Introduction:-

Postpartum hemorrhage is the bleeding caused by the place of placeacca due to the separation of the pancentata before the 28th week of pregnancy and before the birth of the child. This threatens the life of both the mother and the child.

Premenstrual bleeding is classified according to the position of
pescenta, i.e. whether the placenta is implanted in the upper or lower
part of the uterus? Do this on

1. Unavoidable Haemorrhage- Separate before the time of placecenta, which is partially or completely located in the lower uterine section, i.e. The bleeding caused by the placenta preia is called indispensable bleeding.
2. Accidental Haemorrhage- The bleeding caused by separation from place of place before the place of pancenta in general is called contagious bleeding.

Indispensable bleeding / placenta preia

Introduction

It is mandatory to have premature premature separation and hemorrhage, because when the lower uterine section of the pregnancy spreads during the last weeks of pregnancy, then the chorionic membrane burst and the bleeding begins to occur. Initially the bleeding may be reduced, but as soon as the lower uterine section spreads further, the bleeding takes place again or again during intervals. When PaceCenta is located on the Internal Os, the seriousness of the situation increases. Because excessive bleeding with excessive separation is essential, whereas the servix becomes completely wide and the oz also gets expanded.

Due to disease-

• There is no clear reason for bleeding from vaginal path without pain.
• The bleeding is mostly during rest or sleep.
• Initially, hemorrhage is usually minor. And then it gets more. Occasionally the earliest bleeding suddenly becomes severe.
• The blood color is red bright.
• Thirst, air hunger etc.

The following signs are present in the patient due to bleeding:-

• Panditism and Anemia
• The speed of the pulse is acute but weak.
• Respiratory speed is acute and blood pressure is low (Hypotension).
• Oedema is often absent on the body.
• Absent albumin in urine
• Hands-feet cold and sweat on the forehead.
• Soft and uterine normal consistency.
• The normal form of uterus is found by perforation.
• The sound of pregnancy seems normal by sound auditory.

Tools available for diagnosis:-

• Placentography, sonar (ultrasonic technique nowadays, used with more than 94% correct results), radioactive isotope and arteriography (28th to 32th week) etc. are used for this.

Treatment of Placenta Preia:-

• Medical assistance should be provided without any delay.
• After recruitment to the hospital, immediate sedatives like Pethidine 150 mg Or Omnepen 20 min. G Or morphine 15 min. G Give it.

Picture ; Different types of pronounced placenta

(1) First position, (2) Second position, (3) Third position, (4) Fourth position.

Image: (A) Extraction of placenta, (B) Pressing the uterus with both hands.

• Painkiller for pain
• Membrane Routine for Minor Bleeding.
• Caesarean section for severe bleeding.
• Blood transfusion for severe or frequent bleeding.

Caution: Do Not Do It:-

• If the hospital does not have full facilities available, then the patient should not be treated because bleeding may increase at any time and blood transfusion may be needed and such a situation may occur that immediately after surgery, the patient's life needs to be protected.
• After 28 weeks of pregnancy, it is a big mistake to treat bleeding as a minor disease. Therefore, it is the right duty of a General Practitioner to advise the patients of the patient to be admitted to a hospital or a nursing home.

Accidental Haemorrhage *

Although pre-prenatal bleeding caused by place-exemption prior to its time, even if it is located in the common place of placeaceta in the uterus, it is called "accidental bleeding".

Casual bleeding is of the following three types:-

1. Confidential Accidental Haemorrhage - No bleeding from the passage, but the retroplacental blclot becomes behind the placenta.
2. Direct Reversal Accidental Haemorrhage -In this, bleeding tears off the mucous membrane of the uterus and comes out of the vaginal passage. This is very common type. Emergency pain and sensitivity may or may not happen.
3. Mixed Accidental Haemorrhage - Primary bleeding is secret and later becomes latent.

Remember-

• The secret and mixed type of bleeding is of severe type.
• Direct type bleeding is relatively less dangerous.

Note:- Maternal and fetal infant mortality is high in secret incidence of hemorrhage.

Due to disease :-

There is no definite reason, some likely reason:-

• Stretch on the trauma and navel nails.
• Uterine torsion
• Toxicity.
• Uterine thrombosis.
• Chronic nephritis.
• Diabetes.
• Special reduction of vitamin C and K, B in the diet.

Symptoms of disease:-

• Severe secretion of the vagina with pain (in direct and mixed type bleeding).
• Headache, restlessness, thirst, excessive sweating, dizziness, decrease in the inflammation of the feet and urine.
• Secret incidence of bleeding, symptoms of restlessness, thirst, excessive sweating, and breathlessness.
• There is no blood from vagina in the secretive abnormal bleeding, but more pain.

By identifying the disease signs:-

Signs in secret hemorrhage are particularly obvious. Whereas other blood cells - especially lacking.

Some common signs are as follows:-

• Panditas, sweating on the whole body, being cool of hands and feet, low blood pressure and weak pulse.
• Tuberculosis syndrome, Albumin Meh e.t.c.
• The uterus is relatively large in proportion to gestation.
• Rigid like uterine wood. Abdominal muscles get stiff And pressure pain in particular.
• The placenta appears in the normal position after taking X-ray.

Medical treatment of casual hemorrhage:-

• Full rest for 7 days on bed.
• Injection morphine 15 mg Muscle mass.
• Get rid of the feet of the patient and the bed of the bed.
• Start making glucose drip. Saline not in the condition of toxicity. Always use glucose.
• Use of Vulval Pads - to absorb bleeding in the vagina.
• Semi-mediateal medicines among other pains.
• In the case of numbness, blood pressure increases medicines.

Things to remember in medicine:-

• Do not test the vagina in any condition.
• Take the patient's blood pressure from time to time. The speed of the pulse, the respiratory speed, the quantity of urine, the sound of the infant heart, etc. should be kept continuously.

Patient Relations, Forecasting and Guidelines:-

If the general symptoms of the patient improve within 24 hours, vaginal bleeding decreases. If the speed of blood pressure and pulse becomes normal, then the patient will be cured.

If, on the contrary, the universal symptoms of the patient continue to increase and the patient continues to increase continuity in the symptoms of seizure, then should not be advised to take treatment of such a patient and recruit in a Maternity Hospital.