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)

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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

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300

400

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400

400

450

750

850

half soaked towel

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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

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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

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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

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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

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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

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