Complications of Labour Flashcards
what is a PPH?
> 500mls of blood loss in the first 24 hours after delivery
what are the different thresholds for a PPH depending on method of delivery?
SVD = >500mls
operative VD = >750mls
CS = >1000mls
what is the definition of a major PPH?
> 1000mls of blood loss
what are the four main causes of PPH?
tone - uterine atony
trauma
tissue - retained placenta
thrombin - problems with coagulation
what is the most common cause of PPH?
uterine atony
what is uterine atony?
when the uterus fails to contract after delivery, allowing blood vessels to bleed freely
what medications should be given for all haemorrhages, not just obstetrics?
tranexamic acid
what four drugs are given for PPH and in what order?
oxytocin
ergometrine
carboprost
misoprostol
how should oxytocin be given in PPH?
bolus IV/IM
then maintained IV infusion
how should ergometrine be given in PPH?
IM or IV
what are some negatives to giving ergometrine for PPH?
can cause nausea
contraindicated in hypertensive patients
how is carboprost given in PPH?
IM - into thigh or wall of uterus if abdomen opened
every 15 mins for up to eight doses
what other interventions can be considered if drugs are ineffective in PPH?
intrauterine balloon
brace sutures
interventional radiology
hysterectomy
what are the two methods of management of the third stage of labour?
physiological
active
how long does physiological management of the third stage of labour take?
up to an hour
what is involved in physiological management of the third stage of labour?
placenta is delivered by maternal effort alone
what are the disadvantages of physiological management of the third stage of labour?
increased length of third stage
increased risk of PPH
how long does active management of the third stage of labour take?
up to 30 minutes
what is involved in active management of the third stage of labour?
uterotonic drugs (oxytocin or syntometrine)
cord clamping
controlled cord traction
what is syntometrine?
oxytocin and ergometrine
what are the advantages active management of the third stage of labour?
reduced risk of PPH
reduced length of third stage
what are the disadvantages of active management of the third stage of labour?
N+V
risk of cord avulsion or uterine
what is retained placenta?
when the placenta is not separated from the wall of the uterus
what is morbidly adherent placenta?
when the placenta is abnormally stuck to the wall of the uterus
what makes morbidly adherent placenta more common?
previous CS or uterine surgery
what are the three types of morbidly adherent placenta?
placenta accreta
placenta increta
placenta percreta
what is placenta accreta?
placenta adherent to the myometrium
what is placenta increta?
placenta invading into the myometrium
what is placenta percreta?
placenta invading through the myometrium and to adjacent tissues
