Complications of Labour Flashcards
What is the Definitive volume of Post-Partum Haemorrhage blood loss After SVD?
> 500mls
What is the definitive volume for PPH after Operative Vaginal Delivery?
> 750ml
What is the definitive volume for PPH after C-section?
> 1000ml
What what Percentage of Blood loss would a patient become Anuric?
> 40% circulating Volume
At which Percentage of blood loss would a patient begin to have decreased BP?
30-40% of circulating volume. (Compensatory mechanisms beginning to fail)
What percentage of blood loss would cause a patients mental state to be each of the following?
- Normal
- Anxious
- Confused
- Lethargic
Normal: < 15% Circulating Volume.
Anxious: 15 - 30%
Confused: 30 - 40%
Lethargic: >40%
What are the 4T’s causing PPH?
Tone (Uterine Atony - Failure of uterus to contract adequately after delivery).
Trauma (perineal tears, Cervical Tears)
Tissue (placenta, Fragment of Placenta)
Thrombin (coagulation Problems)
What is Severe PPH?
> 2000ml Blood loss
What is Secondary vs primary PPH?
Primary is within 24hrs of delivery.
Secondary is anywhere after this until 12 wks.
What is the General management outline in PPH?
- Resus with ABCDE approach.
- Lie woman flat, keep her warm and communicate to partner.
- Insert two large-bore cannulas.
- Bloods for FBC, U&E and clotting screen.
- Group and cross match 4 units.
- Warmed IV fluid and Blood Resus as required.
- Oxygen (regardless of sats)
What are the Mechanical Treatment options to stop Bleeding in PPH?
Rubbing the uterus (through abdomen to stimulate uterine contraction).
Catheterisation (bladder distention prevents uterine contractions)
What are the Medical treatment Options available in PPH?
- Oxytocin.
- Ergometrine (stimulates smooth muscle contraction).
- IM Carboprost (Prostoglandin Analogue) (stimulates uterine contraction).
- Sublingual Misoprostol (Prostoglandin analogue) (stimulates uterine contraction).
- Tranexamic Acid (antifibrinolytic) (reduces bleeding).
What are the Surgical treatment options for Bleeding cessation in PPH?
Intrauterine Balloon Tamponade.
B-Lynch suture.
(suture around the uterus to compress it.)
Uterine Artery Ligation.
(Ligation of one or more of the arteries, supplying the uterus to reduce the blood flow)
Hysterectomy.
(“Last resort”)
What are the most likely causes of Secondary postpartum haemorrhage?
Retained products of conception (RPOC).
Infection (i.e. Endometritis)
What is the management of secondary PPH?
Depends on cause:
- Surgical evaluation of retained products of conception.
- Abx for infection.
What are the Foetal Complications of Shoulder Dystocia?
Hypoxia,
Brachial Plexus injury,
Fracture of Clavical/Humerus,
Intracranial Haemorrhage,
Death.
What are the Maternal Complications of Shoulder Dystocia?
PPH, Genital tract Trauma, Pelvic Injuries.
What does the “HELPERR” Pneumonic stand for in Shoulder Dystocia?
H - Call for help
E - Evaluate for Episiotomy
L - Legs: Mcroberts Manoeuvre.
P - External Pressure (Suprapubic)
E - Enter - Rotational Manoeuvre.
R - Remove the posterior arm.
R - Roll the patient to her Hands and Knees.
What are the Potential structures that can be damaged with Genital Trauma?
Clitoral,
Anal Sphincters,
Perineum,
Cervix,
Labial.
What are the classifications of First and Second Degree tears?
1st: Injury to the Perineal skin only.
2nd: Injury to the Perineal skin and Muscle but NOT the Anal Sphincters.
What is the Classification of a 3rd degree tear?
- 3A
- 3B
- 3C
Injury Involving the Anal Sphincters.
3A - Tear through <50% external Anal Sphincter.
3B - > 50% external Anal Sphincter.
3C - Involvement of Both Internal and External Anal Sphincters.
What is the Classification of a 4th degree tear?
Disruption of the anal Epithelium/Mucosa.
What are the Risk factors for Postpartum Sepsis?
- Anaemia.
- Prolonged Rupture of the Membranes.
- Long Labour.
- Assisted Delivery.
- Raised BMI.
- Diabetes.
What percentage of maternal deaths are caused by Postpartum Sepsis?
15%
