Post partum haemorrhage Flashcards
What is PPH defined as?
500ml blood loss during vaginal delivery
or
1000ml at c section
What is major obestetric haemorrage defined as?
> 2500ml blood loss
or
blood transfusion of >5 units
What is major obestetric haemorrage defined as in transfusion requirement?
blood transfusion of >5 units
What is PPH defined as for c section
1000ml at c section
What is a primary PPH?
Occurs within 24 hours of delivery of baby
5-7% of deliveries
*described as minor (500) or major (1000+ / signs of shock)
What is a secondary PPH?
24 hours - 6 weeks
Typically due to retained placental tissue or **endometritis **
What are the causes of PPH (4 Ts)
Tone : uterine atony (most common cause)
- uterus fails to contract after birth
Trauma : damage to genital structures
- perineal tear, episiotomy
Tissue : Retained placental fragments in uterine cavity
Thrombin : underlying clotting disorder
Risk factors for PPH?
(PPH MACRO)
P - Previous pph, prolonged labour
P - Placental (praevia, accreta)
H - Hypertension (PE)
M - Macrosomia
A - Assisted delivery
C - Caesarean emergency
R - Retained placenta
O - Overdistension (polyhydramnios)
Most common cause of PPH (primary)
Uterine atony
What is the most common cause of secondary pph
endomitritis
Uterus feeling enlarged, soft and boggy?
Indication of tonal issue = uterine atopy
Will be the main cause of PPH
How to minimise risk of PPH prophylactically?
ALl women give uterotonics in 3rd stage of lavour to reduce risk of uterine atopy
How to minimise risk of PPH prophylactically specific to vaginal delivery?
- vaginal + IM oxytocin
How to minimise risk of PPH prophylactically specific to C section ?
- Csection + IV oxytocin
ABCDE approach for major PPH?
nitiate major obstetric haemorrhage protocol (MOH)
- Lie women flat
- keep patient warm
- two peripheral annula
- bloods (FBC, clotting, G+S, cross match)
- warmed crystalloid infusion until blood available
- transfuse asap
If uterine atopy is suspected cause of PPH, there are mechanical, pharmacological and surgical treatments
outline mechanical management?
1st line
Massage uterine fundus to stimulate smooth muscle contraction
Catherisation to prevent bladder distension
If uterine atopy is suspected cause of PPH, there are mechanical, pharmacological and surgical treatments
outline pharmacalogical management?
2nd line after massage
Uterotonic drugs in THIS ORDER :
step 1 : IV syntocinon / oxytocin *
step 2 : IV or IM ergometrine / syntometrine (c/i HTN)
step 3 : IM carboprost (c/i asthma)
step 4 : surgical management
* syntocinon= synthetic oxytocin (same thing)
If uterine atopy is suspected cause of PPH, there are mechanical, pharmacological and surgical treatments
outline surgical management?
If medical options fail:
step 4 : intrauterine balloon tamponade (bakri catheter)
step 5 : B-lynch suture
step 6 : hysterectomy
