Peripartum hemorrhage
| Classification according to ICD-10 | |
|---|---|
| O45 | Premature placenta detachment |
| O46 | Antepartum haemorrhage, not elsewhere classified |
| O44.1 | Placenta previa with bleeding |
| ICD-10 online (WHO version 2019) | |
Peripartal hemorrhage (also peripartum hemorrhage, PPH for short) is bleeding in late pregnancy (peripartum: "around the birth "). It is a heavy bleeding, which must be distinguished from the normal " drawing bleeding" (normal small bleeding at the beginning of the birth). Fatal complications are very rare in Europe. The most common causes of bleeding are the lack of contraction of the uterus after birth ( uterine atony ), the placenta previa (the placenta is embedded near the cervix and covers the birth canal completely or partially) and premature placental detachment .
Epidemiology
In a French study, the mean blood loss after vaginal delivery was 228 ml. Severe bleeding after delivery occurred in 2.7% of vaginal deliveries.
Risk factors
An early recording ( anamnesis ) of the risk factors (familial bleeding tendency, own increased bleeding tendency , medication intake , previous caesarean section or previous scraping of the uterus ( curettage )) allows the initiation of precautionary measures (therapy).
Finding
Using diagnostic ultrasound and Herztonwehenschreibung ( cardiotocography , CTG) statements can be made about the child's condition, and must be documented by ultrasound, where the placenta is located and whether there is an accumulation of blood, blood collections in the birth canal are also available with a speculum clearly visible. With signs of blood loss, the mother herself can have symptoms of shock development, such as paleness, cold sweat, restlessness, heart rate> 100 / min, blood pressure <100/70 mmHg. Urine production is monitored with an indwelling catheter and should be 60 ml / h.
diagnosis
- Uterine atonia,
- Placenta previa,
- premature placenta detachment,
- birth trauma injury,
- Coagulation disorders,
- placental disorders.
therapy
If risk factors are present, care should be given in a center with appropriate equipment, that would be in a maternity clinic with an attached intensive care unit for adults, an intensive care unit for newborns and a blood bank. Early treatment of the cause of the bleeding, adequate volume therapy, administration of red cell concentrates and adequate replacement of fibrinogen are important.
pathology
Uterine atony is an inability of the uterus to compress and, at 75%, the main reason for peripartum bleeding. A placenta previa is a common Einnistungsstörung the placenta (1: 200 of all pregnancies), with partial or complete coverage of the internal os (which then becomes the birth canal) with placental tissue, vascular injury and bleeding can result from this. Premature placental detachment, i.e. before birth, with possible bleeding between the uterus and placenta, can also result in an insufficient supply of the fetus (including oxygen and nutrients) and result in blood loss for the mother, which, depending on the extent, can be associated with complications.
literature
- S2k guideline peripartum hemorrhage, diagnosis and therapy of the DGGG, OEGGG and SGGG. In: AWMF online (as of March 2016)
- G. Putz: Peripartum Hemorrhage - Causes and Emergency Measures. In: Austrian midwife newspaper. 1/04. (on-line)
- S. Hofer et al.: Bleeding during pregnancy. In: The anesthesiologist. Springer Berlin / Heidelberg, 2007, ISSN 0003-2417 . (on-line)
- Gynecological Clinic of the University of Erlangen: intensive advanced training in "obstetric medicine", peripartum bleeding. pdf .
- F. Kainer et al.: Obstetrics emergencies - peripartum bleeding. In: Dtsch Arztebl. 2008; 105 (37), pp. 629-637. (on-line)
Individual evidence
- ↑ Loïc Sentilhes, Norbert Winer, Elie Azriafor and others for the "Groupe de Recherche en Obstétrique et Gynécologie": Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. In: The New England Journal of Medicine . tape 379 , 2018, p. 731-742 , doi : 10.1056 / NEJMoa1800942 .
