Post Partum Haemorrhage Flashcards
What is PPH
This is >500ml of blood lost after birth
What is minor and major PPH?
minor = 500-1000ml and no signs of clinical shock major = >1000ml or signs of shock or continuous bleeding
What is primary and secondary PPH?
primary = within 24hrs of delivery secondary = 24hrs -6/52 after delivery
What are some antepartum risk factors for PPH?
previous PPH, prev CS, multipregnancy, vasa praevia, placenta praevia, placenta increta/percreta/acreta, placental abruption, uterine rupture, obesity, foetal macrosomnia, polyhydraminos
What are some peri-partum risk factors for PPH?
prolonged labour, operative vaginal delivery, CS, retained products
What are the 4 main causes of PPH?
tone (70%), trauma (20%), retained tissue (10%), thrombin (<1%)
How does tone affect PPH?
uterine atony means that there is less/no constriction of the blood vessels after birth (normally the uterine will contract to apply pressure to the vessels and halt bleeding)
How is uterine atony treated?
Uterine massage (bi-manual)
IV syntocinon
Fluids
Foley’s catheter
How is trauma treated in PPH?
stabilise mother (IV fluids) and confirm no retained tissue
Ergometrine (500mg)
localise the trauma - repair
How is retained tissue related to PPH?
Retained placental products leads to incomplete contraction of the uterus so vessels are not compressed
What is the management of retained placenta?
carboprost IM every 15 mins
misoprostol 800mcg PR
transexamic acid IV
evacuation under anaesthetics
What should be given if PPH is caused by a coagulopathy?
FFP, cryoprecipitate and platelets
What should be done in secondary PPH?
investigate for RPOC (with USS)
investigate for infection (most common cause)
