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Diagnosis and Emergency Management of Postpartum Hemorrhage (PPH) in a Simulated Environment SLIDE 1 Diagnosis and Emergency Management of Postpartum Hemorrhage (PPH) in a Simulated Environment Presented By Name MBBS Phase III Part I Department of Obstetrics & Gynaecology College Name Suggested image Uterus after delivery Labour room emergency team SLIDE 2 Learning Objectives At the end of this presentation, the learner should be able to: Define postpartum hemorrhage. Classify PPH. Explain the etiology using the 4 Ts. Recognize early signs of PPH. Diagnose PPH promptly. Perform emergency assessment using the ABCDE approach. Manage PPH systematically. Understand medical, mechanical, and surgical treatment. Prevent PPH using AMTSL. Demonstrate PPH management in a simulated environment. SLIDE 3 Introduction What is Postpartum Hemorrhage? Postpartum hemorrhage (PPH) is one of the most serious obstetric emergencies. It is a leading cause of maternal morbidity and mortality worldwide. Most maternal deaths occur within the first 24 hours after delivery. Early diagnosis and prompt management can save lives. Every healthcare provider involved in maternity care should be trained in PPH management. Key Message Every minute counts in postpartum hemorrhage. Suggested image Global maternal mortality infographic. SLIDE 4 Magnitude of the Problem Global Burden PPH accounts for approximately 25–30% of maternal deaths worldwide. More common in low- and middle-income countries. Most deaths are preventable. Delayed recognition and inadequate treatment are major contributors. In India PPH remains one of the leading causes of maternal mortality. Institutional deliveries and standardized emergency protocols have reduced mortality. Take-home message PPH is an obstetric emergency requiring immediate intervention. SLIDE 5 Definition of Postpartum Hemorrhage Traditional Definition Blood loss: ≥500 mL after vaginal delivery ≥1000 mL after cesarean delivery Current Clinical Definition Any blood loss sufficient to: Produce hemodynamic instability Cause signs of hypovolemia Require blood transfusion or intervention Remember Visual estimation often underestimates blood loss. Suggested image Measuring blood loss using calibrated drapes. SLIDE 6 Classification of PPH According to Time Primary PPH Occurs within 24 hours after delivery. Accounts for nearly 80% of cases. Secondary PPH Occurs 24 hours to 6 weeks postpartum. Usually due to: Retained products Infection Subinvolution of placental site According to Severity Minor 500–1000 mL Major 1000 mL Severe 2000 mL SLIDE 7 Normal Physiology of the Third Stage of Labour The third stage begins: After delivery of the baby Ends: With complete expulsion of placenta and membranes. Normal duration: Usually 5–15 minutes. Physiological events: Placental separation Uterine contraction Placental expulsion Uterine retraction Compression of uterine blood vessels Failure of these mechanisms predisposes to PPH. Suggested diagram Stages of placental separation. SLIDE 8 Mechanism of Hemostasis After Placental Delivery Following placental separation: Step 1 Powerful uterine contractions occur. ↓ Step 2 Myometrial fibers compress spiral arteries. ↓ Step 3 Blood vessels become mechanically occluded. ↓ Step 4 Coagulation system stabilizes clot formation. ↓ Result Bleeding stops. Clinical Pearl Loss of uterine tone (uterine atony) is the most common cause of PPH. SLIDE 9 Risk Factors for Postpartum Hemorrhage Maternal Factors Previous PPH Severe anemia Multiple pregnancy Polyhydramnios Grand multiparity Placenta previa Placenta accreta spectrum Hypertensive disorders Coagulation disorders Intrapartum Factors Prolonged labour Precipitate labour Instrumental delivery Cesarean section Induction of labour Oxytocin augmentation Chorioamnionitis Important Point PPH can occur even without identifiable risk factors. SLIDE 10 Etiology of PPH – The 4 Ts Nearly all cases of postpartum hemorrhage can be explained using the 4 Ts. Cause Percentage Tone (uterine atony) ~70% Trauma ~20% Tissue ~10% Thrombin <5% The 4 Ts 🟥 Tone – Uterine atony 🟦 Trauma – Genital tract injury 🟩 Tissue – Retained placenta/products 🟨 Thrombin – Coagulation disorders Management always begins by identifying which "T" is responsible.

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