Postpartum Bleeding - Placenta accreta, PPH

Question 1

Placenta accreta
-pathophysiology
-risk factors
-presentation
-management

Answer 1

Attachment of placenta to myometrium => does not separate during labour

Past CS
Placenta previa

Prolonged 3rd stage of labour

Definitive - hysterectomy as placenta cannot be removed

Question 1

Postpartum hemorrhage definitions
-primary
-secondary

Answer 1

Primary - 500ml+ within 1st 24hrs of birth
-minor - 500-1000ml
-major - 1000ml+

Secondary - bleeding between 24hrs and 12wks after birth

Question 2

1ary PPH
-management

Answer 2

ABC
-2 large bore cannulas
-supine
-G+S
-warmed crystalloid infusion

Mechanical - palpate and rub the fundus
-catheterise to prevent bladder distension and monitor UOP

Medical - IV oxytocin
-Ergometrine IV or IM - unless Hx of HTN
-carboprost IM - unless Hx of asthma
-misoprostol SL

Surgical - intrauterine balloon tamponade
-B lynch suture
-ligate uterine arteries or internal iliac
last line - hysterectomy

Question 3

2ndary PPH
-management

Answer 3

Often due to retained placental tissue or endometritis

Remove retained tissue

Question 4

PPH
-risk factors
-causes

Answer 4

Tone - uterine atony
Trauma - perineal tears
Tissue - retained placenta
Thrombin - clotting/bleeding disorder

Past PPH
Prolonged labour
Preeclampsia
Increased maternal age
Polyhydramnios
Emergency CS
Placenta previa, accreta
Macrosomia
Nulliparity