Post partum haemorrhage Flashcards
Define post partum haemorrhage PPH
blood loss >= 500 ml after delivery of the baby
Define primary PPH
within 24 hours of delivery
Define secondary PPH
between 24 hours - 6 weeks post delivery
Define minor PPH
blood loss of 500-1000ml without clinical shock
Define major PPH
blood loss >1000ml
signs of CVS collapse
ongoing bleeding
what are the causes of PPH
4 T's Tone - uterine atony Trauma - operative vaginal delivery Tissue - retained products of conception Thrombin - coagulation disorder
What is the most common cause of PPH
Uterine atony
What is uterine atony
Failure of uterus to contract after delivery
List risk factors for PPH
anaemia placenta previa / accreta / percreta previous c-section previous PPH multiple pregnancy polyhydramnios foetal macrosomia obesity prolonged labour operative vaginal delivery c-section retained placenta
Should the 3rd stage of labour be latent or active in PPH
Active management is necessary with syntocin
initial management of PPH
ABCDE + NEWS every 15 minutes Determine cause - 4T's 2 large bore IV access FBC, U+E, LFT, clotting/coagulation, fibrinogen, lactate crossmatch 6 units major haemorrhage protocol
What is done to attempt to stop the bleeding initially
Bimanual compression/massage of the uterus to stimulate contractions expel clots IV syntocin in 500ml Hartmann's 125ml/hr Foleys catheter Ergometrine (avoid in HTN + PET) repair trauma - vaginal Carboprost / haemobate IM every 15 minutes (prostaglandins) misoprostal PR Tranexamic acid IV
If pharmacological/initial management is unsuccessful what is the next step in management of PPH
Examination under anaesthesia - EUA in theatre to look for trauma, retained products of conception, uterine rupture
List non-surgical management options for PPH
balloons and packs
tissue sealants
Artery embolisation by IR
List surgical management of PPH
undersuturing
brace suture
uterine artery ligation
hysterectomy - only thing that stops the bleeding
what is the function of ergometrine and when should it be avoided
uterotonic agent used in PPH atony
avoid in hypertensive diseases
what is uterine inversion
when the fundus of the uterus inverts within the endometrial cavity
what are the stages of uterine inversion
1st degree - reaches the internal os
2nd degree - protrudes through the cervix
3rd degree - completely inverted and outside the vulva
complications of uterine inversion
maternal shock and collapse PPH pain hysterectomy endometritis damage to intestines or bladder
you should continue oxytocin in the case of uterine rupture / inversion, true or false
FALSE
what is terbutaline
anti-contraction drug
tocolytic
