Postpartum Hemorrhage
Özet
Postpartum hemorrhage (PPH) is a leading preventable cause of maternal morbidity and mortality globally, making early identification and structured management essential. Defined by organizations like WHO and ACOG based on blood loss volume or hemodynamic stability within 24 hours of delivery, PPH can escalate quickly due to significant uterine blood flow. Its etiologies are classified under the "4Ts": uterine atony, trauma, retained tissue, and thrombin disorders, with atony accounting for approximately 70% of cases. Effective prevention relies on prenatal risk stratification into low, moderate, and high groups, coupled with active management of the third stage of labor using prophylactic uterotonics. Once PPH occurs, immediate management requires stabilizing maternal hemodynamics, quantifying blood loss via volumetric or gravimetric methods, and tracking the Shock Index to predict cardiac decompensation. Medical treatments feature first-line oxytocin, along with methylergonovine, misoprostol, carbetocin, and tranexamic acid. If bleeding persists, interventions escalate sequentially to mechanical options like balloon tamponade, radiological uterine artery embolization, surgical compression sutures, arterial ligation, and, as a life-saving last resort, peripartum hysterectomy. Ultimately, establishing a coordinated, multidisciplinary protocol remains vital to mitigating severe long-term complications or maternal death.
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