Obstetric hemorrhage in the cause of maternal mortality. Tactics of GPs. New approaches in the field of maternal and child health

Obstetric hemorrhage in the Obstetric hemorrhage in the cause of maternal mortality. ? cause of maternal mortality. ?

Tactics of GPs.Tactics of GPs.

New approaches in the field of New approaches in the field of maternal and child healthmaternal and child health

Current Approach to Reduction of Current Approach to Reduction of Maternal MortalityMaternal Mortality

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"The ability of women to have a safe "The ability of women to have a safe and healthy pregnancy and and healthy pregnancy and

delivery"delivery"

What is Safe Motherhood?What is Safe Motherhood?


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Health Mother: Scale ProblemsHealth Mother: Scale Problems

180-200 million pregnancies a year180-200 million pregnancies a year 87 million unwanted pregnancies87 million unwanted pregnancies 46 million abortions46 million abortions 18 million illegal abortions18 million illegal abortions 529.000 maternal mortality (1 minute)529.000 maternal mortality (1 minute) One maternal death = 30 maternal diseasesOne maternal death = 30 maternal diseases


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Newborn health: Scale Newborn health: Scale ProblemsProblems

4 million neonatal deaths (within 28 days 4 million neonatal deaths (within 28 days after birth)after birth)

3.3 million stillbirths3.3 million stillbirths


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Maternal mortality -Maternal mortality -

the number of deaths of pregnant women the number of deaths of pregnant women with the beginning of pregnancy, with the beginning of pregnancy, childbirth and postpartum women within childbirth and postpartum women within 42 days after birth per 100,000 live births.42 days after birth per 100,000 live births.


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Каждую минуту...

Hours of maternal mortalityHours of maternal mortality 380 pregnant women380 pregnant women 190 women faced with 190 women faced with

an unplanned and an unplanned and unwanted pregnancyunwanted pregnancy

110 women going 110 women going through complications of through complications of pregnancypregnancy

40 Women make illegal 40 Women make illegal abortionabortion

1 woman dies from 1 woman dies from complications of complications of pregnancypregnancy


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Maternal Mortality: A Global Maternal Mortality: A Global TragedyTragedy

529.000 women die 529.000 women die each year from each year from complications of complications of pregnancypregnancy

99% in developing 99% in developing countriescountries

~ 1% in developed ~ 1% in developed countries countries

Страны Показатель МС

Страны Показатель МС

Дания 8 Армения 51

Новергия 14 Азербайджан 123

Швеция 4 Казахстан 155

Италия 10 Кыргызстан 113

Австрия 4 Таджикистан 186

Франция 22 Туркменистан 128

Германия 11 Украина 39

Швейцария 6 Грузия 89

Канада 7 Россия 64

Бельгия 10 Uzbekistan

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The maternal mortality rate in the world


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Global cause of maternal Global cause of maternal mortalitymortality

7,9

12,9

6,9 12,9

14,9

19,8 24

Кровотечение 24,%

Инфекция 14,9%

Эклампсия 12,9%

Затяжные роды 6,9%

Криминальный аборт12,9%

Другие прямые причины7,9%

Косвенные причины 19,8


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The decrease in MSThe decrease in MS

The most striking example of success - The most striking example of success - antenatal careantenatal care

For optimum safety, every woman should For optimum safety, every woman should receive professional expert helpreceive professional expert help

Improving skilled attendance at delivery - a Improving skilled attendance at delivery - a period when there is a majority of MS.period when there is a majority of MS.


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Making Pregnancy SaferMaking Pregnancy Safer

Providing good antenatal careProviding good antenatal care Prevention and treatment of the Prevention and treatment of the

consequences of an unwanted consequences of an unwanted pregnancypregnancy

Improving care for pregnantImproving care for pregnant


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But WHY these women are But WHY these women are dying?dying? Late decision to seek helpLate decision to seek help Lack of understanding of complicationsLack of understanding of complications Acceptability of maternal mortalityAcceptability of maternal mortality Low status of womenLow status of women Socio-cultural barriers to getting helpSocio-cultural barriers to getting help Later assistanceLater assistance Mountains, islands, rivers - the imperfect organization of Mountains, islands, rivers - the imperfect organization of

transportationtransportation Later assistanceLater assistance Resources, personnelResources, personnel Poorly trained staff under the system of blameworthinessPoorly trained staff under the system of blameworthiness financial difficultiesfinancial difficulties


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Services for maternal healthServices for maternal health

High-quality services for maternal health High-quality services for maternal health care is not always available.care is not always available.

> 35% do not receive prenatal care> 35% do not receive prenatal care ~ 50% of births take place without the ~ 50% of births take place without the

help of qualified health workershelp of qualified health workers ~ 70% did not receive post-natal care in ~ 70% did not receive post-natal care in

the first 6 weeks after birththe first 6 weeks after birth


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Obstetric Pathology:Obstetric Pathology:

Premature detachment of normally Premature detachment of normally situated placenta situated placenta

placenta previaplacenta previaHypo-and metroparalysisHypo-and metroparalysisuterine ruptureuterine rupturePathology of placental attachmentPathology of placental attachmentDICDIC


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In case of emergencyIn case of emergency

Call for helpCall for help Stay calm and focus their attention on the Stay calm and focus their attention on the

womanwoman Leave the woman aloneLeave the woman alone Inform the skilled attendantInform the skilled attendant Give instructions to prepare the necessary Give instructions to prepare the necessary

material and equipmentmaterial and equipment Spend a rapid screening: blood pressure, pulse, Spend a rapid screening: blood pressure, pulse,

respiration, body temperature, skin color, blood respiration, body temperature, skin color, blood lossloss


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Premature detachment of Premature detachment of normally situated placentanormally situated placenta Endometrial vascular pathologyEndometrial vascular pathology

EGD: hypertension, diabetes, renal disease, and EGD: hypertension, diabetes, renal disease, and CVSCVS

hypertensive disordershypertensive disorders Total blood loss - 600-2500ml.Total blood loss - 600-2500ml. Blood loss is composed of three parts:Blood loss is composed of three parts: external bleedingexternal bleeding Retroplacental hematoma (500-1500ml)Retroplacental hematoma (500-1500ml) Internal bleeding due to sequestration and Internal bleeding due to sequestration and

deposition of blooddeposition of blood


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Premature detachment of Premature detachment of normally situated normally situated placentaplacenta

Tension (hypertonia) of the uterusTension (hypertonia) of the uterus uterine tendernessuterine tenderness The absence of fetal movements or weak The absence of fetal movements or weak

perturbationperturbation The presence of bleeding from the genital The presence of bleeding from the genital

tract may no bleedingtract may no bleeding shockshock


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Premature detachment of normally Premature detachment of normally situated placenta(PDNSP)situated placenta(PDNSP) activityactivity Determine the severity of the general condition of Determine the severity of the general condition of

the patient: heart rate, respiration, blood pressure, the patient: heart rate, respiration, blood pressure, shock index of Algovershock index of Algover

Obstetric clarify the situation: the pregnancy, labor, Obstetric clarify the situation: the pregnancy, labor, nature of painnature of pain

Identify the change in the shape of the uterus, Identify the change in the shape of the uterus, tone, local pain, bleedingtone, local pain, bleeding

Status of the fetus (with \ b, stir)Status of the fetus (with \ b, stir)


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Emergency transportation to the nearest rod.dom:Emergency transportation to the nearest rod.dom: Inhalation of oxygen!Inhalation of oxygen! Establish a system for in / infusion in two veinsEstablish a system for in / infusion in two veins Start jetting saline infusion at a rate of 1 liter. for 15-20 Start jetting saline infusion at a rate of 1 liter. for 15-20

minutes. - To restore the VCB.minutes. - To restore the VCB. In the first hour pour at least 2 liters. liquid.In the first hour pour at least 2 liters. liquid.


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Placenta praevia - PPPlacenta praevia - PP

centralcentral

Partial (side and edge)Partial (side and edge)

PP occurs in multiparous women with a PP occurs in multiparous women with a history to:history to:

- Frequent abortions- Frequent abortions

- Scraping the uterine cavity- Scraping the uterine cavity

- After the abortion and postpartum - After the abortion and postpartum septic diseasesseptic diseases


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placenta previaplacenta previa

Indirect signs: High standing of the presenting part of the

fetus Malposition Symptom "pastosity" Blood loss - 1000-2000 ml Bleeding appeared at night or during sleep Bleeding after sexual intercourse appeared The uterus is a relaxed Fetal heart rate is normal shock


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Placenta praevia: activitiesPlacenta praevia: activities

Determine the severity of the general condition Determine the severity of the general condition of the patient: heart rate, respiration, blood of the patient: heart rate, respiration, blood pressure, shock index Algoverapressure, shock index Algovera

Obstetric clarify the situation: the pregnancy, Obstetric clarify the situation: the pregnancy, labor, nature of painlabor, nature of pain

Identify the change in the shape of the uterus, Identify the change in the shape of the uterus, tone, local pain, bleedingtone, local pain, bleeding

Status of the fetus (heartbeat , stir)Status of the fetus (heartbeat , stir)


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Placenta praevia: activitiesPlacenta praevia: activities


minutes. - To restore the BCC.minutes. - To restore the BCC. In the first hour pour at least 2 liters. liquid.In the first hour pour at least 2 liters. liquid. Vaginal examination and inspection of the mirrors are Vaginal examination and inspection of the mirrors are

shown only in the expanded operatingshown only in the expanded operating


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Bleeding in third stage of Bleeding in third stage of laborlaborTight attachment of the placenta or the Tight attachment of the placenta or the

incrementincrementInfringement of the placenta at the internal Infringement of the placenta at the internal

cervical oscervical osSoft birth canal injury:Soft birth canal injury: uterine ruptureuterine rupture tearing the vagina and cervixtearing the vagina and cervix gap vulvagap vulva rupture of the perineumrupture of the perineum


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Bleeding in third stage of Bleeding in third stage of labor: activitieslabor: activities


minutes. - To restore the VCB.minutes. - To restore the VCB. In the first hour pour at least 2 liters. liquid.In the first hour pour at least 2 liters. liquid.


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After the placenta is necessary to After the placenta is necessary to remember the rule of "Four T", ie the four remember the rule of "Four T", ie the four causes of bleeding:causes of bleeding:

Tone, ie decrease uterine toneTone, ie decrease uterine tone Injury, ie soft birth canal injuryInjury, ie soft birth canal injury Tissue, ie remnants of the placenta in the Tissue, ie remnants of the placenta in the

uterusuterus - Thrombin, ie violation of the blood - Thrombin, ie violation of the blood

coagulation systemcoagulation system


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Hypo- and metroparalysisHypo- and metroparalysis

ChastorozhavschieChastorozhavschie large fruitlarge fruit prolonged pregnancyprolonged pregnancy Prolonged and rapid deliveryProlonged and rapid delivery PDNSPPDNSP hypertensive disordershypertensive disorders EGDEGD Retained placenta in the uterusRetained placenta in the uterus Blood loss - 2500.0 ml.Blood loss - 2500.0 ml.


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Hypo- and metroparalysis: Hypo- and metroparalysis: activitiesactivities

Call for help more staffCall for help more staff Empty the bladder, if Empty the bladder, if

necessary, use a urinary necessary, use a urinary cathetercatheter

Establish a system for in / Establish a system for in / infusionsinfusions

Begin implementation of Begin implementation of infusion solution with the infusion solution with the addition of 20 units of addition of 20 units of oxytocin at 60 drops per oxytocin at 60 drops per minuteminute

Post-handed massage of the Post-handed massage of the uterus, in / m enter 10 IU uterus, in / m enter 10 IU oxytocin.oxytocin.

Every 15 minutes to measure Every 15 minutes to measure blood pressure, pulseblood pressure, pulse


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Hypo- and metroparalysisHypo- and metroparalysis

With continuous bleeding:With continuous bleeding:Emergency transportation to Emergency transportation to

your nearest rod.domyour nearest rod.dom inhalation of oxygeninhalation of oxygenContinue in / infusion solution Continue in / infusion solution

oxytocin 20 IU / L at 30 drops oxytocin 20 IU / L at 30 drops per minute.per minute.

During transport to conduct During transport to conduct the pressing abdominal aortic the pressing abdominal aortic punch.punch.


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Uterine rupture (Frequency Uterine rupture (Frequency of 1:5000 births)of 1:5000 births)

Classification:Classification:1. By pathogenic features:1. By pathogenic features:Spontaneous (mechanical, gistopatichesky, Spontaneous (mechanical, gistopatichesky,

combined)combined)violentviolent2. The clinical course:2. The clinical course:threateningthreateningstartedstartedaccomplishedaccomplished3. By the nature of damage:3. By the nature of damage:crackcrackincompleteincompletefullfull


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Uterine ruptureUterine rupture vaginal bleeding or signs of intra-abdominal haemorrhagevaginal bleeding or signs of intra-abdominal haemorrhage severe abdominal painsevere abdominal pain sudden decrease in the same painsudden decrease in the same pain

OBJECTIVE:OBJECTIVE: shock: tachycardia - more than 100 beats / min, shock: tachycardia - more than 100 beats / min,

hypotension - blood pressure less than 90 mm. Hg.hypotension - blood pressure less than 90 mm. Hg. Bloating, free fluid in the abdominal cavityBloating, free fluid in the abdominal cavity Abnormal uterine contoursAbnormal uterine contours abdominal tendernessabdominal tenderness Palpation of fetal parts separate from the uterusPalpation of fetal parts separate from the uterus The absence of fetal heartThe absence of fetal heart


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Uterine rupture: activitiesUterine rupture: activities

Emergency transportation to the nearest Emergency transportation to the nearest rod.dom:rod.dom:

Inhalation of oxygen.Inhalation of oxygen. Establish a system for in / infusion in two veinsEstablish a system for in / infusion in two veins Start jetting saline infusion at a rate of 1 liter. Start jetting saline infusion at a rate of 1 liter.

for 15-20 minutes. - To restore the VCB.for 15-20 minutes. - To restore the VCB. In the first hour pour at least 2 liters. liquid.In the first hour pour at least 2 liters. liquid.


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Delay or defect of the Delay or defect of the placentaplacenta

Empty the bladder.Empty the bladder. If the vagina determined placenta If the vagina determined placenta

or placental fragments remove or placental fragments remove the sterile gloves.the sterile gloves.

If the placenta does not come off If the placenta does not come off or you can not determine the type or you can not determine the type oxytocin 10 IU / moxytocin 10 IU / m

If the placenta does not come off If the placenta does not come off in 30 minutes. after in 30 minutes. after administration of oxytocin, but the administration of oxytocin, but the uterus cut, run controlled uterus cut, run controlled stretching of the cord.stretching of the cord.

If these measures were not If these measures were not effective:effective:


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Delay or defect of the Delay or defect of the placentaplacenta

Emergency transportation to Emergency transportation to the nearest rod.dom for the nearest rod.dom for manual removal of placenta manual removal of placenta and allocation:and allocation:

Inhalation of oxygen!Inhalation of oxygen! Establish a system for in / Establish a system for in /

infusion in two veinsinfusion in two veins Start jetting saline infusion at Start jetting saline infusion at

a rate of 1 liter. for 15-20 a rate of 1 liter. for 15-20 minutes. - To restore the minutes. - To restore the BCC.BCC.

In the first hour pour at least 2 In the first hour pour at least 2 liters. liquid.liters. liquid.


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DICDIC

In hemorrhagic shockIn hemorrhagic shock When bacterial and toxic shockWhen bacterial and toxic shock In traumatic shock.In traumatic shock. 4 main stages:4 main stages: 1 - hypercoagulation1 - hypercoagulation 2 - without generalized activation of 2 - without generalized activation of

fibrinolysis (anticoagulation)fibrinolysis (anticoagulation) 3 - generalized fibrinolysis3 - generalized fibrinolysis 4 - uncomplete blood clotting4 - uncomplete blood clotting

Documents

Obstetric hemorrhage in the cause of maternal mortality. Tactics of GPs. New approaches in the field of maternal and child health