Post Partum Haemorrhage

Question 1

Name the two types of PPH

Answer 1

Primary PPH: w/in first 24 hrs post birth

Secondary PPH: 24 hrs- 6 wks post birth.

Question 2

What are the classifications of PPH

Answer 2

• Minor 500-1000mL

- Major > 1000mL: subcategories mod 1000-2000ml severe > 2000mL

Question 3

Risk factors for PPH

Answer 3

APH 
Prev PPH 
Placenta acreta 
Multiple pregnancy 
Coagulopathies 
Anaemia 
Pre eclampsia 
Fetal macrosomia 
Obesity 
IOL 
LSCS 
Prolonged Labour 
Episiotomy 
Retained Placenta

Question 4

What are the basic principles of management for PPH

Answer 4

Call for help
Assess and Arrest Bleeding
Minimise blood loss and resuscitation
Document

Question 5

what are the four T’s of PPH management

Answer 5

Tone: check tone and position of uterus
Trauma: genital tract trauma
Tissue: retained placental and membrane products
Thrombin: coagulability’s i.e. DIC & exciting conditions such as thrombocytopnea

Question 6

Signs of DIC

Answer 6

ooze
haematuria
blood that doesn’t clot
uterine atony

Question 7

Walk through initial recognition of PPH procedure

Answer 7

Call for help
Assess and Arrest Bleeding: lie her flat, birth placenta, skin to skin with mum, administer uterotonics 10 IU IM Synto, Empty Bladder
- Identify cause: consider 4 ts
- resuscitation: insert large bore cannula, FBC group and hold and coag studies, high flow O2, consult with obstetrician, start IV replacement theraoy
- Maternal Observations and Assessment: BP, RR, PR, Blood loss, Temp, fluid balance

Question 8

Walk through ongoing care for life threatening PPH

Answer 8

• call for support: anaesthetist, prep theatre, inform lab of major pph
• assess and arrest bleeding: reconsider 4 T’s, assess blood loss, massage fundus, consider bi manuel compression, insert indwelling catheter, administer tranxemic acid, carboprost or misoprostal, consider exam under anaesthesia for removal of retained placenta, repair of tears, intrauterine balloon packing
• resuscitation: give crystalloids, red cell infusion ASAP if urgent use o neg
• Obs and Clinical Ass: BP, PR, Fluid Balance chart
• After check Hb via FBC