6.4 POST PARTUM COMPLICATIONS

1. POST PARTUM HAEMORRHAGE (PPH)

It is a blood loss of 500mls or more from the reproductive organs after delivery, or any amount sufficient enough to cause symptoms. Any amount of bleeding can cause shock in a woman who is unready anaemic.

• Primary PPH – it is the blood loss that occurs during the 3rd stage of labour and within the first 24hours of delivery.

• Secondary PPH – it is the excessive bleeding which occurs after 24hours and within the 6 weeks of delivery. Commonly caused by infection.

Causes

1. Uterine inertia (atony) 

2. Retained placenta or fragment of membranes 

3. Ruptured uterus.

4. Uterine inversion 

5. Disseminated intravascular coagulopathy (DIC) 

Signs

1. There is uterine atony

2. Heavy bleeding occurs few minutes after delivery

3. The blood gushes out

4. The uterus is big and soft

5. The uterus rises above the umbilicus

6. There is low BP (systolic of less than 90mmHg), weak and rapid pulse (above 110/min.)

7. The skin is cold and clammy

8. There will be shock or fainting

9. Rapid breathing (greater than 30/min.)

10. Scanty urine less than 30mls/hr.

Risk factors 

1. Over distended uterus e.g. in twins, big baby, polyhydramnious.

2. Prolonged labour.

3. Severe pre eclampsia/eclampsia.

4. Prolonged labour.

5. APH - it weakens the uterus.

6. Anaemia.

7. General anesthesia.

Prevention of PPH

1. Prevent prolong labour (use partogrph).

2. Practice active management of third stage of labour.

3. Avoid perineal/vaginal tear.

4. Monitor woman closely after childbirth.

5. Ensure that you are prepared for any emergency.

1. PUERPERAL SEPSIS

It is a bacterial infection originating in the reproductive tract during labour or the puerperium.

Signs and symptoms

1. Fever

2. Tachycardia

3. Offensive vaginal discharge

4. Bulky uterus

5. Lower abdominal pains

6. Chills and rigors.