Haemorrhage in O&G

Question 1

List two causes of haemorrhage in gyn

Answer 1

ectopic miscarriage

postop bleed

Question 2

List three causes of haemorrhage in obstetrics

Answer 2

uterine rupture
placenta praevia
placental abruption
postpartum haemorrhage
postop bleed
splenic artery rupture
hepatic rupture

Question 3

What is primary PPH?

Answer 3

<24 hr of delivery

Question 4

What is secondary PPH?

Answer 4

between 24 hours and 12 weeks postnatally

Question 5

What is minor, moderate, and severe blood loss?

Answer 5

minor 500-1000ml
moderate 1000-2000ml
severe >2000ml

Question 6

What are the 4T’s in PPH?

Answer 6

Thrombin
Tissue
Tone
Trauma

Question 7

List three antenatal risk factors for PPH

Answer 7

placental abruption
placenta praevia
multiple pregnancy
pre-eclampsia/gestational hypertension

Question 8

List three intrapartum risks associated with PPH

Answer 8

emergency c-section
elective c-section
retained placenta (tissue)
pyrexia in labour (thrombus)
big baby (tone/trauma)
prolonged labour (tone)
age (tone)

Question 9

What is the management of major obstetric haemorrhage?

Answer 9

1. Call for help
2. Resus- ABC:
   - 15L trauma mask
   - Fluid balance= hartmann’s
   - blood transfusion
   - keep patient warm
   - blood products
3. Monitoring and investigations
   - 14g cannulae x2, FBC, coag, U+Es, LFTs, crossmatch, ECG, weigh swabss and estimate blood loss
4. Medical management

Question 10

What is the medical management of major haemorrhage (obst)

Answer 10

bimanual uterine compression
empty bladder
oxytocin
misoprostol (prostaglandin analogue)
carboprost

Question 11

List two agents that promote uterine contractility

Answer 11

syntocinon
ergometrine
carboprost
misoprostol

Question 12

What is the most common cause of PPH?

Answer 12

uterine atony= failure of uterus to contract after delivery (contraction reduces bleeding- tone)

Question 13

What is the surgical management of PPH?

Answer 13

bilaterla uterine artery ligation
bilaterla internal iliac ligation
hysterectomy
uterine artery embolisation

Question 14

What are physical options for management of PPH?

Answer 14

intrauterine balloon tamponade
brace suture
interventional radiology

Question 15

List two causes of secondary PPH

Answer 15

infection (endometritis)

retained tissue

Question 16

List two causes of bleeding in early pregnancy

Answer 16

ectopic

miscarriage

Question 17

What would lead you to think about cervical shock?

Answer 17

products of conception or clot in cervical os (miscarriage)