Post-partum haemorrhage - Diagnosis

Post-partum haemorrhage may occur in large quantities, but often is a medium or bleeding in the small but constant amount over a period of several hours, which causes a severe hypovolemia. The effects of hemorrhage depend largely on blood volume before pregnancy and the degree of anemia at birth. Sometimes blood can accumulate in the uterus (womb increases above the navel) or in one or subperitoneal paravaginal hematoma. Blood is most often red but can be venous.Uterine atony causes continuous bleeding, severe, blood-red waves. The uterus is soft, but with periods of recovery during uterine massage.Retention of the placenta is characterized by bleeding discontinuous waves when they hit the bottom of the uterus or contraction. The elimination of the placenta is normally a period of 30 minutes. Retention is due to placenta: partial takeoff, abnormal adhesions.Bleeding through bleeding disorders are fortunately rare. May occur as a result of preexisting coagulation disorders (idiopathic thrombocytopenic purpura, hemophilia, von Willebrand disease). Disseminated intravascular coagulation may occur secondary, with the activation of coagulation and fibrinolysis. Disseminated intravascular coagulation occurs as a result of various conditions: premature departure of the placenta, amniotic embolism, fetal death and retention in the uterus, eclamsia, corioamniotita. Hemorrhage is blood or cheguri unclotted soft gelatin, as well retracted uterus.Inserted in the lower segment placenta bleeding red blood, continue.Physical examination includes:
- Examining the placenta after placental delivrenta to identify any gaps;- If the placenta was not expelled by the use of manual placental extraction followed by its consideration;- Uterus exceeds umbilical scar, and consistency is low to the accumulation of blood in the uterus, expressing uterus and blood clots will drain the outside;- Control of the uterine cavity to be sure that it is empty;
 - Effective control shrinkage during uterine cancer;
 - Control of the soft parts of the birth canal;
 - Hemodynamic assessment of balance: power, pulse, skin discoloration.Paraclinical investigation include: blood count, determination of blood group and Rh, platelet count, bleeding time (which indicate thrombocytopenia or platelet function alterations), Quick time, activated partial thromboplastin time, fibrinogen.Complications- Hemorrhagic shock, acute renal failure, local infection in praise, Sheehan syndrome (ischemic necrosis of the anterior lobe of the pituitary gland);