Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gaby’s Green Top Guidelines > 2016 52 PPH > Flashcards

2016 52 PPH Flashcards

1
Q

** How can risk factors for PPH be minimised? **

A
  1. Investigate & treat antenatal anaemia
  2. Offer prophylactic uterotonics to all women for the 3rd stage
  3. Uterine massage is of no benefit
  4. Consider IV TXA 0.5-1g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

** What uterotonics should be used for 3rd stage? **

A
  1. NVB no RFs: Oxytocin 10 units IM
  2. CS: Oxytocin 5 units slow IV
  3. Increased risk with no HTN: Syntometrine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

** What are the definitions of PPH? **

A
  1. Minor: 500-1000ml
  2. Major: >1000ml
  3. Massive: >2000ml or >30% blood volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

** What resuscitation measures should be employed for a minor PPH? **

A
  1. Midwife in charge, obstetrician, anaesthetist
  2. 14G cannula (orange, >grey)
  3. Bloods: G&S, FBC, clotting inc fibrinogen
  4. Obs: RR, HR, BP every 15 mins
  5. Fluids: warmed crystalloid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

** What resuscitate measures should be employed for a major PPH? **

A
  1. MDT including senior staff
  2. Evaluate ABC
  3. Position flat
  4. Warming
  5. Transfuse ASAP if clinically required
  6. Fluids: up to 3.5L warmed clear; initially crystalloid, not hydroxyethyl starch
  7. Rapid warmed infusion, no filters
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

** What features should emergency blood have? **

A
  1. Group O
  2. D-negative
  3. K-negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

** How should FFP be transfused in PPH? **

A

If no haemostatic results & bleeding continuing:
1. After 4 units of RBCs
2. At a dose of 12-15ml/kg
3. Earlier if abruption, AFE, delayed detection
If known:
4. PT/APTT >1.5 x normal
5. Give >15ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

** How should cryoprecipitate be used in PPH? **

A

To maintain fibrinogen > 2g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

** When should platelets be transfused in PPH? **

A

When platelet count < 75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

** What surgical methods can be used in PPH? **

A
  1. 1st line: intrauterine balloon tamponade
  2. Brace suture
  3. Hysterectomy sooner rather than later, esp for placenta accreta or uterine rupture
  4. Involve consultant & 2nd opinion for hysterectomy decision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

** How should secondary PPH be managed? **

A
  1. Swabs: HVS & endocervical
  2. Abx if endometritis suspected
  3. Pelvis USS to exclude RPOC
  4. Surgical ERPC under experienced clinician
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 Ts of PPH causes?

A

Tone: abnormalities of uterine contraction
Tissue: retained products of conception
Trauma: genital tract injury
Thrombin: abnormalities of coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors for PPH due to tone

A
  1. Overdistension of uterus: polyhydramnios, multiple gestation, macrosomia
  2. Intra-amniotic infection: fever, prolonged ROM
  3. Uterine distortion: rapid or prolonged labour, fibroids, placenta praevia, uterine anomalies
  4. Bladder distension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the tissue causes of PPH?

A
  1. Retained cotyledon or succenturiate lobe
  2. Retained blood clots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risk factors for traumatic causes of PPH?

A
  1. Lacerations of cervix, vagina or perineum: OVB, precipitous delivery
  2. Extensions or lacerations at CS: malposition, deep engagement
  3. Uterine rupture: previous uterine surgery
  4. Uterine inversion: high parity with excessive cord traction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 4 categories of abnormalities of coagulation that can cause PPH?

A
  1. Pre-existing states
  2. Conditions acquired in pregnancy
  3. DIC
  4. Therapeutic anticoagulation
17
Q

What pre-existing abnormalities of coagulation can cause PPH?

A
  1. Haemophilia A
  2. Idiopathic thrombocytopenic purpura
  3. Von Willebrand’s disease
  4. History of previous PPH
18
Q

What conditions acquired in pregnancy can cause PPH due to abnormal clotting?

A
  1. Gestational thrombocytopenia
  2. Pre-eclampsia with thrombocytopenia inc HELLP
19
Q

What are the causes of DIC?

A
  1. Gestational hypertensive disorder
  2. In utero fetal demise
  3. Severe infection
  4. Placental abruption
  5. Amniotic fluid embolus
20
Q

What are the thresholds for anaemia in pregnancy?

A
  1. 110 in 1st trimester
  2. 105 in 2nd/3rd trimester
  3. 100 postpartum
21
Q

What impact can early cord clamping have on the neonate?

A

Lower blood volume, leading to
Lower birth weight

22
Q

How does syntometrine compare to oxytocin in PPH prophylaxis?

A
  1. Similar efficacy oxytocin 5 or 10 units vs syntometrine
  2. Syntometrine increases N&V & raises blood pressure
23
Q

What prostaglandins can be used in PPH management?

A

Carboprost IM
Misoprostol SL or other routes

24
Q

Why is carbetocin often chosen for PPH prophylaxis at CS?

A
  1. Longer-acting oxytocin derivative
  2. Reduces need for further uterotonics
25
At what keeps of blood loss do signs of hypovolaemic shock usually show in PPH?
1. 1000ml: tachycardia, tachypnoea, slightly reduced systolic BP 2. 1500ml: systolic BP <80, altered mental state, worsening HR & RR
26
What fluids can be used in PPH?
1. Crystalloid: up to 2L isotonic 2. Colloid: up to 1.5L awaiting blood 3. Blood: emergency group O, D-negative, K-negative 4. FFP: 4 units after 4 units RBCs, or 12-15mg/kg if PT or APTT prolonged
27
What fluids can be used in PPH?
1. Crystalloid: up to 2L isotonic 2. Colloid: up to 1.5L awaiting blood 3. Blood: emergency group O, D-negative, K-negative 4. FFP: 4 units after 4 units RBCs, or 12-15mg/kg if PT or APTT prolonged 5. Platelets: 1 pool if <75 6. Cryoprecipitate: 2 pools if fibrinogen <2
28
What blood component targets are we aiming to maintain in PPH?
1. Hb>80 2. Platelets >50 3. PT < 1.5x normal 4. APTT < 1.5 x normal 5. Fibrinogen > 2
29
What point of care tests can be used to assess coagulation?
1. TEG: thromboelastography 2. ROTEM: rotational thromboelastometry
30
What are the risks of FFP?
1. Majority have normal coagulation at time of administration 2. TACO: transfusion-associated circulatory overload 3. Transfusion-related lung injury 4. Small increase so often need cryoprecipitate or fibrinogen as well
31
How much does cryoprecipitate increase fibrinogen level?
2 pools (10 donors) increase fibrinogen by 1
32
What doses of TXA are recommended in PPH?
1g IV 2nd dose can be given after 30 mins
33
What are the recommendations for recombinant factor VIIa therapy in PPH?
Do not use routinely Can use in clinical trials Increases arterial & venous thromboembolism
34
What actions should be taken, in order, for PPH due to atony?
1. Rub up the fundus 2. Indwelling catheter 3. Oxytocin 5 units slow IV, can repeat 4. Ergometrine 0.5mg IM or slow IV, unless HTN 5. Oxytocin infusion 40 units in 500ml saline at 125ml/hr unless fluid restricted 6. Carboprost 0.25mg IM can be repeated every 25 mins up to 8 doses (caution in asthma), theatre after 3rd 7. Misoprostol 800 micrograms SL
35
What surgical methods can be used in PPH if skills & equipment allow?
1. Compression of aorta to allow time for resuscitation 2. Intrauterine balloon tamponade, 4-6 hours, remove in daytime 3. Haemostatic suturing eg B-lynch 4. Stepwise uterine devasularisation 5. Internal iliac artery ligation 6. IR: Selective arterial occlusion or embolisation 7. Hysterectomy
36
What antibiotics are recommended for postpartum endometritis?
Clindamycin & gentamicin
37
What ultrasound findings indicate postpartum RPOC?
1. Echogenic mass 2. Thickened endometrium 3. AP diameter of cavity > 25mm d1-7
38
What should debrief focus on following PPH?
1. Events surrounding birth 2. Postnatal depression 3. Fears of future births 4. Investigations for coagulopathies 5. Screening for Sheehan syndrome: postpartum hypopituitarism

Gaby’s Green Top Guidelines (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions