Obs - PPH

Question 1

A woman had just delivered a baby, NSD, G3P2. What is the routine management during the third stage of labour?

Answer 1

Syntocinon infusion with rate corresponding to risk factors such as previous PPH, prolonged labour, macrosomia, large fibroids

Controlled cord traction if there are signs of separation such as lengthening of cord, gush of blood or fundus rising to the umbilicus (NO fundal pressure) at PWH: more active management to just do this right away

Empty bladder if separated but retained placenta (at pwh done at second stage)

Check placenta for completeness

Question 2

This patient had 1L blood loss, how would you manage the patient?

Answer 2

This is primary major PPH, call for help

Check vitals
resuscitation: IV access full rate NS, consider FFP/unmatched O- RBC
Patient head down

Ix: CBC, clotting, T/S, X match, LRFT

Look for and manage according to cause
1. ATONY
Manual: uterine massage, bimanual uterine compressiom
Pharmacological: syntocinon, hemabate, transamin
Bakri balloon; Uterine artery embolisation
Surgical (if unstable): compression suture, last resort hysterectomy

2. Trauma: inspect genital tract for injury
3. Tissue: examine placenta for completeness
4. Thrombin: hx of PET, no visual clots in blood