Post Partum Haemorrhage Flashcards
What is a postpartum haemorrhage?
A blood loss of 500ml or more after delivery of the baby
What are the 2 categories of a postpartum haemorrhage?
Primary
Secondary
What is a primary postpartum haemorrhage?
Loss of more than 500ml of blood within 24 hours of derlivery of the baby
What are the causes of a primary postpartum haemorrhage
The 4 T's Tone Trauma Tissue Thrombin
How can tone cause a primary postpartum haemorrhage?
Uterine atony- Failure of the uterus to contract after delivery
Most common cause
What are the tone causes of primary postpartum haemorrhage?
Placenta praevia
Uterine relaxants
Previous PPH
Overdistension of the uterus- Multiple pregnancies, Polyhydramnios
How can trauma cause a primary post partum haemorrhage?
Birth canal or tear due to
What can cause trauma to the birth canal?
Caesarean section
Episiotomy
Macrosomia (>4kg baby)
How can tissue cause a primary postpartum haemorrhage?
Retained placenta or foetal tissue can cause continual bleeding
What are tissue causes of a primary postpartum haemorrhage?
Retained placenta
Placenta accrete
Retained products of contraception
How can thrombin cause a primary postpartum haemorrhage?
Clotting factors- Coagulopathies can lead to continued bleeding due to a failure of clotting
What are thrombin causes of a primary postpartum haemorrhage?
Pre-eclampsia
Placenta abruption
Pyrexia in labour
Bleeding disorders- Haemophilia, anticoagulants
What is a secondary postpartum haemorrhage?
> 500ml blood between 24 hours - 12 weeks
Excess per vaginal bleeding
What is the main cause of a secondary postpartum haemorrhage?
Endometritis
What is endometritis?
An endometrial infection
How does endometritis present?
Offensive discharge due to retained placental tissue
What does endometritis cause?
Uterine atony
What are the other possible causes of endometritis?
Displacement of a retained blood clot
Poor healing of a perineal tear or genital tract trauma
Abnormal involution of the placental site
What is the initial management of a postpartum haemorrhage?
ABC
2 peripheral canulae
What is the medical management of a postpartum haemorrhage?
IV oxytocin
IM Carboprost
What is the first line surgical management of postpartum haemorrhage where uterine atony is the main cause?
Intrauterine balloon tamponade
What is the second line surgical management of postpartum haemorrhage?
B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
What is the management of a postpartum haemorrhage when there is severe, uncontrolled bleeding?
Hysterectomy
What is the management of primary PPH in order?
- IV access obtained
- warmed IV crystalloid fluids
- palpating the uterine fundus (‘rubbing up the uterus’) to stimulate uterine contraction
- IV oxytocin
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