Haemorrhage Flashcards
Define Postpartum Haemorrhage (PPH)
Significant blood loss after birth, including vaginal bleeding up to 12 weeks postpartum.
How much blood loss is ‘significant’ after normal vaginal delivery (NVD)?
> 500mL
How much blood loss is ‘significant’ after LSCS?
> 1000mL
Define moderate PPH.
500-1000mL EBL
Define moderate PPH.
1000-2000mL EBL
Define severe PPH.
> 2000mL EBL
What maternal observations may suggest PPH if the bleeding is internal?
Increased HR
Decreased BP
Reduced O2 saturations
What is a primary PPH?
Occurring within 24 hours of labour
What is secondary PPH?
Occurring between 24 hours postpartum and 12/52 postpartum
What are the 4 T’s for PPH?
Tone, Trauma, Tissue, Thrombin
What is uterine atony (tone)?
A spongy, soft, boggy uterus that produces a slow and steady blood loss. This is due to myometrium inactivity and lack of endometrial artery clamping.
What can cause uterine atony?
- Repeated distention (multiparous, twins, triplets)
- Muscle fatigue (after delivery)
- Unable to empty bladder (pushes against the uterus)
- Obstetric medications (anaesthetics, magnesium sulfate, nifedipine, terbutaline)
List the potential treatments of uterine atony?
- Fundal massage (encourages the myometrium to contract)
- Urination or catheterisation to relieve the pressure on the uterus
- Medication (tranexamic acid)
- Surgery (repair, balloon, B.Lynch suture, uterine artery ligation, hysterectomy)
What can cause genital damage?
- LSCS incision
- Baby causing damage coming down the vaginal canal
- Medical instrument damage (forceps, ventouse, episiotomy)
How does trauma PPH need to be dealt with?
As an emergency, bleeding must be prevented immediately via pressure on the site of bleeding and stitching lacerations.
What is a haematoma?
A mass/collection of blood.
Define placenta accreta.
The placental tissue invades the endometrial and myometrial tissue. This means it is hard to detach from the uterus. This can cause excessive bleeding (PPH).
What can cause placental retention?
- Placenta accreta
- Placenta praevia
- Too much cord traction
How do we deal with RPOC?
Remove them surgically
What causes ‘Thrombin’ in PPH?
If mum has a blood clotting disorder
- Genetic - vWD
- Obstetric - Eclampsia, placental abruption
What is a massive obstetric haemorrhage (MOH)?
Blood loss >1500mL
What are the 10 antepartum risk factors for PPH?
- Placental abruption
- Placenta praevia
- Multiple pregnancy
- PET
- GDM
- Previous PPH
- Ethnicity
- Obesity (BMI >30)
- Anaemia
- Uterine anomalies
What are the 8 intrapartum risk factors for PPH?
- LSCS (emergency>elective)
- IoL
- RPOC
- Episiotomy
- Instrumental delivery
- Prolonged labour
- Macrocosmic baby
- Pyrexia in labour
What injection can be given to a woman during PPH?
Tranexamic acid
What is a bimanual compression?
One hand on the anterior abdominal wall, the other in the vagina. Compression on either side of the uterus (outside on the fundus, inside on the cervix).
