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Perdarahan obstetrik(1)

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Text of Perdarahan obstetrik(1)

  • Perdarahan ObstetrikDwi Nurriana

  • INTRODUCTIONOBSTERICS IS BLOODY BUSINESSUS : 17% DIRECT CAUSE OF MATERNAL DEATHSUK: MAJOR FACTOR FOR MATERNAL DEATHSDEVELOPING COUNTRIES : ALMOST HALF OF POSTPARTUM DEATHS.

  • CAUSES AND PREDISPOSING FACTORSABNORMAL PLACENTATIONTRAUMA DURING LABOUR AND DELIVERYSMALL MATERNAL BLOOD VOLUMEUTERINE ATONYCOAGULATION DEFECTS- INTENSIFY OTHER CAUSESOTHER FACTORS

  • ANTEPARTUMPOSTPARTUMTRIMESTER 1TRIMESTER 2TRIMESTER 3POSTPARTUM

  • TRIMESTER 1THREATENED ABORTIONHYDATIDIFORM MOLEBLIGHTED OVUMDEATH CONCEPTUSECTOPIC PREGNANCY

  • TRIMESTER 2THREATENED ABORTIONECTOPIC PREGNANCYDEATH CONCEPTUS

  • TRIMESTER 3PLACENTA PREVIAPLACENTAL ABRUPTIONVASA PREVIAUTERINE RUPTURE

  • POSTPARTUMUTERINE ATONYREST OF PLACENTAELACERATIONCOAGULOPATHYUTERINE INVERSIONUTERINE RUPTURE

  • ObjectivesDefinitionEtiologyRisk FactorsPreventionManagement

    Postpartum Hemorrhage

  • Chart9

    0.15

    0.0166666667

    -0.14

    -0.1535714286

    -0.09375

    -0.59

    2litre PPH

    PPH on bed and floor 2000ml

    ACCURACY (2)

    stained sanitarysoaked sanitary50cm clot75cm clot100cm clotincopadkidney dishbed pan1litre PPH2litre PPHsmall swablarge swab

    actual vol30100500100015002505001001000200060350

    anaesthetist196%122%54%43%64%136%177%257%130%115%93%61%121%

    obstetrician151%114%62%48%51%103%165%253%112%102%99%53%109%

    gynae nurse156%118%79%37%65%97%140%143%109%86%91%61%98%

    midwife202%139%49%41%47%97%120%203%109%85%118%68%106%

    theatre nurse158%218%60%54%62%143%189%239%115%91%169%110%134%

    HCA83%94%46%39%40%68%74%190%79%41%193%49%83%

    mean of all specialty158%134%58%44%55%107%144%214%109%86%127%67%

    sd43%44%12%6%10%28%42%44%17%25%44%22%

    96%22%-46%-57%-36%36%77%157%30%15%-7%-39%

    51%14%-38%-52%-49%3%65%153%12%2%-1%-47%

    56%18%-21%-63%-35%-3%40%43%9%-14%-9%-39%

    102%39%-51%-59%-53%-3%20%103%9%-15%18%-32%

    58%118%-41%-46%-38%43%89%139%15%-9%69%10%

    -17%-6%-54%-61%-60%-32%-26%90%-21%-59%93%-51%

    ACCURACY (2)

    000000

    000000

    000000

    000000

    000000

    000000

    000000

    000000

    000000

    000000

    000000

    000000

    anaesthetist

    obstetrician

    gynae nurse

    midwife

    theatre staff

    HCA

    small swab

    0

    0

    0

    0

    0

    0

    2litre PPH

    abdo pack

    0

    0

    0

    0

    0

    0

    stained sanitary towel

    kidney 500ml

    kidney 500ml

    0.9259259259

    0.9861111111

    0.9090909091

    1.1785714286

    1.6875

    1.9333333333

    half soaked towel

    abdo pack 350mlanaestheticsobstetricsgynae nursemidwifetheatre nurseHCA

    350350350350350350

    8040757570100

    906010010080100

    15060100100175175

    20070120100200175

    20080120100200300

    20090200100200

    300100200100300

    300100250100300

    400100250100350

    100450120500

    130500120750

    1501501500

    150150

    200200

    200200

    200200

    250200

    250200

    250200

    300200

    400200

    400200

    400200

    400200

    200

    200

    220

    250

    250

    250

    250

    250

    250

    300

    300

    400

    400

    400

    400

    450

    750

    850

    half soaked towel

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    abdo pack = 350ml

    75cm clot 1litre

    0.6095238095

    0.5333333333

    0.6142857143

    0.6792517007

    1.1011904762

    0.4857142857

    abdo pack

    100cm clot 1.5litres

    kidney dish 500mlanaestheticsobstetricsgynae nursemidwifetheatre nurseHCA

    500500500500500500

    5001002505025050

    700250300200500150

    750300500200500450

    800300500250600600

    900400500300600600

    900400650300625

    10005401000350700

    12006001000350800

    120065010003501500

    70010004001500

    75010004001500

    8004002250

    850400

    1000400

    1000400

    1000450

    1000450

    1000500

    1000550

    1000550

    1120550

    1200600

    1800600

    2000600

    650

    680

    700

    750

    800

    800

    800

    800

    850

    850

    900

    900

    950

    1000

    1000

    1000

    1000

    1150

    100cm clot 1.5litres

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    kidney dish = 500 ml

    soaked sanitary towel

    1.7666666667

    1.6466666667

    1.4

    1.199047619

    1.8875

    0.74

    Kidney Dish

    incopad

    1/2 soaked sanitary 30mlanaestheticsobstetricsgynae nursemidwifetheatre nurseHCA

    303030303030

    20530101510

    30840101520

    401040202030

    401550202030

    501550202035

    5020502020

    5020502020

    10020502530

    15020502540

    20503070

    205530100

    2530200

    2730

    3030

    3030

    3030

    4030

    5035

    5040

    5050

    5050

    8050

    15050

    0.11%30050

    0.13%50

    0.09%50

    0.19%50

    0.08%50

    0.40%60

    75

    75

    100

    100

    100

    100

    100

    100

    100

    150

    150

    200

    200

    303030303030

    58.945.246.860.647.525.047.3

    40.862.07.247.354.610.037.0

    196%151%156%202%158%83%158%

    incopad

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    000000000000000000000000000000000000000000

    moderatetely soaked sanitary towel = 30 ml

    1 litre PPH

    040.7567308688

    062.0455507053

    07.1668428449

    047.2693679617

    054.5852127828

    010

    2 litre PPH

    1.962962963

    1.5069444444

    1.5606060606

    2.0198412698

    1.5833333333

    0.8333333333

    sanitary towel

    ACCURACY

    75cm clot 1 litreanaestheticsobstetricsgynae nursemidwifetheatre nurseHCA

    100010001000100010001000

    20050502520040

    250150150100300200

    350150200150350200

    400200200200400500

    4002002502004001000

    500200300200400

    600200300200450

    600250400200500

    600250500200700

    300700200750

    35010002501000

    4002501000

    400250

    400250

    420250

    500250

    500300

    700300

    750300

    750300

    900340

    1000350

    1000380

    1500400

    400

    400

    400

    450

    450

    450

    500

    500

    500

    500

    500

    550

    600

    800

    800

    1000

    1000

    1500

    ACCURACY

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    75 cm clot = 1 litre

    anaesthetics

    0

    0

    0

    0

    0

    obstetrics

    100cm clot = 1.5 litresanaestheticsobstetricsgynae nursemidwifetheatre nurseHCA

    150015001500150015001500

    300100300130200100

    500200400150300800

    500400450300600100

    6004005003006001300

    750400500300700700

    100040010003001000

    150040010003001000

    150050010003501000

    200050015003701200

    50015004001500

    60025004001500

    6004001600

    600450

    600450

    750500

    760500

    950500

    1000500

    1000500

    1300600

    1500600

    1500600

    1500600

    2000600

    650

    700

    700

    750

    750

    750

    800

    800

    1000

    1000

    1000

    1200

    1500

    1500

    1500

    1500

    1600

    2000

    obstetrics

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    100 cm clot = 1.5 litres

    gynae nurse

    0.6407407407

    0.5127777778

    0.6454545455

    0.473015873

    0.6222222222

    0.4

    100cm Clot

    midwife

    sanitary towel 100mlanaestheticsobstetricsgynae nursemidwifetheatre nurseHCA

    100100100100100100

    15050901002020

    506020010050100

    100601001005050

    607080200900250

    2004010010050050

    15040050100150

    9020505050

    10040100150400

    20020300200300

    30757570

    3515010070

    7010060

    200120

    30040

    50200

    50200

    200150

    10080

    18060

    100200

    120300

    30080

    100200

    150100

    100

    50

    200

    250

    200

    70

    300

    80

    75

    80

    250

    100

    300

    180

    125

    150

    80

    150

    122.2114.4117.7139.2218.394.0134.3

    100100100100100100

    midwife

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    0000000000000000000000000000000000000000000

    000

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