Post Partum Haemorrhage

Question 1

What is PPH?

Answer 1

> 500ml blood loss per vagina after delivery of baby and placenta

Question 2

What is a primary PPH?

Answer 2

Within 24 hours of birth

Question 3

What is a secondary PPH?

Answer 3

24hrs - 2 weeks post delivery

Question 4

What can cause secondary PPH?

Answer 4

Endometritis

Retained placental tissue

Question 5

How is secondary PPH investigated?

Answer 5

USS

Swabs

Question 6

How is secondary PPH managed?

Answer 6

Abx

+/- surgery

Question 7

What is a major PPH?

Answer 7

> 1000ml blood loss

Question 8

What is a minor PPH?

Answer 8

500-1000ml blood loss

Question 9

What can cause PPH?

Answer 9

4 Ts

Tone = uterine atony 
Tissue = retained placenta tissue
Trauma = perineal tear
Thrombin = coagulopathy

Question 10

What are risk factors for PPH

Answer 10

Previous PPH
Multiple pregnancy 
Obesity 
Large baby 
Pre-eclampsa
Instrumental delivery

Question 11

How can PPH be prevented?

Answer 11

Treat antenatal anaemia
Give birth with an empty bladder
Active management of the third stage

Question 12

How is PPH managed generally?

Answer 12

A to E

Question 13

How is PPH due to tone managed?

Answer 13

Bimanual compression
Oxytocin - increase contractions

Surgical methods

• intrauterine balloon
• B-lynch suture around uterus

Question 14

How is PPH due to trauma managed?

Answer 14

Repair tear

Question 15

How is PPH due to tissue managed?

Answer 15

IV oxytocin + manual removal

Question 16

How is PPH due to thrombin managed?

Answer 16

Tranexamic acid