POST-PARTUM HEMORRHAGE

POST-PARTUM HEMORRHAGE Post-Partum Hemorrhage Uterine fatigue (e.g. prolonged/induced labor, rapid labor, grand multiparity) Overdistension of uterus (e.g. multiple gestation, polyhydramnios, fetal macrosomia) Bladder distension Uterine infection (e.g. chorioamnionitis) Functional/anatomic distortion of uterus Drugs - Uterine relaxants (e.g. nifedipine, magnesium sulfate, NSAIDs) Blood Loss: >500mL post vaginal delivery OR >1000mL post Caesarean section Uterine Atony (70%) Trauma (20%) Remnant Tissue (10%) Thrombin (1%) Perineal laceration (e.g. episiotomy) Vaginal laceration/ hematoma Cervical laceration (e.g. forceps/vacuum delivery) Uterine rupture Uterine inversion Retained blood clots Retained cotyledon or succenturiate lobe Abnormal placentation (placenta accreta, increta, or percreta) Thrombocytopenia Idiopathic thrombocytopenic purpura (ITP) Thrombotic thrombocytopenic purpura (TTP) HELLP syndrome Disseminated intravascular coagulation (DIC) Anti-coagulation agents (e.g. heparin) Pre-existing coagulopathy (e.g. von Willebrand's disease, Hemophilia A)