Obstetric Haemorrhage

Question 1

What is placental abruption?

Answer 1

Placenta comes away from the uterine wall early and starts bleeding behind the placenta

Question 2

What is placenta praevia?

Answer 2

Placenta implants low in the uterine wall and covers the cervix, preventing the baby from being delivered

Question 3

What is placenta accreta?

Answer 3

Abnormally invasive placenta where the placenta grows like a tumour through the myometrial wall

Question 4

What is atony?

Answer 4

After delivery, the uterus stops contracting so where the placenta comes away there is still bleeding

Question 5

What is antepartum haemorrhage?

Answer 5

Bleeding from the genital tract occurring from 24 weeks of pregnancy and prior to the birth of the baby

Question 6

What is antepartum haemorrhage usually caused by?

Answer 6

• Placental abruption

- Placenta praevia

Question 7

What is primary post-partum haemorrhage?

Answer 7

Loss of 500ml or more of blood from the genital tract within 24 hours of birth of baby

Question 8

What is secondary post-partum haemorrhage?

Answer 8

Excessive or abnormal bleeding from the birth canal between 24 hours to 12 weeks postnatally

Question 9

What are the causes of obstetric haemorrhage?

Answer 9

• tone - abnormalities of uterine contraction
• tissue - retained products of conception
• trauma of the genital tract
• thrombin - abnormalities of coagulation

Question 10

What is sepsis?

Answer 10

Ascending infection that reaches the uterus and fetus

Question 11

What equipment is used to manage obstetric haemorrhage?

Answer 11

• Rapid infuser - infuses warm IV fluid and blood products to keep up with rapid blood loss
• Red cell salvage - collects + processes maternal blood from surgical site, centrifuges, washes and returns red cells to patient
• Blood gas machine - check haemoglobin levels
• ROTEM thromboelastrometry to determine required blood products

Question 12

List some uterotonic agents

Answer 12

• syntocinon
• ergometrine
• carboprost
• misoprostol

Question 13

What pharmacological agent is used to treatment PPH due to uterine atony and how?

Answer 13

Tranexamic acid - reduces fibrinolysis –> reduces bleeding

Question 14

What is fresh frozen plasma?

Answer 14

Contains all clotting factors found in blood at normal concentrations

Question 15

What is cryoprecipitate?

Answer 15

Prepared from fresh frozen plasma and contains all of the clotting factors in higher concentrations