Obs - Post-partum complications Flashcards
1
Q
What is the definition of PPH?
A
Loss of >500 ml of blood PV within 24hrs of delivery.
Classified into:
- minor PPH: 500-1000ml blood loss
- major PPH: >1000ml blood loss
2
Q
Describe the 4 main causes of PPH?
A
- Tone: abnormal uterine contraction due to e.g.
- uterus overdistension (polyhydramnios, multiple gestation)
- intra-amniotic infection (fever, prolonged PROM)
- distortion of uterus (e.g. fibroids)
- uterine relaxants e.g. magnesium, nifedipine - Tissue: retained cotyledon, succenturiate lobe or blood clot
- Trauma:
- lacerations of cervix, vagina or perineum
- lacerations during CS
- uterine rupture
- uterine inversion - Thrombin: abnormalities of coagulation e.g.
- pre-existing haemophilia, vWD, ITP, previous PPH
- pre-eclampsia with HELLP
- DIC secondary to e.g. intrauterine foetal death, severe infection, abruption, amniotic fluid embolus
3
Q
How would you manage a woman with minor PPH caused by uterine atony?
A
General:
- IV access + bloods (FBC, coag. screen, G + S)
- warmed IV fluids
Specific:
- rub up uterine fundus
- empty bladder
- uterotonics: OXYTOCIN (10 iu IV) or ERGOMETRINE (0.5 mg IM)
- repeat bolus of above
- to theaters for intrauterine balloon tamponade, hysterectomy, etc.
4
Q
How would you manage a woman with minor PPH caused by placental tissue retention?
A
General:
- IV access + bloods (FBC, coag. screen, G + S)
- warmed IV fluids
Specific:
- OXYTOCIN IV
- examination under anaesthesia + manual removal of placenta
- OXYTOCIN IVI after removal