Post-Partum Haemorrhage (PPH)

Question 1

define PPH

Answer 1

blood loss of >500ml after birth of the baby

Question 2

classification of PPH

Answer 2

primary= within 24 hours of delivery
secondary= >24 hours - 6 weeks post

Question 3

causes of PPH

Answer 3

4T's
tone
trauma
tissue
thrombin

Question 4

prevention of PPH

Answer 4

active management of stage 3 with syntocinon or oxytocin

Question 5

management of PPH

Answer 5

uterine massage
syntocinon/ ergometrine (avoid if hypertension)
carboprost/ haemabate
misoprostol
tranexamic acid
balloons
tissue sealant
arterial embolisation radiology
surgery with ligation and hysterectomy

Question 6

what is Sheehan’s syndrome?

Answer 6

PPH followed by pituitary failure

Question 7

tone causes

Answer 7

uterine atony (infection, distortion, drugs)

Question 8

drug causes of uterine atony

Answer 8

magnesium sulphate
nifedipine
salbutamol
anaesthetic

Question 9

trauma causes of PPH

Answer 9

cervical, vaginal or perineal tears

Question 10

tissue causes of PPH

Answer 10

retained placenta or membranes

Question 11

thrombin causes of PPH

Answer 11

coagulation disorder

Question 12

malpresentations of the foetus

Answer 12

breech (feet first)
transverse (shoulder or arm)
hyperextension

Question 13

three levels of breech

Answer 13

complete
footling
frank

Question 14

management of malpresentations

Answer 14

ECV
amniotomy
C/S

Question 15

classification of perineal tears

Answer 15

• 1st degree,
• 2nd degree
• Episiotomy= usually right medio-lateral
• 3a= <50% external anal sphincter, 3b= >50% external anal sphincter, 3c= internal anal sphincter involved
• 4= anal or rectal mucosa

Question 16

management of perineal tears

Answer 16

3rd and 4th require repair in theatre with regional anaesthetic
antibiotics
laxatives (lactulose)
physio
follow-up