Post Partum Haemorrhage

Question 1

What is a postpartum haemorrhage?

Answer 1

A blood loss of 500ml or more after delivery of the baby

Question 2

What are the 2 categories of a postpartum haemorrhage?

Answer 2

Primary
Secondary

Question 3

What is a primary postpartum haemorrhage?

Answer 3

Loss of more than 500ml of blood within 24 hours of derlivery of the baby

Question 4

What are the causes of a primary postpartum haemorrhage

Answer 4

The 4 T's
Tone 
Trauma 
Tissue 
Thrombin

Question 5

How can tone cause a primary postpartum haemorrhage?

Answer 5

Uterine atony- Failure of the uterus to contract after delivery

Most common cause

Question 6

What are the tone causes of primary postpartum haemorrhage?

Answer 6

Placenta praevia
Uterine relaxants
Previous PPH
Overdistension of the uterus- Multiple pregnancies, Polyhydramnios

Question 7

How can trauma cause a primary post partum haemorrhage?

Answer 7

Birth canal or tear due to

Question 8

What can cause trauma to the birth canal?

Answer 8

Caesarean section
Episiotomy
Macrosomia (>4kg baby)

Question 9

How can tissue cause a primary postpartum haemorrhage?

Answer 9

Retained placenta or foetal tissue can cause continual bleeding

Question 10

What are tissue causes of a primary postpartum haemorrhage?

Answer 10

Retained placenta
Placenta accrete
Retained products of contraception

Question 11

How can thrombin cause a primary postpartum haemorrhage?

Answer 11

Clotting factors- Coagulopathies can lead to continued bleeding due to a failure of clotting

Question 12

What are thrombin causes of a primary postpartum haemorrhage?

Answer 12

Pre-eclampsia
Placenta abruption
Pyrexia in labour
Bleeding disorders- Haemophilia, anticoagulants

Question 13

What is a secondary postpartum haemorrhage?

Answer 13

> 500ml blood between 24 hours - 12 weeks

Excess per vaginal bleeding

Question 14

What is the main cause of a secondary postpartum haemorrhage?

Answer 14

Endometritis

Question 15

What is endometritis?

Answer 15

An endometrial infection

Question 16

How does endometritis present?

Answer 16

Offensive discharge due to retained placental tissue

Question 17

What does endometritis cause?

Answer 17

Uterine atony

Question 18

What are the other possible causes of endometritis?

Answer 18

Displacement of a retained blood clot
Poor healing of a perineal tear or genital tract trauma
Abnormal involution of the placental site

Question 19

What is the initial management of a postpartum haemorrhage?

Answer 19

ABC

2 peripheral canulae

Question 20

What is the medical management of a postpartum haemorrhage?

Answer 20

IV oxytocin

IM Carboprost

Question 21

What is the first line surgical management of postpartum haemorrhage where uterine atony is the main cause?

Answer 21

Intrauterine balloon tamponade

Question 22

What is the second line surgical management of postpartum haemorrhage?

Answer 22

B-Lynch suture, ligation of the uterine arteries or internal iliac arteries

Question 23

What is the management of a postpartum haemorrhage when there is severe, uncontrolled bleeding?

Answer 23

Hysterectomy

Question 24

What is the management of primary PPH in order?

Answer 24

1. IV access obtained
2. warmed IV crystalloid fluids
3. palpating the uterine fundus (‘rubbing up the uterus’) to stimulate uterine contraction
4. IV oxytocin
   5.

Question 25

What is the first step in the management of primary postpartum haemorrhage?

Answer 25

ABCDE
two peripheral cannulae, 14 gauge
lie the woman flat
bloods including group and save
commence warmed crystalloid infusion