General Obstetrics

Question 1

Management of PPH

Answer 1

Primary survey:
Ensure high flow oxygen
Lie woman flat
5 minutely haemodynamic obs
2 large bore IV cannulae (1 for fluid/blood, 1 for drugs
Keep woman warm

Assessment of 4 Ts
Apply bimanual compression
For atonia: uterine massage, syntometrine IM - syntocin infusion (40IU/L saline) - misoprostol - prostaglandin F2a into fundus
IDC insertion and monitoring of fluid balance
Surgical intervention if bleeding continuous

Question 2

Causes of post partum haemorrhage

Answer 2

Four Ts: thrombin, tone, tissue, trauma
Thrombin: acquired coagulopathy (preeclampsia, HELLP, placental abruption, foetal demise, amniotic fluid embolism, sepsis, surgical site bleeding), congenital eg VWf, medication induced
Tone: most common. More so in uterine distension ( multiple gestation, polyhydramnios, macrosomia, infection, uterine relaxants or fatigue)
Tissue (retained placenta)
Trauma: lacerations, incisions, uterine rupture

Question 3

Rate at which expect b-hCG to rise in a normal pregnancy

Answer 3

Expect to double every 2-3 days