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1、JinyingYangObstetric&GynecologyDepartmentPostpartumHemorrhageDefinition:Bloodlossinexcessofvaginalbirth≥500mlcesareanbirth≥1000mlwithinthefirst24hoursofdeliverySeriousandcommonintrapartumcomplicationThemostsignificantcauseofmaternaldeathworldwidemortality（worldwide）:140000peryear(1maternaldeathev
2、ery4minutes)mortality（China）:8.0/100000,thefirstreason(27.1%)ofmaternaldeathIncidence:4–6%ofpregnanciesActualincidence:morehigherbecauseofinaccurate,significantunderreportingPrimaryPPHOccurringwithinthefirst24hoursofdelivery4–6%ofpregnanciesCausedbyuterineatonyin80%ormoreofcasesSecondaryPPHOccurr
3、ingbetween24hoursand6–12weekspostpartum1%ofpregnancies4“T”Tone:uterineatonyTissue:retainedplacentaTrauma:vaginal,cervical,oruterineinjuryThrombin:coagulopathy(pre-existingoracquired)——SOGCguideline(number235,October2009):ActiveManagementoftheThirdStageofLabor:PreventionandTreatmentofPostpartumHem
4、orrhage.ThemostcommonandimportantcauseofPPHTheprimaryprotectivemechanismforimmediatehemostasisafterdelivery:Myometrialcontractioncausingocclusionofuterinebloodvessels——livingligaturesoftheuterusBloodflowfromthevascularspacetotheuterinecavityviathemyometriumisimpededEtiologiccategoryandprocessHigh
5、riskfactorsOverdistensionofuterusPolyhydramnios,Multiplegestation,MacrosomiaUterinemuscleexhaustionRapidlabor,Prolongedlabor,Highparity,OxytocinuseIntra-amnioticinfectionFever,ProlongedruptureofmembranesFunctional/anatomicdistortionofuterusFibroids,Adenomyosis,Placentaprevia,UterineanomaliesUteri
6、ne-relaxingmedicationsHalogenatedanesthetics,NitroglycerinBladderdistensionPlacentaabruption胎儿子宫内膜胎盘脐带宫颈出血PlacentapreviaTwinpregnancy胎儿胎儿胎盘宫颈脐带脐带阴道fibroid肌壁间肌瘤浆膜下肌瘤内膜下肌瘤带蒂浆膜下肌瘤带蒂内膜下肌瘤UterineanomaliesCaseApatientwaspregnancywithtwinsandhadplacentaprevia.At36w,shewakedupwithastarttofindherselflying
7、inpoolofblood.EmergenctCSwasdone.Inoperation,uterineatonyoccurredandwasn’tcorrectedbyutrotonicdrugs.Finallythebleedingwasceasedbyusinguterinetampon.Thenextday,thepatientbledagainwhentamponwasextracting.Soextractionwass
