Obstetric haemorrhage Flashcards
Define Obstetric Haemorrhage
Blood loss of 500mL or more from the genital tract within 24 hours after delivery
- Minor = 500-1000mL
- Major >1000mL
»Moderate = 1000-2000mL
»Massive >2000mL OR 150mL/min
Give 3 antenatal causes of Obstetric Haemorrhage
Previous PPH
Placeta abruption / Placenta pravia
Grand multiparity (>= 6 children prior)
HELLP syndrome
Over distended uterus (eg polyhydramnios - prevents contraction of uterus after)
Give 3 intra-partum causes of Obstetric haemorrhage
Prolonged 1st or 2nd stage
Oxytocin use
Precipitate delivery (rapid delivery)
Operative vaginal delivery (episiotomy)
Second stage caesarean section
Give 4 post-partum causes of Obstetric haemorrhage
4 T’s
Tone - uterine atony
Trauma - episiotomy
Tissue - retained tissue (eg retained placenta)
Thrombin - clotting abnormalities
What is the presentation of Placenta previa?
Painless bleeding, could be life threatening
(usually diagnosed on 20 week scan, often as the uterus grows the placenta moves with it and placenta previa resolves)
What is Placenta Accreta?
Serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall (grows deeply into endometrium)
What is Placenta increta
Condition where the placenta attaches more firmly to the uterus and becomes embedded in the organ’s muscle wall (grows deeply into myometrium)
What is Placenta percreta
Condition where placenta attaches itself and grows through the uterus and potentially to the nearby organs (such as the bladder)
What is Vasa praevia
Presentation of Umbilical vessels lacking Wharton’s jelly below the presenting part, rupture of vessel causes bleeding from the baby
(fetal blood vessels cross or run near the internal opening of the uterus)
What is the management for Placenta Previa?
Delivery by Caeserean section at fetal maturity (usually ~37 weeks) unless massive haemorrhage antenatally where CS is performed ASAP
What is the presentation of Placental Abruption?
Painful bleeding? (due to separation and contractility) - massive Postpartum haemorrhage may occur
Reduced / Absent fetal movements (reduced oxygen supply to fetus - intrauterine fetal death may occur)
TENSE, Tender abdomen
Note, DIC may occur due to disruptions in the coagulation pathway
What is the emergency management for Placental Abruption?
Immediate management by IOL or by Caesarean section
Also remember A-E approach. Major haemorrhage protocol. Empty bladder.
What antenatal management steps can be used to prepare for Obstetric haemorrhage?
Consultant led care.
Optimise haemoglobin antenatally
- Hb check at booking, then 28/40
G&S at booking +/- Crossmatch (especially if risk of haemorrhage or atypical antibodies)
Prophylactic 10 units Oxytocin IM at delivery
What is the management for Post-partum haemorrhage?
A-E approach; Resuscitation + Observations,
Empty bladder + Bimanual compression of uterus
Identify cause and treat:
o Tone»_space; Uterine atony (Tone) = Compress uterus + Oxytocics
o Tissue (retained) = Remove placenta (EUA)
o Trauma = Suturing
o Thrombin = Coagulation correction
Fluid replacement»_space; Crystalloids//Colloids; Blood +FFP +Cryoprecipitate +Platelets
Oxytocics (eg Oxytocin / Ergometrin / Misoprostol / Carboprost)
Massive haemorrhage = Massive haemorrhage protocol + Theatre + Thromboelastogram
Surgical management:
- Atony = Bakri balloon
- Uterine haemostatic sutures (B-lynch sutures)
- Internal iliac ligation (vasc surgeons); Selective artery occlusion/embolisation (by IR)
- Hysterectomy