The basic concept of post partum hemorrhage

Postpartum hemorrhage is bleeding more than 500-600 ml for 24 hours after birth. Including bleeding due to retained placenta. Postpartum hemorrhage is bleeding in stage IV of more than 500-600 cc in 24 hours after the child and the placenta (Prof. Dr. Rustam Mochtar, MPH, 1998).
Haemoragic Post Partum (HPP) is a blood loss of more than 500 ml in the first 24 hours after birth of the baby (Williams, 1998)
HPP usually lose more than 500 ml of blood during or after birth (Marylin E Dongoes, 2001).
Bleeding after childbirth (postpartum) is bleeding vagina 500 ml or more after the child is born. Bleeding is the number one cause of death (40% -60%) of maternal mortality. Postpartum bleeding can be caused by uterine atony, retained placenta, retained placenta, uterine inversio and lacerations of the birth canal.
Postpartum hemorrhage is an important cause of maternal mortality; ¼ of maternal deaths due to haemorrhage (PPH, placenta previa, placenta solution, ectopic pregnancy, abortion and uterine rupture) due to postpartum hemorrhage. PPH greatly affect postpartum morbidity due to anemia subtracting endurance. PPH is classified into two, namely:

1. Early Postpartum Hemorrhage (Early Postpartum Haemorrhage, or Primary Postpartum Hemorrhage, or Immediate Postpartum Hemorrhage). Primary postpartum hemorrhage occurred in the first 24 hours. The main causes of primary postpartum hemorrhage was atonic uterus, retained placenta, retained placenta, birth canal laceration and inversio uteri. Most within the first 2 hours.
2. The post partum hemorrhage (PPH kasep or bleeding Childbirth Postpartum Hemorrhage Secondary or Slow, or Late PPH). Secondary postpartum hemorrhage occurs after the first 24 hours. Secondary postpartum hemorrhage is often caused by an infection, uterine contraction is not good, or retained placental fragments.
3. Etiology
   The causes of postpartum hemorrhage are as follows:
4. The cause of bleeding is divided into two according to the type of bleeding that is
   The cause of early bleeding after childbirth:
   a. Injuries to the birth canal: uterine rupture, laceration of the cervix, vagina and perineum, episiotomy.
   b. Bleeding at the site of attachment of the placenta for: atonic uterus, retained placenta, uterine inversio.
   c. Impaired blood clotting mechanism
5. The cause of bleeding after childbirth too late:
   a. retained placenta
   b. blood clot
   c. infections due to retention of waste products in uterus, causing sub involution of the uterus.
6. Clinical manifestations
   Clinical symptoms commonly happens is the blood loss in large numbers (> 500 ml), weak pulse, pale, lochea in red, thirst, dizziness, anxiety, fatigue, and can occur hypovolemic shock, low blood pressure, cold extremities, nausea. Clinical symptoms based on the cause:
7. Atonia uteri:
   a. Symptoms are always present:
   The uterus does not contract and mushy and bleeding shortly after birth (postpartum perarahan primer)
   b. Symptoms that sometimes occur:
   Shock (low blood pressure, rapid pulse and a small, cold extremities, anxiety, nausea and others)
8. Tear the birth canal
   a. Symptoms are always present:
   Bleeding immediately, fresh blood immediately after birth, contractions uteru good, good placenta.
   b. Symptoms that sometimes occur:
   Paleness, weakness, chills.
9. retained placenta
   a. Symptoms are always present:
   The placenta has not been born after 30 minutes, bleeding immediately, uterine contractions well.
   b. Symptoms that sometimes occur:
   The umbilical cord is cut off by excessive traction, uterine inversion due to the pull, continued bleeding
10. lagging placenta (retained placenta)
    a. Symptoms are always present:
    Placenta or partially membrane (containing blood vessels) is incomplete and bleeding immediately
    b. Symptoms that sometimes occur:
    Uterus is good but the fundus is not diminished
11. Inversio uterus
    a. Symptoms are always present:
    The uterus is not palpable, vaginal lumen filled mass, seemed cord (if the placenta has not been born), bleeding immediately, and a little pain or severe.
    b. Symptoms that sometimes occur:
    Neurogenic shock and pale
12. Patofisologi
    In the delivery of blood vessels in the uterus widens to
    improve circulation there, uterine atony and uterine subinvolution causes uterine contractions to decrease so that the blood vessels are dilated was not close completely so that bleeding occurs continuously. Trauma last resort as epiostomi wide, perineal laceration, and uterine rupture also causes bleeding due to the opening of blood vessels, blood disease in the mother; eg afibrinogemia or hipofibrinogemia because there is no lack of fibrin to help, the blood clotting process is also different causes of bleeding from postpartum. Bleeding difficult to stop can be pushed in a state of shock hermoragik.