Complications of Labour

Question 1

what is a PPH?

Answer 1

> 500mls of blood loss in the first 24 hours after delivery

Question 2

what are the different thresholds for a PPH depending on method of delivery?

Answer 2

SVD = >500mls
operative VD = >750mls
CS = >1000mls

Question 3

what is the definition of a major PPH?

Answer 3

> 1000mls of blood loss

Question 4

what are the four main causes of PPH?

Answer 4

tone - uterine atony
trauma
tissue - retained placenta
thrombin - problems with coagulation

Question 5

what is the most common cause of PPH?

Answer 5

uterine atony

Question 6

what is uterine atony?

Answer 6

when the uterus fails to contract after delivery, allowing blood vessels to bleed freely

Question 7

what medications should be given for all haemorrhages, not just obstetrics?

Answer 7

tranexamic acid

Question 8

what four drugs are given for PPH and in what order?

Answer 8

oxytocin
ergometrine
carboprost
misoprostol

Question 9

how should oxytocin be given in PPH?

Answer 9

bolus IV/IM

then maintained IV infusion

Question 10

how should ergometrine be given in PPH?

Answer 10

IM or IV

Question 11

what are some negatives to giving ergometrine for PPH?

Answer 11

can cause nausea

contraindicated in hypertensive patients

Question 12

how is carboprost given in PPH?

Answer 12

IM - into thigh or wall of uterus if abdomen opened

every 15 mins for up to eight doses

Question 13

what other interventions can be considered if drugs are ineffective in PPH?

Answer 13

intrauterine balloon
brace sutures
interventional radiology
hysterectomy

Question 14

what are the two methods of management of the third stage of labour?

Answer 14

physiological

active

Question 15

how long does physiological management of the third stage of labour take?

Answer 15

up to an hour

Question 16

what is involved in physiological management of the third stage of labour?

Answer 16

placenta is delivered by maternal effort alone

Question 17

what are the disadvantages of physiological management of the third stage of labour?

Answer 17

increased length of third stage

increased risk of PPH

Question 18

how long does active management of the third stage of labour take?

Answer 18

up to 30 minutes

Question 19

what is involved in active management of the third stage of labour?

Answer 19

uterotonic drugs (oxytocin or syntometrine)
cord clamping
controlled cord traction

Question 20

what is syntometrine?

Answer 20

oxytocin and ergometrine

Question 21

what are the advantages active management of the third stage of labour?

Answer 21

reduced risk of PPH

reduced length of third stage

Question 22

what are the disadvantages of active management of the third stage of labour?

Answer 22

N+V

risk of cord avulsion or uterine

Question 23

what is retained placenta?

Answer 23

when the placenta is not separated from the wall of the uterus

Question 24

what is morbidly adherent placenta?

Answer 24

when the placenta is abnormally stuck to the wall of the uterus

Question 25

what makes morbidly adherent placenta more common?

Answer 25

previous CS or uterine surgery

Question 26

what are the three types of morbidly adherent placenta?

Answer 26

placenta accreta
placenta increta
placenta percreta

Question 27

what is placenta accreta?

Answer 27

placenta adherent to the myometrium

Question 28

what is placenta increta?

Answer 28

placenta invading into the myometrium

Question 29

what is placenta percreta?

Answer 29

placenta invading through the myometrium and to adjacent tissues