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NVOG richtlijn - Geneeskunde - Fluxus post partum
Hemorrhagia Postpartum
Pluxus post partum wordt ook wel hemorrhagia Postpartum (HHP) genoemd. Het is wereldwijd de meest voorkomende oorzaak van maternale sterfte. De definitie volgens WHO, bloedverlies van meer dan 500 ml in de eerste 24 uur na de bevalling. In Nederland wordt er meer dan 1000 ml aangehouden.
Oorzaken HHP
Atonie van de uterus is de meest voorkomende oorzaak
Laceraties van de tractus genitalis
Inversio uteri
Retentio placentae
Placentaresten
Maternale stollingsstoornissen
Risicofactoren HHP
Grote uterusuitzetting
Macrosomie
Polyhydramnion
Meerlingzwangerschappen
Langdurige baring
Kunstverlossing
Inleiding
Infectie
Vastzittende placenta
Een grote uterusuitzetting bij macrosomie, polyhydramnion of meerlingzwangerschappen, langdurige baring, kunstverlossing, inleiding en een infectie verhogen de kans op atonie.
Uterotonica
Het wordt aanbevolen om alle vrouwen na het nageboortetijdperk actief te leiden. Hierbij wordt oxytocine gegeven en dient de tonus van de uterus regelmatig te worden gecontroleerd. Het identificeren van hoog risico vrouwen heeft vooral de voorkeur voor de preventieve maatregelen. Het middel van de eerste keus is een uterotonicum, oxytocine genoemd. Er moet zeker geen atonie zijn voordat er word behandeld met uterotonica. Als bloedverlies na een behandeling met oxytocine en uterusmassage aanhoudt, moet de dosis van oxytocine worden opgehoogd. Bij onvoldoende effect van de tweede gift oxytocine, wordt sulproston of methylergometrine gegeven. Bij sulproston moet er worden gelet om eventuele cardio vasculaire bijwerkingen.
Als het geven van uterotonica met een intra-uteriene ballon niet voldoende effectief is, zijn er aanvullende maatregelen nodig. Als er sprake is van ruim bloedverlies, dient de hoeveelheid bloedverlies gewogen te worden.
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