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:

  1. minor PPH: 500-1000ml blood loss
  2. major PPH: >1000ml blood loss
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2
Q

Describe the 4 main causes of PPH?

A
  1. 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
  2. Tissue: retained cotyledon, succenturiate lobe or blood clot
  3. Trauma:
    - lacerations of cervix, vagina or perineum
    - lacerations during CS
    - uterine rupture
    - uterine inversion
  4. 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
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3
Q

How would you manage a woman with minor PPH caused by uterine atony?

A

General:

  1. IV access + bloods (FBC, coag. screen, G + S)
  2. warmed IV fluids

Specific:

  1. rub up uterine fundus
  2. empty bladder
  3. uterotonics: OXYTOCIN (10 iu IV) or ERGOMETRINE (0.5 mg IM)
  4. repeat bolus of above
  5. to theaters for intrauterine balloon tamponade, hysterectomy, etc.
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4
Q

How would you manage a woman with minor PPH caused by placental tissue retention?

A

General:

  1. IV access + bloods (FBC, coag. screen, G + S)
  2. warmed IV fluids

Specific:

  1. OXYTOCIN IV
  2. examination under anaesthesia + manual removal of placenta
  3. OXYTOCIN IVI after removal
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