Postpartum Complications: 
              Principles
    • The most frequent cause of 
     postpartum hemorrhage is 
     uterine atony.
    • Anything that overdistends 
     the uterus, causes it to 
     contract poorly or overworks 
     the uterus is a set-up for 
     uterine atony.
        Postpartum Complications
   Postpartum Hemorrhage
   -  Continues to be a leading cause of
       maternal morbidity and death in 
   the US
   -  Can occur with little 
      warning
    
   -  Definitions (PP lecture)
        * also include 10% drop 
          in Hct between 
          admission and
          postpartum 
   -  50% underestimation of blood loss
          Postpartum Complications
   - Most common cause (90%) is uterine 
     atony (marked hypotonia)
   - Less common causes are retained
      placenta, placenta accreta, 
      cervical/vaginal lacerations, uterine
      rupture
   -  Predisposing causes of uterine atony
       *  Multiparity   *  Hydramnios
       *  Macrosomic fetus * Traumatic birth
           *  Rapid or prolonged labor
        Postpartum Complications
     * Use of magnesium sulfate
       * Use of oxytocin
       * Multiple pregnancy
   -  Management of uterine 
      atony
      *  Manual massage of the 
   uterus
      *  Expression of clots
      *  Eliminate bladder distention
        Postpartum Complications
      * IV of lactated Ringer’s or normal 
   saline
        with 10-40 units of oxytocin added 
     
      *  Ergonovine or methyl-ergonovine 
   (IM)
         if not hypertensive