Post-partum haemorrhage

Question 1

Definition of post-partum haemorrhage

Answer 1

> 500mL in blood loss if vaginal delivery

>1000mL in blood loss if C-section

Question 2

What is the definition of primary and secondary haemorrhage?

Answer 2

Primary - loss of blood in the first 24 hours after delivery

Secondary - loss of blood from 24 hours up to 6 weeks after delivery (suggests retained pdts of contraception)

Question 3

4 risk factors for post-partum haemorrhage?

Answer 3

Grand multiparity
Prolonged labour 
Precipitate delivery
Antepartum haemorrhage
General anaesthesia use

Question 4

4 causes for post-partum haemorrhage (4 T’s)

Answer 4

Tone
- uterine atony secondary to prolonged labour/precipitate delivery
Thrombin
- thrombophilia
- haemophilia
Trauma
- C-section
- Instrumental delivery
Tissue
- Retained products of contraception

Question 5

Management of PPH (in descending order)

Answer 5

Rub the uterus
1st line: Oxytocin 5IU
2nd line: Ergometrine
3rd line: Oxytocin 40IU
4th line: Carboprost
5th line: Misoprostol
6th line: Tamponade using Rusch balloon

Hysterectomy is definitive Tx