Postpartum Haemorrhage

Question 1

What is the definition of primary postpartum haemorrhage?

Answer 1

Loss of >500ml of blood in the first 24 hours after delivery of baby.

Question 2

What is the definition of massive obstetric haemorrhage?

Answer 2

Blood loss of >1500ml in first 24 hours after delivery of baby which is continuing.

Question 3

What are the causes of postpartum haemorrhage?

Answer 3

1. Tone - uterine atony
2. Tissue - retained products of conception
3. Trauma - vaginal/perineal tears
4. Thrombin - clotting disorders

Question 4

What is the management for postpartum haemorrhage?

Answer 4

1. cABCDE, call for help
2. High flow oxygen, 2 large bore cannulae
3. U&Es, LFTs, clotting, cross-match blood, O- if urgent
4. Transfuse 1U RBC to 1U FFP
5. IV fluids, catheterise
6. Deliver placenta
7. Uterine massage/bimanual compression
8. Give syntometrine
9. If syntometrine fails, examine under anaesthetic
10. If no trauma/RPOC - IM prostaglandins in myometrium
11. Consider Rusch balloon/B-lynch suture
12. Uterine artery embolisation/don’t delay hysterectomy is all else fails

Question 5

What is the definition of secondary postpartum haemorrhage?

Answer 5

Excessive blood loss from genital tract between 24h hours-12 weeks after delivery.

Question 6

What causes secondary postpartum haemorrhage?

Answer 6

Usually due to retained placental tissue with/without endometritis. Rarely due to gestational trophoblastic disease.

Question 7

What is the investigation and management of secondary postpartum haemorrhage?

Answer 7

1. USS and antibiotics
2. If heavy bleeding, excavation of retained products of conception.
3. Histology of tissue excluding GTD