Obstetric haemorrhage

Question 1

Significance

Answer 1

50% of maternal deaths

Question 2

Antepartum haem

Answer 2

Bleed 24w - birth
Minor: less than 50ml
Major: 50-1000 ml
Massive: over 1000ml and/or clinical shock

Question 3

Postpartum haem

Answer 3

Loss of 500ml + within 24 hours of birth
Minor: 500-1000ml
Major: 1000ml +

Question 4

Haem shock classification

Answer 4

1-4

Looks at % blood loss, HR, BP, resp rate, urine output, mental status and fluid replacement

Question 5

Causes of OH

Answer 5

Tone - abnorm ut contraction (prolon lab and overdis uterus)
Tissue - retained products of conception (placenta praevia, adherent placenta)
Trauma - uterine and vaginal
Thrombin - abnormal coag (acquired coagulopathy, platelet abnorm)

Question 6

Personnel

Answer 6

Midwife, labour ward coord, neonat team , 2 obs surgeons, 2 anaest, 2 theatre nurse, 2 anaesthetic support staff

Question 7

Equipment

Answer 7

Rapid infuser, red cell savage, point of care testining (ROTEM (clotting), blood gas analyer)

Question 8

Pharmacological

Answer 8

Uterotonic agents; syntocinon, ergometrine, carboprost, misoprostol
Tranexamic acid - decreases fibrinolysis

Question 9

Surgical

Answer 9

Tone - uterine massage, B lynch suture, Bakri balloon
Tissue - remove retained products/placenta
Trauma - surgical repair

Question 10

Haematological

Answer 10

Replace circulating volume
Replace blood
Correct coag with blood products (FFP, fibrinogen, platelets)