemoglobin concentration and hemoglobin is a lab measure of the amount of red blood cells that you have in the in the body and this definition is is even more problematic because it takes time for the blood loss to be reflected in lab values and that time could delay treatment all right so hopefully that convinces you that this whole area of defining what post Partin hemorrhage is need some work well let's step away from that and let's talk about what causes postpartum hemorrhage so first remember that after the delivery of the baby the placenta separates from the uterus and yeah that leaves these vessels that supply the placenta broken and ruptured but the myometrium so the muscular layer of the uterine wall contracts and and constricts these blood vessels to stop the bleeding and the reason why that works is because of the way that the muscle fibers of the uterus are arranged and in kind of a crisscross pattern around the blood vessels so so if these are the muscle fibers of the uterus they're there they're arranged as kind of a lattice around the blood vessels so that so that when the muscle fibers contract they actually clamp down on the blood vessel to stop the bleeding and after that happens the coagulation pathways activate and they form a clot at the site at which the placenta was initially attached okay so if you understand all of that hopefully you'll understand that any disturbance and any one of those events will lead to a postpartum hemorrhage or an excessive bleeding after the delivery of the baby so so for example you can have a problem with the uterus not contracting well enough which is called uterine atony right so uterine atony or the a stands for lack of so lack of tone in the uterus right and you'll actually feel a floppy sort of limp uterus in that case and there are a few different things that can cause uterine atony to occur so if the uterus is over distended for some reason either from having multiple fetuses inside it so if a woman is having twins or triplets or quadruplets or if if the uterus has one baby but that one baby is larger than normal or perhaps if there's too much amniotic fluid inside the uterus so any cause of over distension of the uterus can lead to acne or the acne could result from using uterine relaxing agents or even from uterine fatigue from having really long labor so acne is is one cause of postpartum hemorrhage and actually the most common cause of postpartum hemorrhage now if you feel the uterus and the uterus feels really firm and well contracted then we have to consider another cause right so what are some of the other causes of postpartum hemorrhage well postpartum hemorrhage could also be the result of a coagulopathy so it could be the result of a coagulopathy which is which is a term that we used to describe any sort of problem with the with the clotting cascade and you can have problems with the clotting cascade as a result of acquired or even inherited clotting factor deficiency so you could have too few clotting factors circulating in the blood and there are even certain drugs that can affect coagulation that can make it that can impair coagulation now if none of those causes are present so if there's no uterine atony and there's no quag you lop ëthey it's really important to consider trauma or perhaps even lacerations that occur during the delivery so you need to do a vaginal exam at that point to see if any of those causes are present now as far as treatment goes postpartum hemorrhage isn't treated much differently from other causes of hemorrhage if uterine atony is the cause of the hemorrhage we usually try first a uterine massage and we'll usually add on a uterotonic agent oil an agent that helps the uterus contract to help the mind metrium contract and clamp down and and stop the bleeding and if coagulation defects are our to blame that's treated with usually a transfusion of blood products containing the the factors that are deficient in the patient's blood and traumatic bleeding lesions are usually treated surgically but again with all of these different causes you can't forget how you first and foremost treat a hemorrhage and that is with repletion of blood volume so that's always very important alright so that is postpartum hemorrhage in a nutshell