Post-partum haemorrhage

Question 1

Primary PPH

Answer 1

Blood loss of 500 mL or more from genital tract within 24 hours of the birth
- Minor 500-1000mL
- Major >1000 mL

Question 2

Secondary PPH

Answer 2

Excessive bleeding between 24 hours and 12 weeks postnatally

Question 3

Causes of primary PPH

Answer 3

• Tone: Uterine atony
• Trauma to genital tract (vaginal lacerations, episiotomy bleeds)
• Tissue: Retained placenta
• Thrombin: Coagulopathy

Question 4

Risk factors for uterine atony

Answer 4

1. Overdistension of the uterus
   - Fetal macrosomia
   - Multiple parity
   - Multiple gestation
   - Polyhydramnios (excessive amniotic fluid)
2. Prolonged labor
3. Use of oxytocin for IOL -> can cause uterine rupture if high dose
4. Previous history of uterine atony

Question 5

Risk factors for retained placenta

Answer 5

Placenta accreta
Uterine atony

Question 6

Common cause of secondary PPH

Answer 6

Retained products of conception
Endometritis

Question 7

Symptoms of secondary PPH

Answer 7

Bleeding
- Endometritis: Fever, foul smelling lochia, pelvic pain
- RPOC: passing tissue per vagina

Question 8

Risk factors of endometritis

Answer 8

GDM
GBS +++
Prolonged rupture of membranes
Instrumentation
Meconium staining

Question 9

Risk factors of RPOC

Answer 9

Primary PPH
Retained placenta
MRP

Question 10

Complications of 2’ PPH

Answer 10

Anemic symptoms