Post-partum Haemorrhage

Question 1

What’s the definition of post-partum haemorrhage?

Answer 1

Loss of more than 500ml of blood from the genital tract within 24 hours of delivering a
baby.

Question 2

What’s range defined for major post-partum haemorrhage?

Answer 2

Loss of >1000ml of blood

• severe if >2000ml of blood lost

Question 2

What’s range defined for minor post-partum haemorrhage?

Answer 2

Loss of 500-1000ml of blood

Question 3

4T decribes the causes for post-partum haemorrhage, what are they?

Answer 3

Tone (uterine tone // MC)
Tissue (Tissue retained in uterus)
Trauma
Thrombin

Question 4

Describe how TONE can cause post-partum haemorrhage

Describe some examples.

Answer 4

Inadequate contraction of the uterus after separation of the placenta leads to
profuse bleeding from the decidua.

○ Causes include: multiple pregnancy, macrosomia, polyhydramnios, retained
placenta, prolonged second stage of labou

Question 5

Describe how TISSUE can cause post-partum haemorrhage

Describe some examples.

Answer 5

Typically part of placenta, sometimes retention of part of foetal / maternal
membranes.
○ Prevents proper uterine contraction and resulting vessel occlusion

○ Causes include: placenta praevia, placenta accreta spectrum, succenturiate
placental lobe, preterm delivery.

Question 6

Describe how THROMBIN can cause post-partum haemorrhage

Describe some examples.

Answer 6

Normal bleeding worsened by pre-existing / obstetric coagulopathy /
thrombocytopenia.

Causes include: pre-eclampsia, HELLP syndrome, DIC, puerperal sepsis, von
Willebrand disease, dilutional coagulopathy (resuscitation with high volumes of
crystalloid)

Question 6

Describe how TRAUMA can cause post-partum haemorrhage

Describe some examples.

Answer 6

Trauma to genital tract leading to bleeding - includes caesarean section.

Causes include: vulvovaginal tears, instrumental delivery, episiotomy

Question 7

How is PPH postpartum haemorrhage tx?

Answer 7

○ IV access with 14-gauge cannula
○ G+S Group and Save, FBC, coagulation screen
○ Frequent observations every 15 minutes
○ Warmed crystalloid infusion.

for Major PPH +
○ High Flow O2
○ Stop crystalloid fusion and give O- blood transfusion
○ if ongoing - Fresh frozen platelets
cryoprecipitate

Question 8

Treating uterine atony

Answer 8

■ Fundal massage
■ Catheterisation
■ Oxytocin and ergometrine
■ Carboprost (uterotonic)
■ Misoprostol

2nd line - Surgical (Stepwise)
■ Intrauterine balloon tamponade
■ Haemostatic suturing (B-Lynch)
■ Uterine devascularization / arterial ligation
■ Hysterectomy