1 spirit is too nervous
Some maternal spirit in childbirth is too nervous, cause uterine contractility is not good, which is the main cause of the postpartum hemorrhage. Under normal circumstances, the placenta from the decidual layer stripping, stripping the blood sinus open, common some bleeding, but when the placenta completely stripped and expelled from the uterus bleeding, rapid reduction. However, if the maternal psychological stress and other reasons, caused by the contraction of the uterus is not good, not closed vessels, bleeding can occur. Such as maternal mental strain, the production process is too long, long, the use of sedative drugs too much, deep anesthesia, also can cause the placenta contraction weakness, bleeding. And as polyhydramnios, fetal macrosomia, multiple pregnancy at. Because of the excessive expansion of the uterus, uterine fiber excess elongation, postpartum recover fertility is not good; excessive and frequent, the uterine muscle fiber degeneration, connective tissue increased, decreased muscle fiber contraction weakness and so on, is one of the reasons causing the postpartum hemorrhage.
2 placental retention
Is one of the reasons causing bleeding. Such as the placenta, Placenta Adhesion peeling failure, can cause bleeding.
3 blood coagulation dysfunction
Maternal blood disease, severe hepatitis, the consequences are very serious, we must pay great attention to. Childbirth should to conditional hospital, so as to avoid accidents. Coagulation dysfunction as a cause of postpartum hemorrhage is rare. Such as blood diseases (thrombocytopenia, leukemia, coagulation factor VII, VIII reduced, aplastic anemia) many already exists in the pre pregnancy, pregnancy contraindication. Severe hepatitis, intrauterine fetal death stay too long, placental abruption, severe PIH and amniotic fluid embolism, can affect coagulation or caused by disseminated intravascular coagulation, blood coagulation disorder postpartum bleeding, blood coagulation is not, is not easy to stop bleeding. So, women must do prenatal care, postpartum hemorrhage history of bleeding tendency, suffering from diseases such as blood disease, hepatitis, and there have been many curettage women, should be ahead of time to wait for admission, check the blood type, blood prepared, in case in case of in childbirth. Postpartum hemorrhage is sometimes hard to estimate in advance, often happen suddenly, so do care is very important: if the bleeding caused by uterine atony, should immediately uterine massage, promote uterine contract quickly, or press the abdominal aorta, to reduce the amount of bleeding.
4 uterine atony
After delivery of fetus, the placenta from palace wall peeling and discharge, the maternal uterine wall blood sinus bleeding. Under normal circumstances due to postpartum uterine cavity volume reduced, muscle fiber contraction strengthen, interweave in the uterine wall muscle fibers within the vascular oppression hemostasis, meanwhile blood sinus closed, stop bleeding. At the same time as the maternal blood hypercoagulable state, sticky vascular injury in the placenta after endothelial collagen platelet aggregation and thrombosis, fibrin deposition in platelet thrombus, more blood clot formation, effectively blocking the uterine vascular, muscle contraction and relax when they are no longer bleeding. If the fetal childbirth uterine inertia uterine abnormal contraction and retraction, placenta if not peeling, blood Douwei open fashion without bleeding, if a partial separation of the placenta or peeling after discharge, uterine inertia can not effectively shut down the wall of the uterus placenta attachment of blood sinus due to excessive bleeding, is the main cause of the postpartum hemorrhage. Uterine inertia can be due to maternal mental strain, delivery process, excessive use of sedative, anaesthetic; abnormal head presentation or other obstructive dystocia, resulting in the production process is too long, maternal failure; maternal uterine muscle fibrous dysplasia of uterus; excessive expansion, such as twins, fetal macrosomia, polyhydramnios, make uterine flesh fiber over extension; maternal anemia, pregnancy induced hypertension syndrome or pregnancy with uterine fibroids, uterine contraction can influence.
5 soft birth canal laceration
Another important cause of postpartum hemorrhage. Uterine contraction is too strong, birth process progress too fast, the fetus is too large, often can cause the fetus undelivered cervical and (or) has a laceration of vagina. Improper protection of perineum, midwifery operation improper operation can cause perineal laceration of vagina. The incision is too small the fetus can be easily formed during severe perineal laceration, premature lateral perineal incision also can cause excessive bleeding. Perineal laceration of vagina serious can last dome, para vaginal space, even into the basin wall, deep vaginal vault located near badly torn, the hematomas can expand upward to the broad ligament.
During childbirth, the cervix has the slight laceration laceration is almost inevitable, usually shallow and no obvious hemorrhage, diagnosis of cervical laceration without. The bleeding of cervical laceration happened quickly by not to open the whole cervical in fetus, serious when can down with vaginal vault, extending up to the lower uterine segment due to massive bleeding.
6 placental factors
Placental factors of postpartum hemorrhage, including incomplete separation of placenta, placenta, placental retention after impacted, adherent placenta, placental implantation, placental and (or) and fetal membranes residue.
The main clinical manifestations of postpartum hemorrhage were vaginal bleeding too much, within 24 hours postpartum bleeding more than 500ml, secondary hemorrhagic shock and prone to infection. With the different etiology, clinical manifestations are different.
1 uterine atony
In the delivery process for uterine atony, until after delivery of fetus, but there are exceptions. Hemorrhage is characterized by placental abruption delay, without stripping the front vaginal bleeding or bleeding is not only a few, the placenta after uterine atony uterine bleeding. The outflow of blood coagulation. Failed to reduce the bleeding time, maternal bleeding hemorrhagic shock performance; pale, cold sweat, dizziness, palpitation, weak pulse and blood pressure. Check the abdomen often feel uterine outline is not clear, can not touch the palace at the end, because the uterus contraction soft without reason. Sometimes the placenta has been peeled off, but the uterine inertia can be exhausted, accumulation of blood in the uterine cavity, massage push Palace at the bottom, the product of a placenta and blood pressure.
2 soft birth canal laceration
Hemorrhage is bleeding occurred in the fetus after delivery, the postpartum uterine atony bleeding and caused by different. The soft birth canal laceration of shed blood self setting, if the laceration loss and small arteries, blood red.
3 blood coagulation dysfunction
Performance for the blood coagulation is not, is not easy to stop bleeding.
1 bleeding time
From postnatal days around January; cesarean section, uterine incision infection, necrosis, dehiscence, many in 20 days after operation, polyp placental hemorrhage can be in postpartum weeks to months;
2 bleeding patterns
Often repeated bleeding, or less profusely than, or sudden vaginal bleeding, the latter is more common in wound infection after cesarean section was made, mostly each bleeding volume in 500ml above, serious person can reach 2000 ~ 3000ml and the blood off; concurrent infection, lochia smelly, particle pollution, low heat. And check the uterine and soft, Miyaguchi Matsu, blood from the uterine cavity, or placental tissue; examination of blood, bleeding for hemoglobin and red blood cell count down, a hemorrhagic anemia; increased white blood cell count and neutrophil infection; B ultrasound examination, and blood residual tissue of uterine cavity, poor involution of uterus the wall of the uterus, or split.
3 blood, urine routine
To understand the infection and anemia. Uterine secretion culture and smear examination. To check understanding intrauterine without residue, uterine incision healing status. If intrauterine curettage or hysterectomy specimens. The main and the reproductive tract tumor bleeding phase identification. Within 24 hours postpartum bleeding volume of more than 500ml, secondary hemorrhagic shock and prone to infection.
1 rapid hemostasis
The principle is to stop bleeding quickly, correct hemorrhagic shock and infection control. To strengthen the contraction is hemostatic method in the treatment of uterine atony most quickly and effectively. Midwifery were quickly placed Palace at the bottom with a hand, thumb in the front wall, the remaining 4 fingers on the rear wall, even the palace at the end of the massage, massage the uterus begins to shrink, but also hand clenched in anterior vaginal fornix, against the anterior uterine wall, on the other hand since the abdominal wall pressing the posterior wall of the uterus, uterine body flexion, the relative pressed his hands to massage the uterus. On the other hand necessary on upper edge of pubic symphysis, pressing the middle part of the lower abdomen, the uterus pushed, massage the uterus must be emphasized Palace by hand, so that higher pelvic, rhythmical massage gently. Compression of time to return to normal uterine contraction, and can maintain the contraction inflammation, so that higher pelvic, rhythmical massage gently. Compression of time to return to normal uterine contraction, and can protect the contraction. While massaging, can slow intramuscular injection or intravenous infusion of oxytocin, followed by intramuscular or intravenous injection of ergonovine (fill with those who have heart disease). Then oxytocin in 10- glucose intravenous infusion, in order to maintain the contraction of the uterus in good condition.
2 control of infection
Through the above treatment, can cause contraction of the uterus and rapid hemostasis. If still does not work and may take the following measures:
(1) packing in uterine cavityModern obstetrics rarely used gauze packing in uterine cavity in treatment of uterine bleeding, if required for this operation should be performed as early as possible, patients often have poor effect is not good, because the uterine muscle contraction may be the very poor. Method for sterilization, patients with a hand in the abdomen fixing palace bottom, with the other hand or the oval forceps 2cm wide gauze into the uterine cavity, gauze must start at the end of an inside outside packing, should be plugged. Packing in general no longer bleeding, pregnant women after anti shock treatment, the situation can be improved gradually. If can be wrapped with gauze not cotton sewn into intestinal form instead of gauze, better. After 24 hours slow out of gauze, pulled out before the intramuscular injection of oxytocin, ergometrine and other tocolytic agents. Packing gauze in uterine cavity should be closely observed in general and blood pressure, pulse and other vital signs, pay attention to the changes of uterine fundal height, size, vigilance for packing is not tight, gauze only filled in the lower uterine segment, intrauterine bleeding continues, but no bleeding of vagina bleeding.
(2) of uterine artery ligationMassage failure or massage half an hour still can not cause contraction of the uterus restoration, can be implemented by transvaginal bilateral ascending uterine artery ligation. After disinfection and two long rat tooth clamp clamps cervical lip, gentle downward traction suture ligation of bilateral wall, with 2 gut in the vagina on both sides of upper cervical deep tissue, about 0.5cm, if ineffective, should quickly open, ascending uterine artery ligation, namely in the endocervix plane, from the cervical lateral wall 1cm at the beginning, palpation no ureter suture needle, cervical lateral wall, into the cervical tissue about 1cm, on both sides of the same treatment, if see uterine contraction is effective.
(3) the ligation of internal iliac arteryIf the above treatment is invalid, can be separated from the starting point of bilateral internal iliac artery in 7, ligation, after the ligation of uterine contraction good general visible. This method can preserve the uterus, preservation of fertility, easy to apply in cesarean section.
(4) hysterectomyVascular ligation or filling uterine cavity are still valid, should immediately subtotal hysterectomy, can not be shilly-shally and bungle rescue opportunity.
(5) repair and sutureEffective measures of hemostasis is timely and accurate repair and suture. In general, the serious cervical laceration can be split into the vault and even adjacent tissue, suspected cervical laceration should exposure of cervix in disinfection, side by side with two oval forceps clamp cervical anterior lip to the vaginal opening direction of traction, the clockwise direction gradually move the oval forceps, direct visual observation of cervical, if discover the laceration with catgut suture, the first needle should rip top slightly above the gap, the last shot should be apart from the lateral cervical end 0.5cm check, if the suture to the outer edge, may the future occurrence of cervical stenosis. Suture of vaginal laceration suturing to the bottom note, avoid leaving dead space, pay attention to the effect of a good organization and hemostatic suture. Vaginal suture process to avoid suture through the rectum. Suture taken with the blood vessel to the vertical can more effectively. Perineal laceration according to anatomic site suture muscle layer and the submucosa, the vaginal mucosa and perineal skin suture.
3 incomplete separation of placenta, retention and adhesion can be hand stripping out
Some residues can not be removed by hand, can be large curette biopsy residues. If the manual separation of placenta, feel not clear demarcation line is not attached to the finger force for separation of placenta, placenta accreta is likely, this situation should laparotomy incision cervical screening, if confirmed Zeyi purposes of hysterectomy is appropriate. The placenta in uterine constriction ring inlaid above, should use ether anesthesia, the uterine constriction ring after neurolysis, hand out the placenta when no difficulties.
4 blood coagulation dysfunction
If the early pregnancy, should be collaborative treatment in the Department of internal medicine physicians, early termination of pregnancy underwent artificial abortion. In late pregnancy, was found, should be collaborative Department of internal medicine physicians treated actively, strive for the removal of the cause or the condition improved markedly. Delivery time should be in the etiology and treatment at the same time, a little more bleeding the treatment, using drugs to improve the blood clotting mechanism, infusion of fresh blood, and actively prepare anti shock and acidosis and rescue work.