Hello welcome back on EMCURE AICOG tv, I am Dr .Swati Naik and I am pleased to have with me Dr. Dilip Dutta sir. He is the director at gynecology institute of clinical excellence Kalyani in West Bengal. He is the senior vice president of IMA bengal branch in 2016 and 17. He is the dean of Indian Academy of obstetrics and gynecology in 2015, vice chairman of ISSAR Bengal 2015-2017,he is the author of 36 books. Sir, Thank you so much for joining us on EMCURE AICOG tv The topic of our discussion is postpartum hemorrhage. I think the topic which is very close to your heart so let me begin with my question like how common is this postpartum hemorrhage and what are the different causes of postpartum hemorrhage. You know it depends upon the condition of the patient, age and other factors. Most important cause is uterine atony, but it is not contracted or it may be traumatic or it may be any deficiency in the blood, which is called DIC or sometime the placenta is retained after delivery, it may cause othe PPH so usually PPH after normal delivery is more than the PPH following cesarean section. The reason is that in the normal delivery that happens mainly in the rural area where the placenta maybe retained or placenta maybe half partially removed and that causes the PPH so there is a problem we are facing each and everywhere the rural sector. In the urban sector or any middle college you do not find this one because so many people are there so there is we have to look after that one. Sir in the setting postpartum bleeding how do I categorize my patient as a mild PPH, moderate PPH or severe PPH? Is it the amount of the blood loss or directly it is a hemoglobin that is to be tested on what grounds do I categorize my patient? See when we talk the PPH postpartum hemorrhage means after delivery at that time we have to define first what does it causes so 80 to 90% cause due to uterine atony but it was is not contracted so if you take the uterine atony, say following cesarean section and for a normal delivery. In a normal delivery, we will find some bleeding is there say 100-200 we say mild because you know during the pregnancy the bladder is diluted if you loss about 100 or 200 you maybe loss blood of 1 or 2 gram so does not mean, but if it is more than 200 to 500 we call the moderate and after 500, which leads to our problem like shock any other things than we definitely called that is severe PPH How do we manage this postpartum hemorrhage? What are the ways in that? now see again on depends upon you know the causes, now if the cause is uterine atony but it was not contracted so we have to give the drip and the drugs,. Main drugs are Oxytocin. Oxytocin we are using. Now who will using the Oxytocin it may be used by you given IM, intramuscular or intravenous. Now who is using, say in the skilled transfer cases in the rural area. The women they are using the IM or we may give in the drip also saline we may use any saline you can give it. It will make the control if it is not controlled then we have using the mesophosphorus drugs also, but I suggest for last 4 years I am using Tranexamic acid and there is 1 gram IM very slowly for 6 minutes is better in addition to the Oxytocin that is we call the medical treatment in the uterine I think W.H.O has also revised their guidelines recently on the role of Tranexamic acid in the postpartum hemorrhage being to be used irrespective of the cause of the bleeding to safeguard the placenta To say this one that only come in the 2017, but I used it in my books. I mentioned the Tranexamic should be given during all cesarean section cases, in all normal delivery before 5 days. So I am very lucky that my conception has taken by World Health Origination. That’s really nice sir. That I have written in many, I given many lectures in books also. so what is a placenta previa how does with what proportion it does terminates into the postpartum hemorrhage. Yes it is my close of my heart, you know for the placenta previa I have advocated many techniques, everyone knows my Dutta’s innovate techniques Oh nice. Now what is placenta previa, normally the placenta is above in the fundus of the uterus is above and baby is below so when the baby is delivered, placenta delivered. In placenta previa placenta is below, baby is above now if she imagine that how much bleeding will come Now most of the death in India and outside also all during the placenta previa. Now everybody doing these techniques after the bleeding occurs. I say why. I have done preventive aspects, say any girls or women primary a first baby, she is a placenta previa if she bleeds they remove the uterus I say why so I developed some techniques, what techniques that is during the caesarian section normally what we will do we take the baby first then we take placenta then we giving that injection, but here what I am doing since the placenta is below I take the baby first then I am giving the injection Oxytocin then I am giving that Tranexamic acid is very much essential because after that when the uterus is contract I take the placenta where bleeding will be less so Tranexamic acid acts 100% role because a friable vessels are there that will control by Tranexamic acid so I say the Tranexamic acid is a must is a must to tackle a case of bleeding following major degree placenta previa because placenta is below when you take the placenta friable vessels are there bleeds Tranexamic . Sir are you referring for a section for such cases. Are you referring to a cesarean section for such cases. In all placenta previa, is a cesarean section is a must and we call the deventors of the placenta previa main placenta is a major degree placenta previa that means type 3 and type 4 all the patient will die from that way, but type 1 and type 2 you may tackle the normal delivery, but depending on the situation concern, but as you in a heard the placenta previa in any women. We are very much cautious with the observation are very much afraid of this because all the pregnancy, after cesarean section or even delivery in placenta previa next time that occurs because of bleeding and then to prevent the bleeding everybody remove the uterus and that is the problem for us so I say why you remove, because all the people develop the technique after bleeding occurs after losing 1 or 2 times of blood with anemia existing anemia women how is possible in India so my friends in Christopher buildings in London he said that I am being curative you are Dr. Dutta doing the preventive so I am the preventing from there, and that is I am telling the placenta previa message to each and everyone you take the baby first then give the Oxytocin drip other drug Tranexamic acid when the uterus is contracted then you take the placenta then the baby at the same time placenta one time bleeds like any things. so this is my message to you that is placenta previa no deaths in my service till today and of course that is why I go many prize and all these things innovative. congratulations for that sir and thank you very much for joining us on Emcure AICOG tv and sharing your very valuable views on the management of postpartum I am also very happy, I saw your message I am giving the message to my generation people how can you prevent the maternal deaths caused by major degree placenta, thank you very much inviting me. Thank you sir. Thank you very much.