Adult Post Partum Haemorrhage

Question 1

Causes of PPH include the ‘four Ts’:

Answer 1

Tone (uterine atony)
Trauma (to genital structures)
Tissue (retention of placenta or membranes)
Thrombin (coagulopathy)

The most common cause of PPH is uterine atony.

Question 2

Why do we only massage the fondus when it is not firm

Answer 2

Massaging a fundus that is firm, central and contracted may interfere with normal placental post birth
separation and worsen bleeding. Fundal massage should only be applied when the fundus is not
firm.

Question 3

What type of uterus does not bleed?

Answer 3

An empty and contracted uterus does not bleed.

Question 4

Higher risk patients for PPH

Answer 4

multiple pregnancy, more than four pregnancies, past history of PPH, history of APH, large baby.

Question 5

Higher risk patients for PPH

Answer 5

multiple pregnancy, more than four pregnancies, past history of PPH, history of APH, large baby.

Question 6

What is secondary PPH

Answer 6

Where severe bleeding occurs at 24 hrs to 6 weeks post birth

Question 7

What classifies as a PPH

Answer 7

Blood loss >500mL in the first 24hrs post birth

Question 8

Mgx for SD4

Answer 8

R+R
POC - Semi Recumbent
MICA C1
O2 NRB 15L/min
Pain Relief
Fluids - NS 40mL/kg to pt response
Massage fundus - cupped hand, firm pressure in circular motion - encourage mother to empty bladder - encourage baby to suckle breast
Oxytocin 10 IU IM - repeat 5/60 if bleeding continues
External Aortic Compression

Question 9

External Aortic Compression

Answer 9

Locate the point of compression just above the umbilicus and slightly to the left side
Apply downward pressure with a closed fist directly through the abdominal wall
The effectiveness of compression may be evaluated by assessing palpable femoral pulse with pressure applied

Question 10

APGAR