Post Partum Haemorrhage (PPH)

Question 1

what is PPH?

Answer 1

loss of 500ml or more from the genital tract within 24 hours of the birth of a baby.

can be further defined as minor haemorrhage (500-1000ml) or major haemorrhage (>1000ml)

Question 2

what are the causes of PPH? – 4Ts

Answer 2

• tone
• tissue (retained placenta)
• trauma
• thrombin (coagulation abnormalities)

Question 3

what is primary PPH?

Answer 3

• occurs within 24 hours
• most common cause of PPH is uterine atony (90% of cases).
• Other causes include genital trauma and clotting factors

Question 4

what are the risk factors for 1˚ PPH?

Answer 4

• previous PPH
• prolonged labour
• pre-eclampsia
• increased maternal age
• polyhydramnios
• emergency Caesarean section
• placenta praevia, placenta accreta
• macrosomia
• ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis)

Question 5

what is the mx for 1˚ PPH (medical)?

Answer 5

1. ABC including two peripheral cannulae, 14 gauge
2. IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
3. IM carboprost

Question 6

if medical options failure to control the bleeding then surgical options will need to be urgently considered

what is the mx for 1˚ PPH (surgical)?

Answer 6

1. intrauterine balloon tamponade - first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
2. other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
3. if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

Question 7

what is 2˚ PPH?

Answer 7

• occurs between 24 hours - 12 weeks**

- due to retained placental tissue or endometritis