Postpartum haemorrhage

Question 1

Define postpartum haemorrhage.

Answer 1

Blood loss after pregnancy, major haemorrhage is defined as loss of >1L.

Question 2

What is the aetiology of postpartum haemorrhage? What are risk factors for postpartum haemorrhage?

Answer 2

Uterine atony - This is the most common cause of PPH

Uterine inversion

Uterine rupture

Placental abruption

Placenta accreta, placenta increta or placenta percreta

Placenta previa

Retained placenta

Tearing

Failure to progress

Other conditions

von Willebrand Disease, DIC

Infection e.g. chorioamnionitis

Intrahepatic cholestasis of pregnancy

Obesity

Preeclampsia

Question 3

Summarise the epidemiology of postpartum haemorrhage.

Answer 3

It usually happens within 1 day of giving birth, but it can happen up to 12 weeks after having a baby.

1-5% have PPH.

Question 4

What are signs and symptoms of postpartum haemorrhage?

Answer 4

Heavy PV bleeding

Hypotension or signs of shock

Nausea and vomiting

Pale skin

Pain around the vagina or perineum

Question 5

What are some investigations for postpartum haemorrhage?

Answer 5

Basic obs

Clinical diagnosis

FBC + Hematocrit

Blood loss measurement

Pelvic exam

Physical exam

USS

Question 6

What is the management for postpartum haemorrhage?

Answer 6

IV fluids/blood

Hysterectomy or laparotomy

Massaging the uterus by hand

Oxygen

Embolisation of the blood vessels that supply the uterus

Iron

Question 7

What are complications associated with postpartum haemorrhage?

Answer 7

Sheehan’s syndrome

Shock

Maternal death

Asherman’s syndrome

Prognosis depends on treatment and efficiency of diagnosis