post partum haemorrhage

Question 1

criteria for PPH

Answer 1

> 500mls post vaginal birth
1000mls post c-section
10% decrease from baseline haemocrit

Question 2

differentiate from primary and secondary PPH

Answer 2

primary <24 hrs after birth
secondary >24 hrs after birth

Question 3

4 Ts of PPH

Answer 3

tone
trauma
tissue (retained tissue)
thrombin (disordered clotting)

Question 4

explain how uterine atony causes PPH

Answer 4

After delivery myometrium is meant to continue to contract, this ‘clamps’ down on the placental arteries to slow and stop bleeding. In uterine atony this process fails leading to slow and steady loss of blood.

Question 5

presentation of trauma/ haematoma in PPH

Answer 5

severe pain and persistent bright red vaginal bleeding, despite firmly contracted uterus.

Question 6

causes of incomplete delivery of the placenta

Answer 6

placenta accreta
too much cord traction during active management

Question 7

mechanical interventions for PPH

Answer 7

fundal massage (increases contractions)
catheterisation

Question 8

surgical interventions for PPH

Answer 8

Intrauterine balloon tamponade
Uterine artery ligation
B-lynch suture (a suture around the uterus to apply pressure)
Hysterectomy (last resort but can save their life)

Question 9

medication which can be used to increase uterine tone in PPH

Answer 9

Oxytocin
Ergometrine (contraindicated in hypertension)
Carboprost (prostaglandin analogue)
Misoprostol (prostaglandin analogue)

tranexamic acid

Question 10

causes for secondary PPH

Answer 10

retained products of conception
infection