O&G

Question 1

Primary PPH management

Answer 1

1- a-Resuscitation:O-ve blood and massive transfusion protocol, can be guided by ROTEM
B-Tranexamic acid 1 g IV over 10 minutes repeated after 30 minutes if bleeding ongoing

2-Stimulate uterine contraction 
A-uterine fundus massage
B-oxytocin 5 units IV or 10 units IM followed by infusion, ergometrine if no HTN .25-.5 mg im or slow iv, repeat oxytocin in 5-10 minutes if no effect, carboprost.25 mg im, misoprostol 1000 mcg pr 
C-bimanual uterine massage, needs OT
D-IDC

3-inspect placenta for completeness, manual removal of products, likely in OT

4-control external bleeding, with sutures or pressure, if cervical needs OT to control

5-uterine inversion, push back gently

6-intrauterine tamponade

7-Recombinant activated factor VII

8-Abdominal aorta compression

9-OT for : uterine haemostatic suture, ligation, hysterectomy or IR for selective arterial embolization

Question 2

Secondary PPH management

Answer 2

• ABC
• Analgesia
• Ergometrine .25-.5 mg slow IV or im
• Antibiotics: ampicillin, gentamicin and metronidazole
• curettage