OSCE in PPH

- الpph هو نزيف بعد الولادة أثر على الgeneral condition

* more than 500 ml after vaginal delivery

* more than 1000 ml after CS

- uterine atony is the most common cause

- risk factors for atonic pph: History of previous atonic PPH, MP>= 5 deliveries, Twins, Multifetal pregnancy, polyhydramnios, fetal macrosomia, Myometrium Exhaustion in prolonged & precipitate labor, improper use of oxytocin, Placenta Praevia, Placental abruption, Large uterine leiomyoma, Chorioamnionitis, intrauterine infection, Severe maternal anemia and vitamin D deficiency. كتير معلش👉👈

- step wise uterine devascularization

1-unilateral uterine vessel ligation

2-bilateral (contralateral) vessel ligation

3-low bilateral uterine vessel ligation

4-unilateral ovarian vessel ligation

5-bilateral ovarian vessel ligation