POSTPARTUM HAEMORRHAGE

Question 1

What is PPH?

Answer 1

• Occurs in 24hours after delivery

- blood loss > 500ml in NVD or >1000ml in C/S

Question 2

What is the Intervention rate of PPH?

Answer 2

• 2,5% of women need surgery

- 0,8% of women need hysterectomy

Question 3

How can PPH be prevented?

Answer 3

• Fe supps to prevent anemia
• anticipate and prepare for PPH
• at risk pt should deliver in referral hospitals with immediate management, blood, theatre
• all maternity wards should have available supplies
• IV fluids, blood, cannula, oxytocin’s, misoprostol
• active management of 3rd stage of labour(AMTSL)
• PP and post C/S monitoring of vitals and bleeding every 15 minutes in the 1st hour

Question 4

Explain the AMTSL

Answer 4

• Oxytocin
• palpate ab for other babies
• oxytocin IM or IV if already present
• cord clamping
• clamp 5cm from navel and then cut
• delayed cutting by 1mjn advised
• cord retraction
• one hand on pubis and the other maintains tension in cord
• when uterus contracts and gets rounder, pull cord and apply pressure on uterus(to prevent inversion)
• after placenta is delivered, massage uterus every 15 mins to contract it and prevent bleeding

Question 5

What are the risk factors of PPH

Answer 5

• abruptio placenta
• placenta previa
• pre-clampsia
• overdistended uterus
• precipitous and prolonged labour
• meds:oxytocin, tocolytics, general anaesthesia
• assisted delivery

Question 6

What are the causes of PPH

Answer 6

• 4 Ps
• tone
• tissue
• thrombus could be due to drugs
• trauma

Question 7

How is PPH managed?

Answer 7

• resuscitation
• IV line with pitocin, syntometrine, misoprostol(PGE2), tranexamic acid(causes blood clotting to prevent blood loss)
• Rub the uterus
• urine catheter
• vaginal exam to remove placenta, suture lacerations