Post-partum haemorrhage

Question 1

What is the definition of Post-partum haemorrhage (PPH)?

Answer 1

Blood loss of >500mls.

Question 2

What are the 2 categories of PPH?

Answer 2

Primary and Secondary

Question 3

What is the most common cause of primary PPH?

Answer 3

Uterine atony (90%)

Question 4

What are some other causes of PPH?

Answer 4

Genital trauma

Clotting factors

Question 5

What % of deliveries are affected by primary PPH?

Answer 5

5-7%

Question 6

Within how many hours after birth does primary PPH usually occur?

Answer 6

Within 24 hours

Question 7

What are some risk factors for primary PPH?

Answer 7

• Previous PPH
• Prolonged labour
• Pre-eclampsia
• Increased maternal age
• Polyhydramnios
• Emergency Caesarean section
• Placenta praevia
• Macrosomia
• Ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis)

Question 8

Within how many hours after birth does secondary PPH occur?

Answer 8

24 hours to 12 weeks

Question 9

What are the 2 cause of secondary PPH?

Answer 9

• Retained placental tissue
• Endometriosis

Question 10

What is the treatment for primary PPH?

Answer 10

• ABC
• IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
• IM carboprost
• Other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
• if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure